Chorea as the only presenting clinical feature of rheumatic fever: a case report.

Introduction and importance: Sydenham's chorea (SC), a major neurological manifestation of acute rheumatic fever (ARF), is commonly seen in young children and adolescents. It is characterized by rapid, unpredictable, involuntary, and nonpatterned contractions affecting mostly distal limbs. It can also be associated with clinical or subclinical carditis. SC has been reported as a major manifestation in only 3.87% cases of acute rheumatic fever in Nepal. Case presentation: The authors report a case of a 12-year-old boy with abnormal movement of his right hand and unsteady gait for 12 days. On examination, he had an abnormal hand grip with difficulty maintaining a tetanic contraction (Milkmaid's grip). Laboratory investigations revealed increased anti-Streptolysin O titre and erythrocyte sedimentation rate. Echocardiography revealed subclinical carditis. After thorough clinical examination and pertinent investigations, the final diagnosis of ARF with SC was made. Clinical discussion: SC is a major clinical feature of rheumatic fever according to the revised Jones criteria. It is related to a previous Group A ß-haemolytic Streptococcus pyogenes (GABHS) infection. Approximately 50-65% of the patients with rheumatic fever later develop clinically detectable carditis. Although a self-limiting condition, it might need treatment with antiepileptics, neuroleptics, and phenothiazines. Conclusion: Any child presenting with a movement disorder should also be considered for SC, necessitating additional testing, including a cardiovascular assessment. It needs to be distinguished from other causes of movement disorders as well as psychiatric conditions. Treatment is necessary for moderate to severe chorea that interfere with daily activities. Compliance with subsequent antibiotic prophylaxis is essential for avoiding future cardiac complications.

Colonic pedunculated polypoid vascular ectasia mimicking ileocolic intussusception: a rare case report.

Vascular ectasias are characterized by abnormal blood vessel enlargement and presumed to be caused by degenerative processes. About 3% of lower gastrointestinal bleeding is caused by it. On endoscopy, colonic arteriovenous malformations are frequently solitary, sizable, flat, or raised red lesions. Conversely, colonic vascular ectasia that manifests as pedunculated polypoid lesions are rare. Case presentation: A 45-year-old woman presented with hematochezia and abdominal pain. Abdominal ultrasound and Contrast enhanced computed tomography abdomen, both showed features of ileocolic intussusception. Intraoperatively, an intraluminal pedunculated polypoid growth extending up to the hepatic flexure of the colon was discovered. A right hemicolectomy was performed, removing the polypoid growth as well. After histopathological evaluation, a final diagnosis of colonic polypoid vascular ectasia was made. Clinical discussion: Gastrointestinal bleeding is the common initial manifestation of vascular ectasia, while some individuals may continue to be asymptomatic. According to a study from July 2022, vascular ectasia that manifests as polypoid growth is an uncommon phenomenon that has only been documented in 17 other cases. An intussusception may have a polypoid vascular ectasia as its lead point. Conversely, a large polypoid vascular ectasia may have radiographic characteristics that resemble an intussusception. Conclusion: Large colonic vascular ectasia, which tends to enlarge over time, can occasionally be misinterpreted as an intussusception due to comparable radiological appearances. In the event that a polypoid colonic vascular ectasia is misidentified for intussusception, the surgical team must be ready to adjust the treatment protocol as needed.

Supernumerary digit of bilateral hands: a rare congenital anomaly presented as a case report.

Abnormalities in the development of hands and fingers are caused by faulty signaling centers, together with or without abnormal production of important regulatory proteins. One of those abnormalities is the supernumerary digit. Postaxial supernumerary digit can present as a functioning or a nonfunctional digit. Case: We describe a case of a 29-year-old male with a postaxial supernumerary digit of the ulnar aspect of the bilateral fifth digit. Clinical Findings and Investigations: The patient had a growth of 0.5 cm over the ulnar aspect of the proximal phalanx of the fifth digit of the right hand and 0.1 cm over the ulnar aspect of the proximal phalanx of the fifth digit of the left hand with a broad base. X-rays of bilateral hands were sent. Intervention: Suture ligation or surgical excision was recommended for the patient, but they were both rejected by the patient. Conclusion: Bilateral hands with supernumerary digits are a rare congenital defect. The differential diagnosis of digital fibrokeratoma should be used by doctors. Simple observation, suture ligation, or excision with skin sutures are examples of potential treatments.

Comparison of Effectiveness and Safety of Low-Dose Versus Standard-Dose Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke: A Meta-Analysis.

The aim of the present meta-analysis is to compare the efficacy and safety of low-dose and standard-dose recombinant tissue plasminogen activators (r-tPA) in patients with acute ischemic stroke. The present meta-analysis was conducted according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted a systematic search in PubMed, Embase, and the Cochrane Library to identify studies published between January 1, 2010, and January 31, 2023, using the following terms: "stroke," "alteplase," "doses," "efficacy," "tissue plasminogen activator," "r-tPA," and "safety." Primary efficacy outcomes included favorable outcomes (Modified Rankin Scale scores of 0-2), while secondary efficacy outcome was all-cause mortality at 90 days. Safety outcomes included asymptomatic intracerebral hemorrhage (ICH) and symptomatic ICH assessed using the National Institute of Neurological Disorders and Stroke (NINDS) study and the Safe Implementation of Thrombolysis in Stroke-Monitoring (SITS-MOST) study. We also compared parenchymal hematomas as safety outcome between the two groups defined by the authors themselves in their research. A total of 16 studies were included in the present meta-analysis. The meta-analysis did not report any significant difference between low-dose and standard-dose r-tPA in terms of mortality, symptomatic intracranial hemorrhage (SICH), asymptomatic ICH, and parenchymal hematomas. However, the favorable outcome was significantly greater in patients receiving a standard dose of r-tPA.

Cutaneous larva migrans: A case report successfully treated with albendazole.

Introduction: Cutaneous larva migrans (CLM) is helminthic infection that is mostly found in tropical and subtropical areas [1]. It is commonly seen with those who have contact with soil that is contaminated by cat and dog's hookworm larvae. CLM present as erythematous, serpiginous, pruritic cutaneous eruption that is caused by accidental percutaneous penetration and subsequent migration of larvae. Case: We present a case of 45 year old male with erythematous, serpiginous, pruritic eruption over the dorsum of foot.Clinical findings and investigations: Patient had a 2-3 cm linear, erythematous, serpiginous localized lesion characteristic of a papular tip on the dorsal surface of the right foot. Total and differential blood counts, peripheral blood smear and chest x-ray were sent for investigations. Intervention and outcome: Patient was prescribed Albendazole at a dose of 400mg, once a day for seven days. After treatment, the lesion and pruritus had regressed significantly. Conclusion: Hookworm-related CLM is diagnosed clinically based on the typical clinical presentation (skin findings). Clinicians should be aware of the possibility of hookworm-related CLM with history of travel to tropical areas, specially walking barefoot.