Necrotizing Fasciitis Co-existing With Oral Squamous Cell Carcinoma: A Case Report of a Diagnostic Dilemma.

Necrotizing fasciitis is an uncommon yet highly dangerous bacterial infection characterized by rapid spread along the fascial planes and subcutaneous tissue, leading to extensive tissue necrosis and often resulting in death. The swift progression of necrosis can induce systemic sepsis, toxic shock syndrome, and multi-organ failure. While necrotizing fasciitis of the neck is rare, it typically originates from dental or pharyngeal sources. Successful treatment hinges on early diagnosis, appropriate antibiotic therapy, and surgical intervention for tissue debridement. This article presents the case of a 40-year-old individual with necrotizing fasciitis of the neck. We herein review the clinical features, pathogenesis, and treatment approach for the case. Rapid recovery necessitated comprehensive medical treatment targeting the underlying cause with aggressive supportive measures. Surgical intervention involved thorough debridement to remove necrotic tissue, irrigation with antiseptic solutions, and early application of topical antimicrobials.

Concomitant Two-Temporal Cilioretinal Artery Occlusion (CLRAO) With Impending Central Retinal Vein Occlusion (CRVO) in a Young Adolescent With Protein C Deficiency: A Rare Case.

We report structural changes in the retina of an adolescent diagnosed with the concomitant two temporal cilioretinal artery occlusion (CLRAO) with impending central retinal vein occlusion (CRVO) along with mild protein C deficiency. An 18-year-old girl came to the emergency room with sudden onset painless loss of vision in her right eye. On comprehensive ophthalmic examination, she had a pale superior-temporal retina with spongy macular edema corresponding to two temporal CLRAO and blurred disc margins with mild disc swelling and mild tortuosity of retinal veins all over the retina with few superficial hemorrhages in the right eye corresponding to impending CRVO. Optimal coherence tomography (OCT) showed thickening of the nerve fiber layer in the superior-temporal quadrant involving some part of the macula in the right eye. Perimetry showed a right eye visual field defect in the inferior nasal quadrant. Her coagulation profile was normal but her autoimmune profile was suggestive of mild protein C deficiency. Immediately she was started on anticoagulants. After one month, her visual acuity improved from finger counting close to face to 6/9 with treatment. Over a period of one month, retinal and OCT changes recovered with the same perimetry findings as earlier. This case shows how prompt treatment resulted in dramatic improvement in the form of good visual outcomes.

Fatal Acute Disseminated Encephalomyelitis Post-COVID-19 Vaccination: A Rare Case Report.

Acute disseminated encephalomyelitis (ADEM) is a disease of the brain and spinal cord that is an immune-mediated inflammatory and demyelinating disorder, which is commonly preceded by an infection. Some reports have also shown the association of acute demyelination of the central nervous system (CNS) with vaccination. Primarily, the involvement of the white matter of the cerebral hemispheres, brain stem, and spinal cord is observed. Such lesions should be considered as the differentials of ADEM. We would like to report a case of a 77-year-old female who was of post-COVID-19 vaccination status and presented to us with altered sensorium with imaging revealing acute demyelination.

Supernumerary Kidney (Triple Kidney) With Horseshoe Malformation: A Case Report.

The presence of an extra (third) kidney is an unusual congenital anomaly of the urinary system (US), having less than a hundred cases reported globally. Owing to the rare occurrence of this complex anomaly, the fused supernumerary kidney and horseshoe portion is very scarcely reported with unknown incidence. This paper presents a rare renal anomaly case of a fused supernumerary kidney with a horseshoe portion in a 41-year-old male who presented with fever, abdominal pain, and burning micturition. CT of the kidney urinary bladder showed non-rotation of the right kidney with a supernumerary malrotated horseshoe-shaped kidney and malrotated left kidney with features of acute pyelonephritis. The patient was managed with double J stenting and appropriate antibiotics till discharge.

Acquired Refractory Angioneurotic Edema in a Known Case of Systemic Lupus Erythematosus.

A woman came to the emergency room with swelling of the face, which included swelling around the lips and the eyes. The patient had undergone root canal treatment under lidocaine anesthesia one day prior, after which she developed swelling. Because angioneurotic edema was a possibility, the complement components C3 and C4 and C1 esterase inhibitor (C1-INH) were tested. The C4 level was found to be very low (0.08 gm/l) and the C1 level was also on the lower side (0.26 gm/l). Angioneurotic edema with acquired C1-INH deficiency was diagnosed after complete systemic and physical examinations. The patient made a complete recovery with the help of steroids, fresh frozen plasma, antibiotics, and antiallergic medications. For its rarity, this case of systemic lupus erythematosus refractory angioneurotic edema with acquired C1-INH deficiency is being reported.

