Visual and Auditory Hallucinations: An Uncommon Side Effect of Levetiracetam in an Elderly Patient.

This report focuses on a 77-year-old female who was admitted to an acute geriatrics unit at a tertiary care hospital with a history of recurrent falls and right leg weakness. Computed tomography of the head demonstrated acute left subdural hemorrhage with a possible extradural component at the vertex. This was causing mass effect with effacement of the left superior, frontal, and parietal lobes with no hydrocephalus or fracture. She had an episode of non-convulsive seizure secondary to a head injury and was commenced on levetiracetam. The patient started to display previously unreported visual and auditory hallucinations within four days of starting the medication. After ruling out other potential causes of the symptoms, our team narrowed it down to levetiracetam-induced hallucinations and subsequently discontinued the medication. We commenced pregabalin for seizure control, and there were no further episodes of hallucinations.

Laparoscopic Gastro-jejunostomy: An Ideal Solution to the Problem of Gastric Outlet Obstruction Post-corrosive Intake.

OBJECTIVE: To evaluate the outcome of Laparoscopic Gastro-jejunostomy in patients presenting with Gastric Outlet obstruction secondary to Corrosive intake at the Services Hospital. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Surgery, Services Hospital, Lahore, Pakistan, from June 2013 to June 2021. METHODOLOGY: Data was gathered from the patients who presented with gastric outlet obstruction with a pre-hospitalised history of corrosive intake. Consenting patients subsequently underwent laparoscopic gastro-jejunostomy and were followed up post-operatively at a 1-week time-point and 4-week time-point to monitor progress. Studied variables included duration of surgery, duration of hospital stay, complications, and mortality at the 1st and 4th weeks. RESULTS: A total of 30 patients participated in the study including 27 (90%) females and 3 (10%) males. The mean age was 27.2 ± 4.07 years. The mean duration of hospital stay was 9.3 ± 3.2 days. Complications were seen in 3 patients (10%) with 1 death (3.33%). CONCLUSION: Laparoscopic gastro-jejunostomy appears to be safe and effective in corrosive intake patients presenting with gastric outlet obstruction. KEY WORDS: Corrosive Intake, Gastric outlet obstruction, Laparoscopic, Gastrojejunostomy.

Spindle Cell Carcinoma in the Breast: A Case Report.

We aim to report on a patient presenting with a rare breast tumor. The tumor was recurrent with the patient having undergone wide local excision twice previously and the diagnosis was inconclusive both times. Under our care, the patient underwent a modified radical mastectomy with a level III dissection and a transverse rectus abdominis myocutaneous (TRAM) flap for reconstruction. The entire procedure was performed in front of a live audience comprising medical students, junior doctors, and consultants, managed with audio-visual feedback enabling a real-time discussion. The final histopathological report showed a spindle-cell tumor of the breast but also mentioned that a Phyllodes tumor could not be ruled out.

Smoking and Inflammatory Bowel Disease: A Comparison of China, India, and the USA.

BACKGROUND: Cigarette smoking is thought to increase the risk of Crohn's disease (CD) and exacerbate the disease course, with opposite roles in ulcerative colitis (UC). However, these findings are from Western populations, and the association between smoking and inflammatory bowel disease (IBD) has not been well studied in Asia. AIMS: We aimed to compare the prevalence of smoking at diagnosis between IBD cases and controls recruited in China, India, and the USA, and to investigate the impact of smoking on disease outcomes. METHODS: We recruited IBD cases and controls between 2014 and 2018. All participants completed a questionnaire about demographic characteristics, environmental risk factors and IBD history. RESULTS: We recruited 337 participants from China, 194 from India, and 645 from the USA. In China, CD cases were less likely than controls to be current smokers (adjusted odds ratio [95% CI] 0.4 [0.2-0.9]). There was no association between current or former smoking and CD in the USA. In China and the USA, UC cases were more likely to be former smokers than controls (China 14.6 [3.3-64.8]; USA 1.8 [1.0-3.3]). In India, both CD and UC had similar current smoking status to controls at diagnosis. Current smoking at diagnosis was significantly associated with greater use of immunosuppressants (4.4 [1.1-18.1]) in CD cases in China. CONCLUSIONS: We found heterogeneity in the associations of smoking and IBD risk and outcomes between China, India, and the USA. Further study with more adequate sample size and more uniform definition of smoking status is warranted.