Recurrent Pancreatic Pseudocysts Due to Alcohol-Related Chronic Pancreatitis With Double-Duct Sign and Spontaneous Rupture.

A 36-year-old female presented with recurrent attacks of alcohol-related acute on chronic pancreatitis complicated by a pancreatic pseudocyst in the head of the pancreas. The cyst was causing obstruction of the common bile duct (CBD) and pancreatic duct (PD) on magnetic resonance cholangiopancreatography (MRCP). She underwent endoscopic ultrasound (EUS)-guided aspiration of the cyst to dryness. A few months later, she presented with epigastric pain and jaundice. MRI pancreas and MRCP revealed a pancreatic cyst in the head of the pancreas, which had grown in size, compressing the CBD and PD with extra and intrahepatic biliary dilatation. There was a recurrence of a new lobulated peripancreatic pseudocyst, which had ruptured resulting in a large collection compressing the right renal capsule. Percutaneous drainage of the ruptured pseudocyst was performed, followed by endoscopic retrograde cholangiopancreatography (ERCP) that revealed distal CBD stricture, which was stented. Her symptoms improved and she was discharged with no further recurrences of obstructive jaundice during the one-year follow-up period.

Bilateral pleural effusion and pneumomediastinum: rare complication resulting from punctured left subclavian vein following insertion of PICC line for total parenteral nutrition.

This is a rare case of development of bi-lateral chylous pleural effusion (containing parenteral nutrition material) along with pneumomediastinum due to punctured left subclavian vein following insertion of a peripherally inserted central venous catheter (PICC) line. Parenteral nutrition is usually preferred for patients unable to tolerate enteral feeding. Due to hypertonicity of the total parenteral nutrition material, it is usually administered via internal jugular or subclavian vein which have a rapid blood flow; therefore, resulting in adequate mixing. Literature studies are yet to clearly explain the communications between two pleural cavities; therefore, development of bilateral pleural effusions in association with pneumomediastinum makes this case more intriguing. We present the journey of a 43-year-old woman who required insertion of bilateral chest drains, followed by sternotomy and repair of the left subclavian vein after she was found in hypoxic respiratory failure 2 days following insertion of PICC line into her left subclavian vein.

A tale of two extremities: A dynamic case of Covid-19 induced hypokalemia and bradycardia leading into Torsade's de pointes.

INTRODUCTION: As researchers and academics around the world scramble ahead to dissect and analyse every aspect of the SARS-CoV2 virus, one such study explored the various underlying electrolyte abnormalities that were precipitated in patients suffering from a confirmed COVID-19 infection. A significant proportion of such patients were noted to be hypokalemic. Hypokalemia can be life threatening as it is known to cause cardiac arrhythmia. CASE PRESENTATION: Our encounter with said presentation was incidental. The on-call medical team was involved in a cardiac arrest call for a 74-year -old gentleman who developed torsades de pointes, Retrospective analysis of the clinical picture pointed out the fact that he was found to be persistently hypokalemic and bradycardic solely triggered as a result of COVID-19. CONCLUSION: Although initially thought to be a pulmonary disease but along with time extra-pulmonary manifestations of Covid-19 has demonstrated significant consequences. Electrolyte abnormalities and cardiac dysfunction are examples of such extra-pulmonary pathologies. Therefore, it is important to keep close monitoring for such abnormalities otherwise could lead into life threatening arrythmias.

Case of Guillain-Barré syndrome following COVID-19 vaccine.

Guillain-Barré syndrome (GBS) is a rare immune-mediated disorder of the peripheral nerves. Although its cause is not fully understood, the syndrome often follows infection with a virus or bacteria, although in rare occasions, vaccination may precede GBS. We describe a case of a 62-year-old woman who presented with paraesthesia and progressive weakness of both lower limbs over 3 days. Clinical examination and investigation findings including lumbar puncture and nerve conduction studies were consistent with the diagnosis of GBS. She had no history of either diarrhoea or respiratory tract infections preceding her presentation. However, she had her first intramuscular dose of the Oxford/AstraZeneca COVID-19 vaccine 11 days prior to her presentation. Although no direct link could be ascertained, the purpose of this report is to highlight the incidence and consider this issue while evaluating any case of GBS in the light of the current pandemic and vaccination programme.