A Narrative Review on Intermittent Fasting as an Approachable Measure for Weight Reduction and Obesity Management.

Obesity can be regarded as the curse of this modern advanced and efficient lifestyle as it is the crux of very precarious comorbidities. The prevalence of obesity is so widespread that cases of obesity can be seen on either end of the age spectrum. With the rise of the twenty-first century and the rise of ease of living, the sedentary lifestyle also went on the rise to become the primary contributor to the rise in obesity. For the management of obesity, various dietary modifications grew in popularity, among which is intermittent fasting. Intermittent fasting grew in popularity with the rise of the internet. Intermittent calorie restriction/time-restricted feeding is a form of caloric restriction revolving around a short window for eating and a comparatively larger window for fasting. This form of feed-fast cycle promotes increased consumption of adipose tissue and glycogen stores, leading to increased fat loss and reduced satiety. Intermittent fasting is also said to have cardioprotective functions as well known to control diabetic parameters and reduce the incidence of diabetes. This narrative review article's goals are to outline the benefits of intermittent calorie restriction while accounting for any of its potential limitations and pinpoint any knowledge gaps that may exist.

Riluzole and Edavarone: The Hope Against Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is one of the most frequent motor neuron illnesses. Motor neuron illnesses are various disorders that include upper and lower motor neuron abnormalities. Amyotrophic lateral sclerosis accounts for roughly 80% of motor neuron disorders. ALS is a fatal motor neuron disease that involves the loss of motor neurons in the spinal cord and brain, resulting in gliosis and muscle weakening and wasting in the upper, lower, and respiratory muscles, reducing life expectancy to 2-5 years from the onset of symptoms. Up until now, oral riluzole, a glutamatergic neurotransmitter inhibitor, has been used to manage ALS, the only drug for the management of ALS that has been approved by the United States (US) Food and Drug Administration (FDA). In recent studies, edaravone has been used through intravenous mode to halt the progression of ALS. We conducted a systematic search on PubMed; we selected Google Scholar, PubMed, websites regarding ALS, WebMD, Researchgate, als.org, consultant360, and the relevant articles for the review. It shows us riluzole and edaravone's efficacy for managing A.L.S. and how it can increase the life span of the patients.

Therapeutic Use of an Inhaled Drug Delivery in Pulmonary Hypertension: A Review.

Pulmonary arterial hypertension (PAH) is a serious condition in which there is increased blood pressure in arteries of the lungs (pulmonary arteries). The therapies or drugs for PAH have expanded with the revelation of three key pathological processes - encompassing prostacyclin, nitric oxide (NO), and endothelin pathways. An outlook for patients suffering from PAH is still mediocre amidst recent advancements. The evolution of pre-clinical and clinical research on PAH has facilitated the identification of several new targeted therapies for the disease. In this article, we examine recent data on new pulmonary hypertension physiological pathways, primarily concentrating on administering drugs through the inhalation route and their effects. Although they have been given clinical use approval, medications based on these routes are presently being studied in clinical or pre-clinical settings. To confirm these innovative medicines' therapeutic efficacy and safety, extensive clinical trials are needed.

Single Ventricle With Hypoplastic Left Heart Syndrome in a 22-Year-Old Male: A Rare Case Report.

Uni-ventricle transposition of great arteries with ductus-dependent pulmonary circulations with hypoplastic pulmonary atresia (PA) represents rare cardiac malformations. We are presenting a unique case of a 22-year-old male who complained of dizziness since morning with numbness of the left lower and upper limbs. He also complained of palpitations on and off for two to three years with episodes of cyanosis on exertion. He gave a history of cough with frothy pink sputum at the same time. At birth, he was diagnosed to have cyanotic congenital heart disease (CCHD), for which he was prescribed a combination of ambrisentan 5 mg and tadalafil 20 mg and tablet aspirin 75mg along with some lifesaving modalities like proper hydration and phlebotomy as and when required. He was told to go for high-risk surgery like Blalock Taussig shunt or bidirectional Glenn. A Blalock Taussig shunt is a short tube only a few mm wide, which makes a path for blood to go from the arterial circulation to the lungs and bidirectional Glenn sends blood directly from the upper body to the lungs. Strict compliance with drug therapy is implied for the patient for a better outcome.

Fatal Manifestations of Methotrexate Overdose in Case of Psoriasis Due to Dosing Error.

For more than 50 years, methotrexate (MTX), when used in low doses, has been one of the most commonly used drugs in the treatment of psoriasis. It has immunosuppressive as well as anti-inflammatory properties. Pancytopenia, hepatic dysfunction, respiratory toxicity, and acute renal failure are some of the reported side effects. This is a case study of a patient who had developed florid symptoms of methotrexate toxicity as a result of erroneous overdosing of methotrexate, which was given to her for psoriasis management.

