A rare sight: Childhood blepharochalasis presenting as recurrent eyelid swelling: A case report.

INTRODUCTION AND IMPORTANCE: Blepharochalasis is a rare eyelid condition that usually affects the upper eyelids and is characterized by persistent, painless edema. This article emphasizes how difficult it can be to diagnose blepharochalasis and how crucial it is to take it into account when making a differential diagnosis for recurrent eyelid swelling. Additionally, it highlights the necessity of surgical intervention and the limited effectiveness of medicinal therapy. CASE PRESENTATION: This case report features a 12-year-old kid who has experienced recurring swelling of the upper eyelid for the previous six years. This was eventually diagnosed as a rare condition called blepharochalasis, and treated with blepharoplasty. CLINICAL DISCUSSION: When nephrotic syndrome was first suspected, systemic involvement was ruled out by careful investigation. Upon physical examination, there was laxity of the eyelids and bilateral ptosis. Renal and liver function tests, among other laboratory testing, came back within normal ranges. The patient was sent to plastic surgery and had blepharoplasty. CONCLUSION: Blepharochalasis presents with recurrent eyelids swelling and is often misdiagnosed as other pathologies such as nephrotic syndrome. This case highlights the importance of clinical manifestation and management of blepharochalasis.

Navigating Pakistan's immunization landscape: Progress and pitfalls.

Objectives: This study aims to assess the impact of the 2022 floods in Pakistan on the incidence of vaccine-preventable diseases (VPDs) in flood-affected regions, specifically focusing on areas with traditionally low vaccination coverage. Design: Weekly incidence data of VPDs from September to November 2021 and 2022 were collected and analyzed for the provinces of Sindh, Khyber Pakhtunkhwa, and Baluchistan. The study compared year-on-year changes in disease incidence to evaluate the effect of the floods on disease burden. Results: The analysis revealed significant increases in the incidence of various VPDs in the flood-affected regions compared to the previous year. Diseases such as pertussis showed a 171% increase, while mumps exhibited nearly a 1000% increase in reported cases. Other diseases including polio, diphtheria, neonatal tetanus, measles, chickenpox, and rubella also experienced substantial rises in case numbers. Concurrently, cases of lower respiratory tract illnesses and diarrheal diseases in children under five years old surged notably. Conclusions: The findings underscored the failure of relief and healthcare efforts in managing vaccine-preventable diseases in flood-affected areas of Pakistan. The study highlights an urgent need for targeted intervention strategies, including enhanced immunization drives and healthcare infrastructure improvements in vulnerable regions. The post-flood scenario presents a critical opportunity to address existing challenges in vaccination coverage and to mitigate future disease outbreaks through comprehensive public health initiatives.

Unveiling an atypical meningioma amidst stroke symptoms: importance of accurate diagnosis and comprehensive follow-up: A case report.

Meningiomas are common brain tumors that are classified as either benign, atypical, or malignant. This case involves a 75-year-old woman with a medical history of ischemic heart disease, hypertension, and diabetes. She was diagnosed with an atypical meningioma while being evaluated for symptoms related to a stroke. Upon her presentation at the hospital, the patient displayed symptoms such as loss of motor function on the right side of her body, weakness, dysphagia, and aphasia, indicating a possible stroke. Imaging tests confirmed both the stroke symptoms and the presence of an atypical meningioma. The primary focus of her treatment was addressing the stroke symptoms. Despite being asymptomatic for the meningioma, the patient opted for conservative treatment and declined invasive procedures. Her decision was respected, and a plan was put in place for regular monitoring and counseling regarding the meningioma. This case emphasizes the significance of tailored treatment decisions in complicated clinical situations involving incidental brain tumors.

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.

Breaking the Bubble: Bullous scabies - A case report.

The article describes a rare case of bullous scabies in a 30-year-old female. Scabies is a skin condition caused by the mite Sarcoptes scabiei and is typically transmitted through skin-to-skin contact. Bullous scabies is a rare presentation of scabies and is characterized by tense bullae and blisters that resemble bullous pemphigoid. The patient presented with pruritus, bullae on the hands and feet, and papules on various body parts. After a provisional diagnosis of scabies was made, microscopic examination confirmed the presence of mites and eggs. The patient was treated with Permethrin cream and antihistamines, and her symptoms regressed over the next two months. The husband and two other family members also reported improvement after treatment. While bullous scabies is an uncommon presentation of scabies, it is important to consider it in the differential diagnosis for patients presenting with bullae and pruritus. The exact pathophysiology of bullous scabies is yet to be determined, but theories include a staph aureus superinfection or production of autoantibodies in response to scabies lytic enzymes. Early recognition and appropriate treatment can lead to good outcomes in patients with bullous scabies.

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.

Statin-Induced Thrombocytopenia in a Young Female: A Case Report and Literature Review.

The causal relationship of thrombocytopenia with statin intake has been described in many research articles. Our case discusses the refractory nature of thrombocytopenia in a 22-year-old female, one month following a daily intake of 20 mg atorvastatin. This is the first case ever of drug-induced refractory thrombocytopenia reported in a young patient. We will also discuss previously reported cases of drug-induced thrombocytopenia (DIT) in our manuscript.