Diagnosing the culprit behind a subtle case of concomitant right atrial myxoma and atrial fibrillation: A case report.

Myxomas are rare tumors arising from the uncontrolled proliferation of mesenchymal cells. Among cardiac conditions, cardiac myxomas account for less than 0.1% of cases, with the majority found in the left atrium and only 8% in the right atrium. Atrial myxomas present with various clinical manifestations, including constitutional symptoms, symptoms caused by blood flow obstruction, and tumor embolism. This case report describes a 50-year-old male patient presenting with syncope, fatigue, and dyspnea, who had a history of well-controlled hypertension and atrial fibrillation. Physical examination, further diagnostic workup, and echocardiography led to a provisional diagnosis of right atrial myxoma. The patient underwent a median sternotomy, and the tumor was surgically excised, resulting in both diagnostic and curative outcomes. Histological analysis confirmed the diagnosis of myxoma. This case report contributes valuable insights into the presentation, diagnostic challenges, and treatment of atrial myxoma.

Massive left atrial myxoma leading to recurrent cerebrovascular accidents (CVAs) in a young woman: A case report.

Myxomas are tumors that occur due to uncontrolled proliferation of mesenchymal cells. Cardiac myxomas although very rare, are still the most common primary tumor of heart. Cardiac myxomas have a prevalence of 0.03% in the general population. They can have a variety of clinical presentations with obstructive cardiac symptoms, constitutional symptoms and symptoms due to embolism to other body parts chief among them. CNS embolism with stroke is among the rarest clinical presentation of cardiac myxomas. Our article portrays a case of cardiac myxomas that initially resulted in episodes of dyspnea and syncope and eventually led to recurrent episodes of transient ischemic attack and stroke. Case was confirmed by transesophageal echocardiography and managed surgically by medial sternotomy. Myxoma, a benign primary cardiac tumor is itself a rare occurrence, embolization of myxoma leading to multiple strokes is an atypical clinical presentation. Our report would be a valuable addition to the already existing literature.

Diphtheria: The rising cases of "Throat Distemper" in Pakistan: A short communication.

Background: The objective of this short communication is to summarize the current situation in Pakistan regarding the rising cases of diphtheria and to emphasize the need for public health interventions to control the spread of the disease. Study design: This study is a short communication. Methods: Data on diphtheria cases were collected from various sources including the Pakistan Ministry of Health, the World Health Organization (WHO), and media reports. Descriptive statistics were used to summarize the data on the number of cases and trends over time. Results: As of 2023, the number of reported diphtheria cases in Pakistan has increased by 50% compared to the previous year. The majority of cases are being reported from the Sindh and Punjab provinces. The incidence of diphtheria is highest among children under the age of 10. Conclusions: The rising cases of diphtheria in Pakistan are a cause for concern and indicate the need for effective public health interventions to control the spread of the disease. This includes increasing vaccine coverage, improving hygiene practices, and enhancing surveillance and reporting systems. The public health community should also work towards educating communities on the importance of vaccination and preventative measures to reduce the burden of diphtheria in Pakistan.

Double cortex syndrome (subcortical band heterotopia): A case report.

Double cortex syndrome is an uncommon familial syndrome with X-linked dominant inheritance and most commonly presents with developmental delay and seizures. We present a case of a 14-year-old girl who came to neurology department of the hospital with severe generalized tonic-clonic fits and loss of consciousness. The mother of child gave history of uneventful antenatal period and labor. There was history of immediate cry and normal APGAR score. She was achieving milestones normally until at the age of 3 years when she suffered decline in her speech and vision. She had problems with learning with lack of concentration during her schooling. Physical examination was also unremarkable. Her lab values including complete blood count, serum calcium, and arterial blood gas tests, all were within normal limits. Electroencephalogram showed significant changes suggestive of epilepsy. Magnetic resonance imaging of brain showed continuous band of gray matter that was located deep and paralleling the cortex in both cerebral hemispheres suggestive of band heterotopia or double cortex syndrome. She was discharged and prescribed antiepileptics; and was advised regular outpatient follow-up.

An infant with Joubert syndrome: A case report.

Joubert syndrome is a rare neurological and developmental malfunction represented by decreased muscle tone, ataxia, and delayed developmental milestones. Joubert syndrome-related disorders, besides central nervous system, can involve other systems and thus can lead to multi-organ malfunction. We report a case of pure Joubert syndrome who presented with developmental delay, decreased muscle tone, and ataxia. Identification of molar tooth sign on magnetic resonance imaging studies assisted to make a definitive diagnosis. Detailed examination revealed no other significant findings of any organ of the body. Patient was managed conservatively with symptomatic treatment. Although these types of cases are rarely encountered, they can lead to multiple organ disabilities. Therefore, clinicians should always keep this diagnosis in mind whenever an infant presents with the aforementioned neurodevelopmental symptoms.

Efficacy, safety and cost-effectiveness of vonoprazan vs Proton Pump Inhibitors in reflux disorders and H. pylori eradication: A literature review.