Cell-Free Fetal Deoxyribonucleic Acid (cffDNA) Analysis as a Remarkable Method of Non-Invasive Prenatal Screening.

The cell-free fetal DNA (cffDNA) analysis for screening fetal genetic anomalies has increased dramatically since its commercialization in 2011 worldwide. In the early weeks of pregnancy, it offers a hassle-free, non-invasive procedure of antenatal screening. It guides and protects mothers from undergoing unwanted risk-laden invasive prenatal testing. cffDNA testing is accurate at detecting the abnormal fetus chromosome among a large pool population. Patau syndrome, Edward syndrome, and Down syndrome are currently being accurately screened by this method. Due to their sensitivity and specificity, they now have become the screening method of choice, approaching almost 100% in various studies with a large sample pool. The latest procedures to analyze cffDNA, like the new digital droplet polymerase chain reaction (ddPCR) and sophisticated next-generation sequencing (NGS), have increased detection rates with decreased analyzing time. The latest techniques make it possible to screen large numbers of the population with faster report generation. Screening for Rh incompatibility and its timely prevention is now more accessible and more accurate with the help of cffDNA analysis. The problem arises when we deviate from the primary disease and start testing for anomalies not intended to be screened by cffDNA in the first place. Fetal sex chromosome aneuploidy screening by cffDNA is one area where the test gives mixed results either due to differences in machinery, laboratory parameters, or human error. Other rare occurrences like trisomes, such as trisomy 7, trisomy 16, trisomy 22, and a few microdeletion syndromes are also being screened but with less accuracy. Like every technology, cffDNA analysis is not entirely free of criticism. Its high testing cost, potential to accurately prognosticate the gender of the developing fetus and absence of standard testing practices will become an issue as the test becomes routine worldwide.

Relationship Between Vaccination and Immune Thrombotic Thrombocytopenia: Coincidental or Causal?

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a complication developed in patients due to vaccination. High-risk factors like a prothrombotic state predispose such a condition. Due to the increase in vaccinations after the coronavirus 2019 (COVID-19) pandemic, the predisposition to risk factors has increased. Hence, complications occur at a very young age. This case report is of a young male who developed venous sinus thrombosis post the COVID-19 vaccination and was diagnosed and treated promptly.

Thrombotic Thrombocytopenic Purpura Treated Successfully in a COVID-19 Patient Having a Computed Tomography Severity Score of 22/25.

We present a case of a 50-year-old female who came to us with chief complaints of breathlessness, general weakness, and cough. She tested positive for coronavirus disease 2019 (COVID-19) on testing with Reverse Transcription Polymerase Chain Reaction (RT-PCR). She had high resolution computed tomography (HRCT) thorax score of 22/25. On investigation, she had thrombocytopenia with schistocytosis on the peripheral smear and evidence of acute kidney injury. She was diagnosed with thrombotic thrombocytopenic purpura (TTP) and was treated with oral prednisone, plasma exchange, and remdesivir. There was an improvement in clinical as well as biochemical parameters such as lactate dehydrogenase, haemoglobin, and platelet counts. This case report highlights TTP that may be a serious complication in COVID-19 patients, especially with a CT severity score of 22/25. Early diagnosis and intervention can lead to a positive outcome.

Lightning Strike Presenting as Fatal Lung Contusion: A Case Report.

Electrical injuries to humans from a lightning strike are associated with significant rates of morbidity and fatality. High-voltage injuries including those caused by lightning strikes are pulmonary edema, pulmonary contusion, acute respiratory distress syndrome, and pulmonary hemorrhages. Patients who get injured experience secondary trauma in addition to direct and indirect injury. In this report, we present the case of a 62-year-old male patient with complaints of shortness of breath, vomiting, and hoarseness of voice. The patient's treatment included airway protection, antibiotics, corticosteroids, and supportive care; however, the patient did not survive due to a severe lung contusion.

Aorta-right Atrial Tunnel Presenting with Heart Failure in an Adult.

Aorta-right atrial tunnel (ARAT) is a rare congenital anomaly characterized by extracardiac tunnel-like vascular connection between aorta and right atrium. Patients are usually asymptomatic, but patient may present with palpitation, dyspnea, and fatigue on exertion. Diagnosis can be made by transthoracic echocardiography during investigations for continuous murmur. Diagnosis can be confirmed by computed tomography, aortography, and coronary angiography. We report a case of a 26-year-old man diagnosed with ARAT arising from right sinotubular junction extending anteriorly and opening into right atrium near the opening of superior vena cava complicated with cardiomegaly and heart failure.