Penile angioedema in a child: A nightmare to parents!

Angioedema is a transient, non-pitting oedema that involves subcutaneous or submucosal tissue. Angioedema in children can have varied aetiology and clinical manifestations, unlike that in adults. We report a case of angioedema of penis in a child resulting from insect bite and treated successfully with anti-histamine and leukotriene inhibitor. Penile angioedema should be kept in mind as a differential diagnosis of penile swelling, as early diagnosis and management may prevent fatal complications.

Symptomatology and Clinical Features of Human COVID-19

Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19), which was identified at the end of December 2019 in China. Symptoms of COVID-19 can appear after an incubation phase of the virus of 2 to 14 days, the most common being fever, cough, and asthenia. Other specific symptoms may include shortness of breath or difficulty breathing, muscle pain, sore throat, chills, loss of smell or sensation, chest pain, headache, nausea, rash, diarrhea, and vomiting. The severity of these symptoms can be mild or even extreme causing serious damage to several organs, directly and indirectly, namely pulmonary, renal, hepatic, cardiac, digestive, neurological. Some people have only mild symptoms, while others are asymptomatic. Seniors or those at risk for certain chronic diseases, such as massive obesity, diabetes, heart disease, lung disease, kidney disease, immune system abnormalities, and liver disease are more susceptible to COVID-19 and can develop more serious and fatal complications.

An increase in cases of complicated chronic otitis media: an indirect impact of COVID pandemic

<p><strong>Background:</strong> Chronic otitis media is the most common disease dealt by an otologist, the cases of complication of which are remarkably low. The use of antibiotics and mastoidectomies have resulted in the fall of the fatal complications. COVID-19 pandemic called for restrictions which lead to medical care delay.</p><p><strong>Methods:</strong> This study was conducted in the department of otolaryngology of GMC and associated hospitals, Jammu from June 2020 and May 2021. The data was retrospectively collected the data from March 2018 to June 2020. The study group included the patients diagnosed with Chronic suppurative otitis media (CSOM) on otoscopy and the patients with complications of CSOM were evaluated for the symptoms of complication, type of complication, bacteriology, treatment and hospital stay.</p><p><strong>Results:</strong> The 38 (7.5%) patients among these were diagnosed with one or other complication, out of which 29 (76.3%) cases occurred during the COVID pandemic. The extra-cranial complications were more common and young to middle age group was more commonly involved.</p><p><strong>Conclusions:</strong> COM is a common otological disease, the occurrence of which should not be taken lightly. Without timely and accurate treatment, the complications ensue which are difficult to treat and require expertise.</p>

Extensive Myocardial Infarction complicated with Stroke as First Presentation of HIV in A young Sudanese Male: Case Report

HIV can be associated with cardiovascular complications. We highlight unusual presentation of HIV patient with MI and stroke. 30 year old HIV male presented with MI complicated by stroke. Recovered within 5 days with anti-ischemic and diuretics. Screening tests for unusual presentations prevent fatal complications of common diseases.

Extensive Myocardial Infarction complicated with Stroke as First Presentation of HIV in A young Sudanese Male: Case Report

HIV can be associated with cardiovascular complications. We highlight unusual presentation of HIV patient with MI and stroke. 30 year old HIV male presented with MI complicated by stroke. Recovered within 5 days with anti-ischemic and diuretics. Screening tests for unusual presentations prevent fatal complications of common diseases.

SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review

Coronavirus disease 2019 (COVID-19) is the health crisis of our time and a great challenge we face, requiring the implementation of worldwide general containment. The symptoms and complications of COVID-19 are diverse, and rhabdomyolysis is an atypical manifestation. We report a case of a 63-year-old patient, admitted to the emergency room for myalgia and fever evolving over 5 days, in whom laboratory and other examinations indicated rhabdomyolysis complicated by renal insufficiency. During the diagnostic workup, the real-time polymerase chain reaction (RT-PCR) test result for COVID-19 was positive, revealing infection with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the severity of COVID-19 infection relates mainly to acute respiratory syndrome, other complications can be prognostic, and these complications make the management of this disease difficult. Rhabdomyolysis is one of the fatal complications; first, because the pathophysiological mechanism is not yet understood, and second, because rhabdomyolysis, itself, is usually complicated by acute renal failure. This complication makes the disease management difficult, especially in patients with SARS. Rhabdomyolysis during COVID-19 infection represents a significant challenge, given the few reported cases, and further research is required to develop a therapeutic consensus.

Study on rickettsial diseases evidenced by Weil-Felix test among febrile patients visiting a tertiary care hospital in Mymensingh

Background: Rickettsial diseases are neglected, re-emerging vector borne zoonosis & increasingly considered as one of the most important causes of pyrexia of unknown origin (PUO). They are grossly underdiagnosed due to wide range of non-specific symptoms, low index of clinical suspicion, lack of widely available specific diagnostic tools, leading to significant morbidity & mortality. Appropriate diagnosis in early stages is therefore necessary to prevent fatal complications associated with this disease. Objective: Present study was attempted to assess the burden of rickettsial illness by Weil-Felix agglutination test, among the suspected febrile patients, visiting a tertiary care hospital as well as to analyze the demographic profile & clinical manifestations of the seropositive cases. Methods: This was a cross-sectional study, conducted at department of microbiology, Mymensingh Medical College from March 2018 to February 2019. A total of 453 febrile patients of suspected rickettsial illness, irrespective of age and sex, were enrolled in this study. Serum sample from all the enrolled cases were then analyzed for rickettsial antibodies by Weil-Felix slide agglutination test. Results: Out of 453 cases, a total of 260 (57.39%) showed significant agglutination by Weil-Felix test, of which 101 (38.84%) were reactive to OX2 (spotted fever group rickettsiae), 65 (25%) were reactive to OXK (Scrub typhus) & 13 (5%) showed significant titers to OX19 (typhus fever). Remaining 81 (31.15%) sera were reactive to more than one antigens (mixed reactivity). Seropositivity was higher among female subjects (142; 54.61%) & age group >15-30 accounted for highest number of cases (95; 36.53%). Positive cases showed diverse clinical manifestations like headache (55.76%), myalgia (50.76%), skin rash (10.38%), eschar (9.23%), oliguria (7.3%), jaundice (10.76%), splenomegaly (6.81%), hepatomegaly (7.30%) etc. Conclusion: Rickettsial diseases should be considered as an important etiology of PUO & early diagnosis should be done to initiate proper treatment to prevent fatal complications. Though it lacks sensitivity & specificity, in a resource constraint area like Bangladesh, Weil-Felix test still serves as the cheapest initial diagnostic tool for rickettsial illness to guide the physician for further approaches. Mediscope 2021;8(2): 112-121

Drugs associated with drug-induced hyponatremia

Hyponatremia (HN) is a significant disturbance of the water-electrolyte balance in clinical practice. Drugs are one of the leading causes of low sodium level. Antidepressants, antiepileptic, antipsychotic, antineoplastic drugs and opioid analgesics are the most common medications that induce hyponatremia. Special attention should be paid to people with cancer, who often receive several drugs that induce HN. Risk factors for the development of drug-induced (DI) HN when taking most medications are female sex, weight loss, and old age. In persons receiving therapy with the listed drugs, it is necessary to assess the risk factors for a decrease in the sodium level, clinical manifestations from the nervous system, and to determine the sodium level in dynamics. Special care must be taken when treating elderly patients, since they have several risk factors for the development of DI HN. These measures will help prevent the development of HN and its severe and sometimes fatal complications.