Gastroesophageal reflux disease (GERD) is one of the most prevalent conditions worldwide and is conventionally treated by proton pump inhibitor therapy. However, around 40% of people have reported some form of resistance to this therapy. Vonoprazan has recently been approved for the treatment of GERD. Literature was searched on PubMed, Google Scholar, Embase and Medline. Inclusion criteria were 1) Human subjects; 2) papers published in English language; 3) study types that are RCTs. In pre-clinical studies, VPZ was unaffected by changes in pH, making it 1.2-2 times more potent than PPI, both in-vivo and in-vitro. In studies involving GERD, several RCTs proved higher efficacy of VPZ than conventional PPI. RCTs on patients affected by H. Pylori showed a higher efficacy than VPZ (95.8%) as compared to PPI (69.6%). In another RCT, adverse effects including diarrhea, nausea and body rash were observed in 32.7% of the people taking VPZ as compared to 40.5% of the people taking PPI. VPZ was shown to be much more cost effective as compared to PPI. This article concludes that VPZ is superior to PPI in terms of efficacy, safety and cost-effectiveness in reflux disorders and H. pylori eradication. Hence, use of vonoprazan should be preferred over conventional PPIs in these disorders. As most of the research was conducted in Japan, studies should be carried out in different regions of the world to explore if these results are extrapolated in those regions. Research is also needed to explore the efficiency of VPZ in scenarios of PPI resistance.

Chronic Suppurative Otitis Media leading to cerebellar brain abscess, still a problem in 21st century: A case report.

Introduction and importance: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear associated with tympanic membrane rupture and purulent discharge for at least 6 weeks. Owing to the proper use and easy availability of antibiotics, these types of cases are rare in developed regions, but they are still occasionally seen in the developing world with poor hygiene and a lack of availability of antibiotics and immunizations. Case presentation: Patient presented with complaints of headache, yellow-colored discharge from ear, fever and vomiting. The patient's Glasgow Coma Scale (GCS) was 12/15, neck stiffness and positive Kernig's sign, horizontal nystagmus and exaggerated deep tendon reflexes. Positive CSF findings and Magnetic Resonance Imaging showing right sided cerebellar abscesses, led to the diagnosis of right-sided CSOM leading to cerebellar brain abscess. Patient was treated with anti-pyrectics, intravenous mannitol, IV and topical antibiotics and IV-dexamethasone. Abscess evacuation was performed in neurosurgery department while mastoidectomy was performed in ENT department. Patient's condition improved quickly and was discharged with regular follow-up. Discussion: CSOM is a long-standing middle ear infection, associated with ear discharge and permanent perforation of the tympanic membrane. Divided into two main types, a) Tubo tympanic b) Atticoantral. CSOM occasionally presents with severe intracranial complications, especially in developing countries. Conclusion: CSOM is a chronic inflammation of the middle ear. Without early and effective management, it can lead to serious intracranial complications. So, diagnosis of complications like cerebellar abscess should be on the differential while dealing with patients with CSOM in developing countries.

Worsening situation of smog in Pakistan: A tale of three cities.

Lahore, Faisalabad and Gujranwala, the most populous and polluted cities of Punjab, are facing the worsening issue of smog which returns every winter with a greater intensity. Major contributing factors are immense traffic pollution, crop burning and industrialization. These have led to major health issues including lungs, eyes, skin and heart problems. Although the government has taken some measures to mitigate these dangerous effects of smog but they have proven to be of little significance. Major efforts are still needed and public cooperation will play the most significant role in combating this issue. We aim to highlight this alarming situation to the relevant authorities so that the true gravity of this problem can be understood and anti-smog efforts can be accelerated.

An infant with omenn syndrome: A case report.

BACKGROUND: Omenn syndrome is a rare, autosomal recessive disorder. It is a disorder that stems from severe combined immunodeficiency in an affected individual. The disease is also of rare occurrence in children in Pakistan because this is the age where this disease usually presents, after having developed in the child. This case report will explore all the reasons that lead to the occurrence of this syndrome while also reflecting on the management profile of the child. CASE PRESENTATION: This case report deals with the discussion of one such child who was diagnosed with Omenn Syndrome after being diagnosed with several other diseases, which were being mistaken for being the actual problem and disease, but the reality was that the child was suffering from Omenn syndrome. DISCUSSION: The child is only 3 months old and his symptoms pose a great risk to his overall health status while also making him predisposed to develop several complications and nutritional deficiencies as a result, all of which keep on adding to the burden of diseases that the child faced. In Omenn syndrome, there is an increased susceptibility to develop infections of the skin, lungs, joints, as well as sepsis. Usually, the death of the patient ensues due to pneumonia and septicemia or septic shock. CONCLUSION: Omenn syndrome is a rare disease caused by missense mutations in the recombinase activating genes. It can be treated by bone marrow transplantation or lymphocytic stimulation depending on the severity of the presenting underlying immunodeficiency.