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.

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.