ABSTRACT
Otocephaly is a rare congenital abnormality characterized by the absence or underdevelopment of the mandible, misplacement of the ears towards the front, a small mouth, and absence or underdevelopment of the tongue. The syndrome complex of otocephaly can be categorized into four types based on associated anomalies. We present a case of this congenital anomaly in a newborn baby delivered by a 40-year-old woman who presented in active labor with premature rupture of membranes. Unfortunately, the newborn did not survive due to severe respiratory distress, which was consistent with the clinical features of this congenital anomaly. The rarity of otocephaly poses challenges for both parents and healthcare providers. Early antenatal scans are suggested for the early diagnosis of this condition. Further research and awareness are needed to better understand and manage this rare congenital disorder.
ABSTRACT
Dengue fever is a globally prevalent, viral disease transmitted by Aedes mosquitoes, which is becoming increasingly common and can cause a range of symptoms, including fever, flu-like symptoms, and circulatory failure. Although it is classified as a non-neurotropic virus, research has suggested that dengue fever can also affect the nervous system and lead to conditions such as myositis, Guillain-Barré syndrome, or hypokalemic paralysis. We describe a case study of a young pregnant female with dengue-associated hypokalemic paralysis, who made a full recovery within 48 hours of receiving potassium supplementation. The case underscores the importance of recognizing and treating neurological complications of dengue fever promptly, particularly in areas where the disease is prevalent.
ABSTRACT
The objective of this study was to evaluate the impact of vitamin D supplementation on hemoglobin levels (Hb) in patients with chronic kidney disease (CKD) undergoing hemodialysis. A systematic search was conducted in electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to April 21, 2023. Inclusion criteria were applied to select relevant studies. Statistical analyses were performed using Review Manager 5.4.1. A random-effects model was used to address heterogeneity, and the mean difference (MD) with the corresponding 95% confidence interval (CI) was reported. Ten studies were included in the analysis, comprising seven clinical trials, two randomized clinical trials, and one retrospective observational study. Subgroup analysis was conducted based on the duration of follow-up: 12 weeks, three months, six months, 12 months, 15 months, and 18 months. A significant increase in hemoglobin levels was observed after 12 months (MD = -0.98 [95% CI -1.88, -0.08]; p = 0.03; I2 = 91%) and 18 months (MD = -1.80 [95% CI -2.56, -1.04]; p < 0.00001; I2 = Not applicable). However, there was no statistically significant relationship between vitamin D supplementation and hemoglobin levels at 12 weeks, three months, six months, and 15 months. The pooled analysis demonstrated a significant increase in hemoglobin levels with vitamin D supplementation (MD = -0.61 [95% CI -0.96, -0.26]; p = 0.03; I2 = 60.7%). This analysis highlights the significant role of vitamin D supplementation in improving anemia in patients with CKD undergoing hemodialysis. Vitamin D supplementation was found to significantly increase hemoglobin levels, particularly after 12 months and 18 months of supplementation.
ABSTRACT
The article discusses the use of dulaglutide (Trulicity) in treating type 2 diabetes mellitus. Dulaglutide is a synthetic analog of glucagon-like peptide (GLP-1) that binds to GLP-1 receptors, enhancing insulin secretion and reducing postprandial glucagon and food intake. Dulaglutide has a longer half-life than GLP-1, making it more clinically useful. The recommended dosage of dulaglutide is 0.75 mg/0.5 mL subcutaneously once weekly, which can be increased as needed for adequate glycemic control. We describe a case of acute pancreatitis in a 37-year-old male with a past medical history of type 2 diabetes mellitus who was admitted for epigastric pain radiating to the back. Lipase level was elevated at 1508, and a computed tomography (CT) scan of the abdomen showed fat stranding around the pancreas consistent with pancreatitis. The patient was on dulaglutide (Trulicity) at 0.75 mg q. weekly for about two years; this dose was increased to 1.5 mg q. weekly two months ago. He developed symptoms of abdominal pain, nausea, and vomiting after receiving the last dose of Trulicity, which was two weeks before he presented to the emergency department as a cause of acute pancreatitis. Dulaglutide use has been known to cause a mild elevation of pancreatic enzyme levels; there have been few reported cases of dulaglutide-associated acute pancreatitis in the literature. The case report highlights the adverse effects of dulaglutide in diabetic patients and the importance of monitoring pancreatic enzyme levels in patients taking dulaglutide.
