Cardiac Tamponade in Down's Syndrome Associated With Hypothyroidism: An Uncommon Presentation.

Down syndrome often coincides with hypothyroidism, a condition that may lead to pericardial effusion (PE), though cardiac tamponade remains an infrequent complication. Cardiac tamponade is an emergency that requires immediate diagnosis and treatment. Here, we present a case of a patient who presented to the emergency department (ED) with Down syndrome associated with hypothyroidism and underwent immediate pericardiocentesis and pericardial window placement. A 52-year-old male, with a history of Down's syndrome and hypothyroidism, presented to the ED complaining of shortness of breath and chest pain. He had previously been diagnosed with PE. On examination, he exhibited average heart rate, low blood pressure, decreased heart sounds, and jugular venous distention, with no murmur or frictional rub. Initial investigations revealed normal sinus rhythm on EKG but an enlarged cardiac silhouette on chest X-ray. Laboratory tests showed elevated C-reactive protein and sedimentation rate, suggestive of inflammation, while arterial blood gas showed compensated respiratory alkalosis. Thyroid-stimulating hormone (TSH) was elevated. Despite supplemental oxygen, the patient's condition worsened, prompting a bedside ultrasound revealing cardiac tamponade. A cardiology consultation recommended immediate transfer for treatment. At a different hospital, pericardiocentesis was performed, followed by the placement of a pericardial window to prevent recurrence. Follow-up imaging showed improvement in pleural effusion and resolution of cardiac tamponade. The patient's symptoms improved, and he was discharged with regular follow-up. Down's syndrome is a chromosomal disorder characterized by the trisomy of chromosome 21. It is associated with various cardiac complications. Such patients have an elevated risk of PE due to a variety of reasons, such as viral infections, hypothyroidism, or autoimmune diseases. Although PE has been found, the incidence of cardiac tamponade has rarely been reported. The pathogenesis of PE in hypothyroidism is due to the leakage of fluids from the capillaries and the build-up of fluid in the pericardial space. The treatment of PE is treating hypothyroidism with thyroxine. In rare cases like ours, when the patient develops cardiac tamponade, the patient often needs pericardiocentesis. Our patient had to undergo pericardial window placement, as well to prevent recurrent symptoms. In conclusion, this case report sheds light on the occurrence of cardiac tamponade in a patient with Down's syndrome and hypothyroidism, a relatively rare complication that necessitates prompt recognition and intervention. Through this report, we emphasize the importance of considering cardiac tamponade in the differential diagnosis of patients with Down's syndrome presenting with symptoms suggestive of cardiovascular compromise.

Hemophagocytic Lymphohistiocytosis (HLH) Flare Following the COVID-19 Vaccine: A Case Report.

Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory state that leads to overactivation of the immune system due to underlying disease. It can lead to multiorgan failure and death if not treated properly. HLH after vaccination is rare but has been reported in a few cases. Here, we present a case of a patient who developed HLH after she received the COVID-19 vaccine. Workup was done to find the underlying cause of her symptoms. However, as all investigations yielded negative results, the close temporal association with the COVID-19 vaccine suggested that the vaccine might have been the causative factor. She was treated appropriately with steroids and discharged with follow-up appointments. The exact pathogenesis of HLH caused by COVID vaccine is unknown, but it is likely related to the inflammatory response caused by the vaccine in the body. The treatment of HLH depends on the treatment of underlying conditions causing the HLH. Very few cases have been reported in the literature regarding HLH caused by COVID vaccine. Immediate recognition and treatment are imperative for improved prognosis and improved chances of survival.

Exploration of gut microbiome and inflammation: A review on key signalling pathways.

The gut microbiome, a crucial component of the human system, is a diverse collection of microbes that belong to the gut of human beings as well as other animals. These microbial communities continue to coexist harmoniously with their host organisms and perform various functions that affect the host's general health. Each person's gut microbiota has a unique makeup. The gut microbiota is well acknowledged to have a part in the local as well as systemic inflammation that underlies a number of inflammatory disorders (e.g., atherosclerosis, diabetes mellitus, obesity, and inflammatory bowel disease).The gut microbiota's metabolic products, such as short-chain fatty acids (butyrate, propionate, and acetate) inhibit inflammation by preventing immune system cells like macrophages and neutrophils from producing pro-inflammatory factors, which are triggered by the structural elements of bacteria (like lipopolysaccharide). The review's primary goal is to provide comprehensive and compiled data regarding the contribution of gut microbiota to inflammation and the associated signalling pathways.

Purple Urine Bag Syndrome: An Unusual Presentation of Urinary Tract Infection.

Purple urine bag syndrome (PUBS) is a very rare phenomenon strongly associated with long-term indwelling catheterization that results in an increased risk of urinary tract infection. The color change in the urine bag results from the altered metabolism of tryptophan into color pigments by certain bacteria which produce sulfates and phosphates enzymes. Although it is benign in nature, PUBS results in greater anxiety among patients and their families. The most important risk factors include long-term catheterization, female gender, chronic constipation, old age and bed-bound patients. Here, we present a case of PUBS in a middle-aged woman with a history of the neurogenic bladder that needed long-term catheterization along with chronic constipation.

Spontaneous Intramural Duodenal Hematoma: A Rare Complication of Pancreatitis.

Intramural duodenal hematoma is an uncommon entity, usually associated with trauma. Spontaneous intramural duodenal hematoma is an even more rare phenomenon reported in patients with anticoagulation therapy, gastrointestinal endoscopy procedure or coagulopathy. We report a case of spontaneous intramural duodenal hematoma in a 30-year-old male as a pancreatitis complication, very few cases have been known in the past and still a lot is to be discovered about this rare hematoma associated with pancreatitis. This condition can have catastrophic consequences and should be managed appropriately.