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  • Fatal diffuse pleural calcification due to Tuberculosis- An unexplained entity

    Diffuse pleural thickening has many causes and often need to be diagnosed early as delay in treatment can be lethal. Diffuse pleural thickening can be due to calcifications and may occur as a result of chronic infections including Tuberculous effusion. Primary pleural calcification due to Tuberculosis is extremely rare. A 28 year old patient was presented with exertional dyspnea, chronic cough and pleuritic type chest pain for a period of 4 months. CXR showed left sided diffuse pleural calcifications and ultrasonography showed calcified pleura with thick echogenic material suggestive of an empyema. Further evaluation with a CECT showed left sided diffusely calcified, septated pleura with empyema and contralateral early pleural and peritoneal calcification. Pleural aspiration showed a hemorrhagic exudative lymphocytic effusion with high ADA titer. Cytology did not reveal malignant cells. His serum calcium level was normal. He was diagnosed to have extra-pulmonary tuberculosis and was treated with standard anti TB treatment with an intercostal tube drainage. Despite TB treatment he passed away due to respiratory distress caused by pleural thickening. This case highlights the importance of timely initiation of anti TB treatment and the capacity of Tuberculosis to cause diffuse pleural calcification which can be fatal in an untreated setting.

  • Food security in the time of Coronavirus (COVID-19). The Argentine case

    The context of pandemic of the human coronavirus COVID-19, preventive strategies based on mandatory social isolation (quarantine) were imposed by governments to reduce transmission in the community. However, they have had a strong impact on the economies of the countries and on the people as massive layoffs, decreased wages, uncertainty, inability to work formally, increasing precariousness and inequality and food insecurity. Without a doubt, the pandemic surprised Argentina without the necessary tools to amortize the attacks of the disease, and all the collateral consequences that emerge from it. The concept of food insecurity represents a situation or a process experienced by households in which there is a limited and uncertain availability of the quantity and quality of food that allow covering the nutritional requirements of people, thus as an also limited and uncertain availability of the ability to acquire them in an acceptable way from a social and cultural perspective. This work addresses household food insecurity at the micro-social level based on their own surveys and describes the strategies carried out by households in the metropolitan area of Buenos Aires city, Argentina to withstand the effect. FI status was assessed among 200 adult university students a mean age of 28±6 years (57% female, 43% male) during isolation period in April -May 2020 using the food insecurity experience scale (FIES). The students responded affirmatively and with a higher percentage value to the items related to the lack of money to consume healthy and nutritious food. Food security status of the 200 students survey, 23.5 per cent (n = 47) were food secure. Food insecurity was reported by 76.5% (n = 153). Of these, 50% (n = 100) were mild food insecurity, 25.5% (n = 51) were moderate, while 1% (n = 2) were severe food insecurity. Food insecurity derived from access,…

  • Successful non-operative management of extensive pneumomedia- stinum and pneumoperitoneum

    Background: A 70 year old male presented with acute left flank pain and was found to have extensive free air in both the mediastinal and peritoneal cavities. He was managed successfully without surgery. Case: A 70 year old male presented with left flank pain that began an hour prior to arrival. He had a history of obstructive sleep apnea that had been treated with continuous positive airway pressure therapy (CPAP) at home for many years. His vital signs, physical exam, and laboratory testing were all unremarkable. However, imaging findings were impressive for massive pneumoperitoneum and pneumomediastinum. Given his clinical stability, operative exploration was deferred, and he was admitted for observation and bowel rest. He was discharged less than 48 hours after admission without incident. His history of home CPAP therapy was the only attributable cause for the ominous findings seen on his imaging. Recognizing that this was a case of benign free air saved this patient from the morbidity and potential for death that comes with an unnecessary operative exploration. Conclusion: Continuous positive airway pressure therapy can result in benign free air within the mediastinal and peritoneal cavities. Evaluating the complete clinical scenario will allow for recognition of similar cases in which these grim findings are not indicative of surgical disease, thus avoiding the iatrogenesis of unnecessary surgery.

  • Shewanella, not just found in the marine environment. A rare case of Shewanella algae bacteremia

    A 63 year old Caucasian female with ampullary pancreatic cancer s/p pancreaticoduodenectomy in 2016 was admitted to our cancer center with complaints of fever (temperature 103° F) and abdominal pain. She was found to have multiple liver abscesses. Her blood culture grew out Shewanella algae. We herein report on this rare human bacterial infection.