ABSTRACT
Mushroom poisoning, known as mycetism, represents a pressing health concern worldwide. Although the majority of mushroom ingestions are benign, select species like "Amanita phalloides" can induce catastrophic liver damage, culminating in acute liver failure. In this report, we detail a case involving a 35-year-old female who presented to the emergency department exhibiting symptoms of nausea, vomiting, abdominal pain, and palpitations merely six hours post-ingestion of "Amanita phalloides." Accurate identification of the specific mushroom species consumed proves challenging in over 90% of poisoning incidents, underscoring the necessity for clinical vigilance. While many mushroom exposures lead to mild gastrointestinal symptoms, recognizing the potential for severe outcomes is paramount for timely and effective intervention.
ABSTRACT
An anomalous origin of the right coronary artery from the left coronary sinus is a rare congenital disorder, characterized by an asymptomatic presentation and an increased risk of myocardial infarction, arrhythmias, and sudden cardiac death. This disorder with an inter arterial course of the right coronary artery is subject to mechanical compression leading to various symptoms. Only a handful of studies are published related to the atypical origin of coronary arteries. Therefore, we present a case of a hospitalized adult diagnosed with an atypical origin of the right coronary artery from the left coronary sinus. A 51-year-old female presented with mid-sternal heaviness, pressure, and burning sensation, not accompanied by sweating, dizziness, or light-headedness. Biochemical studies revealed an elevated troponin 1 level of 0.12 ng/mL. A coronary arteriogram showed proximal stenosis of the right coronary artery. CT cardiac angiography revealed a large right coronary artery arising from the left cusp anterior to the left main coronary artery. The patient was treated with surgical revascularization therapy.
ABSTRACT
To analyze the effect of Inhaled insulin in Type 1 Diabetes Mellitus and compare it with other routes of administration of Insulin. A systemic search was conducted from the following electronic databases: PubMed/Medline, Cochrane Library, and Google Scholar, from inception to 28th January 2022. All statistical analysis was conducted in Review Manager 5.4.1. All studies meeting inclusion criteria were selected. A random-effect model was used to pool the studies, and the result was reported in the Standard Mean Difference (SMD), Mean Difference (MD), and Risk Ratio (RR) with their corresponding 95% Confidence interval (CI). Thirteen randomized control trials were selected for our meta-analysis. Statistically significant results were obtained for comparing change in weight after insulin administration (MD= -1.08 [-1.21, -0.94]; p< 0.00001; I2= 74%). Other factors assessed were found to be non-significant like HbA1c (SMD= 0.03 [-0.80, 0.86]; p= 0.95; I2= 99%), fasting blood sugar (SMD= -0.31 [-1.52, 0.91]; p= 0.62; I2= 99%) and adverse effects (RR= 1.06 [0.97, 1.16]; p= 0.18; I2= 96%). In this systematic review and meta-analysis, we found that inhaled insulin is equally effective as subcutaneously administered insulin in patients with Type 1 Diabetes. The inhaled insulin was found to show less weight gain and fewer hypoglycemic shifts, with a similar effect on the blood glucose level. No significant difference was observed in the incidence of adverse events.
ABSTRACT
BACKGROUND: A 42-year-old man, known case of neurofibromatosis type 1 with café au late spots on trunk and extremities, neurofibromas, axillary freckling, pseudoarthrosis of distal tibia. He presented to the district cancer hospital with complaint of huge mass on lateral chest wall. Incisional biopsy was done and case was diagnosed with pleomorphic rhabdomyosarcoma. Immune/histochemical staining is positive for desmin. Rhabdomyosarcoma is a malignant soft tissue tumour with rare incidence in general population. There are few cases of pleomorphic rhabdomyosarcoma in NF 1 patient are reported in literature. This case study reports a rare occurrence of rhabdomyosarcoma in adult neurofibromatosis 1 patient.
