Tuberculous meningitis with stroke: A case report of diagnostic dilemma and therapeutic triumph.

Tuberculous Meningitis (TBM) is a rare manifestation of Mycobacterium tuberculosis infection affecting the meninges. We present a case of a 40-year-old male initially presenting with neurological deficits mimicking ischemic stroke. Despite classic signs, including fever, headache, and neck stiffness, TBM was initially overlooked, leading to delayed treatment. Comprehensive assessment, imaging findings, and characteristic cerebrospinal fluid findings, confirming TBM with tubercular stroke. The patient responded positively to antitubercular therapy and steroids. This case underscores the diagnostic challenges of TBM, emphasizing the need for a broad differential diagnosis, particularly in regions with a high tuberculosis prevalence. Recognition of atypical presentations is crucial for timely intervention and improved outcomes.

Creutzfeldt-Jakob disease: A case report and differential diagnoses.

Although sporadic Creutzfeldt-Jakob disease is a rare neurodegenerative disease and often difficult to diagnose at the earliest onset, meticulous clinical examination, electroencephalography, and neuroimaging findings will help in diagnosis.

Chilaiditi's syndrome in a patient under long-term antidepressants- A case report.

Introduction: Chilaiditi's sign is a rare radiological sign characterized by interposition of the colon between diaphragm and liver. It is called Chilaiditi's syndrome if the patient presents with associated symptoms. Its diagnosis is incidental and can be confused with other acute conditions. Case presentation: This is a case of 85-year-old gentleman who presented with complaints of epigastric pain and vomiting. The patient had a history of long-term antidepressant medications. X-ray of chest and abdomen revealed presence of bowel loops under the diaphragm. CT scan helped confirm the diagnosis of Chilaiditi's sign. Discussion: Chilaiditi's sign has a low prevalence on chest and abdominal X-rays. Common associated symptoms include abdominal pain, nausea, vomiting and constipation. It can be misdiagnosed as bowel perforation and can lead to unnecessary surgical interventions. Symptomatic patients are managed conservatively. Conclusion: Chilaiditi's syndrome is a rare radiological entity and should be diagnosed carefully to avoid unwanted surgical procedures.

Diagnostic accuracy of glycogen phosphorylase BB for myocardial infarction: A systematic review and meta-analysis.

PURPOSE: We tried to investigate the diagnostic accuracy of glycogen phosphorylase BB as a cardiac marker for myocardial infarction. METHODS: We searched through different electronic databases (PubMed, Google-scholar, Embase, and Cochrane Library) to locate relevant articles. Studies, with sufficient data to reconstruct a 2 × 2 contingency table, met our inclusion criteria were included. Three reviewers independently screened the articles. Discrepancies were resolved by other reviewers. Unpublished data were requested from the authors of the study via email. Subsequently, data extraction was done using a standardized form and quality assessment of studies using the QUADAS-2 tool. Meta-analysis was done using a bivariate model using R software. RESULTS: Fourteen studies were selected for the final evaluation, which yielded the summary points: pooled sensitivity 87.77% (77.52%-93.72%, I2  = 86%), pooled specificity 88.45% (75.59%-94.99%, I2  = 88%), pooled DOR 49.37(14.53-167.72, I2  = 89%), and AUC of SROC was 0.923. The lambda value of the HSROC curve was 3.670. The Fagan plot showed that GPBB increases the pretest probability of myocardial infarction from 46% to 81% when positive, and it lowers the same probability to 12% when negative. CONCLUSION: With these results, we can conclude that GPBB has modest accuracy in screening myocardial infarction, but the limitations of the study warrant further high-quality studies to confirm its usefulness in predicting myocardial infarction (MI).

Intra-abdominal propylene suture fragment leading to complete small bowel obstruction: A case report.

INTRODUCTION: Propylene sutures are non-absorbable sterile surgical sutures, which when present intra-abdominally act as a foreign body leading to adhesion formation. Post-operative adhesions are a common cause of bowel obstruction, with complete closed loop obstruction presenting as a surgical emergency. CASE DETAILS: A 66-year-old man who had undergone a laparotomy for bowel obstruction two years back, presented to our emergency department with features of complete bowel obstruction. Midline laparotomy revealed propylene suture and intra peritoneal adhesions acting as a constricting band around the jejunum to be the cause. DISCUSSION: Adhesions are common perturbing problem after surgeries. The presence of a foreign body further incites the process of adhesion formation by causing hindrance to the fibrinolysis process. In this case, the adhesive bands acted synergistically with the encircling prolene suture material from the previous surgery in causing a complete loop obstruction. CONCLUSION: Propylene sutures used in routine surgical procedures can migrate intra-abdominally, and lead to adhesion formation. Adhesions along with the non-absorbable suture can cause complete bowel obstruction.