Crochet Leads the Way.

The crochetage sign-a notch near the R-wave peak in the inferior leads-in conjunction with right axis deviation, complete or incomplete right bundle branch block, and right ventricular hypertrophy (R/S ratio >1 in lead V1) on 12-lead electrocardiogram are highly suggestive of atrial septal defect. (Level of Difficulty: Intermediate.).

Recurrent Spontaneous Pneumothorax Associated With Marijuana Abuse: Case Report and Literature Review.

Marijuana is the most commonly used illicit recreational drug in the United States. Growing public support for marijuana law reform has resulted in a significant increase in its use. The harmful pulmonary consequences of chronic marijuana smoking are less researched and discussed than those of tobacco smoking. We present a case of recurrent spontaneous pneumothorax in a patient with heavy, persistent marijuana abuse who has no past medical or surgical histories and denied smoking cigarettes or other illicit substance use.

Coronary Vasospasm After Dobutamine Stress Echocardiogram Triggered by Esmolol.

Dobutamine stress echocardiography (DSE) is a commonly utilized method for coronary artery disease (CAD) diagnosis, and it provides important long-term prognostic information. We report a case of a 53-year-old female with multiple cardiovascular risk factors who underwent DSE for evaluation of underlying CAD. The examination was complicated by wide complex tachycardia and promoted administration of esmolol, which shortly led to ST-segment elevation myocardial infarction (STEMI). Coronary angiography showed complete absence of CAD. Coronary vasospasm was a possible suggested mechanism due to the pharmacologic interaction between beta-blockers and dobutamine on alpha- and beta-adrenergic receptors.

Recurrent hospitalisations in a rare case of hemicorporectomy: a challenging case for medical management.

Hemicorporectomy, or translumbar amputation, is a radical surgery involving the dissection of the body at the waist and is usually reserved for complex medical conditions including locally invasive malignancy and terminal pelvic osteomyelitis. Only 71 cases have previously been reported. We present a rare case of hemicorporectomy in a 53-year-old patient with terminal pelvic osteomyelitis which occurred after he suffered a gunshot wound at T6 causing paraplegia at the age of 31. Unfortunately, this patient continued to suffer recurrent hospitalisations and sepsis events secondary to chronic, non-healing advanced pressure ulcers and complicated urinary tract infections despite repeated courses of broad-spectrum intravenous antibiotics and surgical debridements. In light of his diminished quality of life and poor prognosis, the patient's family chose to manage his condition conservatively with home hospice. This case illustrates the significant challenges in the medical and surgical management of hemicorporectomy patients.

Empowering the Community to Manage Diabetes Better: An Integrated Partnership-Based Model.

CONTEXT: Rising number of diabetes cases in India calls for collaboration between the public and private sectors. AIMS: Municipal Corporation of Greater Mumbai (MCGM) partnered with Eli Lilly and Company (India) [Eli Lilly] to strengthen the capacity of their diabetes clinics. MATERIALS AND METHODS: Medical Officers, dispensaries and Assistant Medical Officers (AMOs) located at attached health posts were trained on an educational tool, Diabetes Conversation Map™ (DCM) by a Master Trainer. This tool was then used to educate patients and caregivers visiting the MCGM diabetes clinics. RESULTS: Twenty-eight centers conducted 168 sessions, and 1616 beneficiaries availed the education over six months. General feedback from health providers was that DCM helps clear misconceptions among patients and caregivers in an interactive way and also improves compliance of patients. CONCLUSIONS: This communication highlights a unique public-private partnership where the sincere efforts of public sector organization (MCGM) were complemented by the educational expertise lent by a private firm.

Idionyx (Odonata: Corduliidae) of the Western Ghats with a description of a new species.

The status and distribution of Idionyx Hagen, 1867 (Odonata: Corduliidae), of the Western Ghats, India, is updated and a new species Idionyx gomantakensis is described and illustrated based on male and female specimens from Kulem (= Collem), Goa, India. This new species can be differentiated from other species of Idionyx by long and slender cerci and epiproct, absence of teeth in the basal half of the cerci, and a tuft of golden hairs at the end of the lateral lobes of the epiproct. A revised key to the species of the genus is provided, and its diversity and ecology in the Western Ghats is discussed.

Case and management of incidentalomas in patients with Von Hippel-Lindau disease.

Adrenal incidentalomas, those adrenal masses discovered on imaging studies undertaken for other indications, represent an evaluation and management conundrum. Evaluating every incidentaloma for functional status and/or resecting all incidentalomas would not be cost-effective because the vast majority of incidentalomas are benign, non-functioning adenomas. Current management strategies focus on size, functionality and imaging characteristics. These strategies do not take into account individual patient characteristics, for example, comorbid hereditary syndromes. In this article we report a case of a pheochromocytoma presenting as a small incidentaloma in a patient with Von Hippel-Lindau disease. We review the current literature describing the appropriate evaluation and management of adrenal incidentalomas and investigate the nuances of evaluation of these masses in patients with Von Hippel-Lindau disease.

A neglected gland: a review of Cowper's gland.

Cowper's glands are pea sized glands present inferior to the prostate gland in the male reproductive system. They produce thick clear mucus prior to ejaculation that drains into the spongy urethra. Though it is well established that the function of the Cowper's gland secretions is to neutralize traces of acidic urine in the urethra, knowledge regarding the various lesions and associated complications of this gland is scarce. This review provides a comprehensive report on the development, function and various lesions associated with Cowper's gland.