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This case report describes a 52-year-old patient presenting with recurrent episodes of pancreatitis and renal stones. Further investigation revealed hypocalcemia and elevated parathyroid hormone (PTH) levels, leading to diagnosis of a parathyroid adenoma. This case highlights the importance of considering primary hyperparathyroidism in patients with recurrent pancreatitis and renal stones, as early diagnosis and surgical intervention can prevent recurrence and reduce morbidity. Abstract: Primary Hyperparathyroidism secondary to Parathyroid adenoma, rarely presents as acute pancreatitis. A 38-year-young male with a history of recurrent renal stones referred from a local center, presented to the emergency services, with a diagnosis of acute pancreatitis and bilateral renal stones. Laboratory evaluation showed an elevated calcium level, elevated PTH levels, low vitamin D, and low phosphorus levels. CT scan done outside was suggestive of acute pancreatitis along with bilateral renal calculi. USG neck and MIBI scan done as a part of hypercalcemia evaluation showed presence of a right parathyroid adenoma. Parathyroid adenoma was later removed, and calcium and parathyroid levels were normal on subsequent follow ups.
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Key Clinical Message: Migration of any foreign body can cause potentially life threatening complications and should be reviewed by a multidisciplinary approach for the management. Diagnosis can be challenging; a history of foreign body injury could be suspicious. Abstract: Foreign body injury to the chest wall can be an emergency situation and require a multidisciplinary approach for the management of the condition. Migration of the foreign body, though rare, can lead to potentially life threatening complications and require a multidisciplinary approach for the localization of the foreign body and subsequent management of the condition. A 50-year-old male presented to the emergency department with the complaint of left sided chest pain. Upon examination, the patient was found to have a penetrating injury 6 years back by a sharp object. Radiological investigations helped in the localization of the migrating foreign body, which was removed with effective surgical intervention. The postoperative chest x-ray was normal, the patient was asymptomatic and thus the patient was discharged on the same day following surgery.
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Key Clinical Message: This case underscores the importance of considering myocardial infarction with nonobstructive coronary arteries (MINOCA) in patients experiencing acute chest pain following rabies vaccination, emphasizing the need for heightened awareness and further research into the association between MINOCA and Rabies vaccination. Abstract: Rabies is a vaccine-preventable deadly viral disease prevalent in Asia and Africa that causes thousands of deaths annually. Rabies pre (PrEP) and postexposure prophylaxis (PEP) is highly effective in annulling rabies-associated deaths. The adverse reactions following rabies vaccination are typically mild. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare condition, and its association with rabies vaccination is unprecedented. We present a case of a 43-year-old male with MINOCA following Rabies PEP. A 43-year-old male, nonsmoker and nonalcoholic, presented to the ER with complaints of acute onset left sided chest pain following the completion of the third dose of intradermal rabies vaccine, whose clinical features, ECG changes and lab reports were suggestive of acute presentation of inferior wall MI. Coronary angiography was performed, which however revealed normal coronaries with only slow flow being noted in the left anterior descending (LAD) artery. Echocardiography later showed a normal study with no other relevant diagnosis unveiled on further investigations. Hence a diagnosis of vaccine-induced MINOCA was made. Treatment included antiplatelet therapy, statins, and beta-blockers. MINOCA following rabies vaccination is an unprecedented finding. The clear etiology behind this couldn't be ascertained. The patient's treatment was conventional, emphasizing the need for further research and clinical trials in MINOCA diagnosis and management. This case highlights the need for clinicians to consider MINOCA in patients with acute chest pain post-rabies vaccination. Further research is essential to unravel the association between MINOCA and rabies vaccination, paving the way for optimal management strategies.
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Introduction: Stroke is the second most common cause of mortality after ischemic heart disease and the leading cause of morbidity around the world. This study aimed to find out the stroke among patients admitted to a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Internal Medicine and Neurosurgery from 15 July 2021 to 15 June 2022 after taking ethical approval from Institutional Review Committee (Reference number: 78/79-083). Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 5034 patients, 149 (2.95%) (2.48-3.41, 95% Confidence Interval) patients had stroke. Out of 149 cases, male to female ratio was 1.06 with a mean age of 65.05±14.06 years. The most common presentation was hemiparesis 128 (85.90%). Hypertension 106 (71.14%) was the most common underlying condition. The frontal area 17 (32.02%) was the most common site of ischemic stroke. Putamen (55.26%) was most common site in hemorrhagic stroke. The mean hospital stays was 6.3±5.18 days. There were 5 (3.40%) cases of in-hospital mortality. Conclusions: The prevalence of stroke was similar to other studies done in similar settings. Keywords: hemorrhagic stroke; ischemic stroke; prevalence.