  • A suspected insulinoma with the unexpected histopathological finding of a nesidioblastosis – A case report and literature review

    Introduction: Nesidioblastosis is a hyperplasia of the beta cells that causes persistent hyperinsulinemic hypoglycemia, unfortunately, it is difficult to diagnose through imaging studies. Case presentation: A 68-year-old woman with palpitations, diaphoresis, dizziness and alterations in the level of consciousness that improve with food intake. Laboratories: glucose 35.0 mg/dl, insulin 12.5 mUI/ml, proinsulin 14.1 pmol/L and peptide C 2.55 ng/ml. Octreoscan reveals an abnormal epigastric uptake area and the tomography shows a focal hypervascular lesion in pancreatic body of 12×11 mm. A distal pancreatectomy was performed without palpating the tumor in transoperative period, and a diffuse nesiodioblastosis was reported in the histopathological study. The patient persists with hypoglycemia and an additional pancreatic resection was performed, resecting 90% of the organ. Although an insulinoma was not located in the piece, an area surrounded by connective tissue was observed where islet hyperplasia was more accentuated. Discussion: The pathophysiology of nesidioblastosis is unknown, its main differential diagnosis is insulinoma and this should be suspected when the tumor can not be identified. Most agree that a pancreatectomy that involves 60-80% of the total organ can control glucose levels with low risk of diabetes and pancreatic insufficiency. Conclusion: The nesidioblastosis should be suspected when a hyperinsulinemic hypoglycemia is difficult to control and when a tumor can not be identified. The extension of the pancreatectomy should be individualized and if an insulinoma is not localized and a nesidioblastosis is suspected, an intraoperative histopathological examination with frozen section evaluation for the margins could determine the extent of pancreatectomy.

  • Rare case of ectopic pleomorphic adenoma on the plane of the cheek

    Pleomorphic adenoma is a benign tumor of the salivary gland with the highest incidence rate among all salivary gland tumors in the general population. Even though it’s common, ectopic presentation of the same is rare. When it happens, it presents in the head and neck region. We discuss in this paper a rare case of ectopic pleomorphic adenoma on the plane of the cheek.

  • Phosphate Enema Causing Life-Threatening Rectal Perforation

    We report a near fatal rectal perforation due to a phosphate enema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intraluminal faeces in a loaded rectum could be a cause of ongoing sepsis. Although enemas are commonly used for constipation in the elderly, suppositories and oral preparations should be used preferentially where appropriate.

  • Methemoglobinemia – A review and recommendation for management – Acute methemoglobinemia with hemolytic anemia following suicidal use of aniline based substance

    Methemoglobinemia is a rare disease classification related with congenital or acquired (usually iatrogenic) hemoglobin oxygenation disorder. Despite the fact that number of potentially methemoglobin forming agents is very long, methemoglobinemia is still a case-report of patients admitting to the Emergency Departments. The patient was brought after consuming resin hardener for suicidal purposes from the Center of lower reference to the hospital Emergency Department with suspected burns of the gastrointestinal tract. The patient presented cyanosis, dyspnoea and brown-colored urine on admission.

  • Giant Cell Tumor of Bone, current treatments, and potential therapeutic alternatives

    Giant cell tumor of bone (GCTB) is a primary bone tumor, locally aggressive. For many, a GCTB is considered a tumor with an unpredictable behavior, particularly regarding recurrences, pulmonary implants, and the possibility of primary malignancy. In terms of risk of recurrence, it is known that it is associated with the type of treatment used initially for the GCTB. The greater the number or recurrences, the greater the risk of pulmonary implants, and the greater the risk of malignant degeneration. Therefore, much of the prognosis of this tumor could be related to the type of initial treatment. Hence the importance of the treatment theme. This review includes a comparison between the various modalities for treatment in GCTB, considering the advantages and disadvantages of each one. Existing GCTB treatments are not 100% safe and effective at the same time. and this is the reason why the search for other treatment modalities should continue to offer a better oncologic and functional outcome to patients. In the end of this review, based on research work, we also mention other possible therapeutic options that could be explored and used in the future for GCT treatment.

  • Unexplained Harmony; Tuberculosis and Sarcoidosis

    Sarcoidosis and tuberculosis are chronic granulomatous diseases with predominant pulmonary involvement. Simultaneous occurrence of sarcoidosis and tuberculosis is a rarely encountered clinical entity. We present two Sri Lankan males with coexisting bacteriologically confirmed tuberculosis and histologically diagnosed sarcoidosis. Careful and timely commencement of anti-tuberculous treatment followed by steroids treatment for sarcoidosis lead to improvement of both conditions. These cases are reported to describe the dilemmas in diagnosis and management of this underrecognized clinical entity.