Ileocecal knotting as a rare cause of small bowel obstruction: a case report.

Introduction: Ileocecal knot syndrome, a rare cause of small bowel obstruction where the ileum wraps around the cecum, poses a significant challenge for preoperative diagnosis. Prompt intervention is crucial due to the risk of rapid bowel deterioration and increased mortality. Case presentation: A 45-year-old female presented with central abdominal pain associated with vomiting, abdominal distension, and obstipation. On examination, she was ill-looking with hypotension, tachycardia with a feeble pulse, direct and rebound abdominal tenderness, and absent bowel sounds. Aggressive fluid resuscitation was done. Based on the clinical presentation and abdominal radiograph suggestive of intestinal obstruction, an emergency exploratory laparotomy was done, which showed an ileocecal knot and 130 cm of gangrenous ileum. Peritoneal lavage followed by resection of non-viable ileum with double barrel ileostomy was done. Discussion: Ileosigmoid, appendico-ileal, ileoileal, and ileocecal knotting are the various types of intestinal knotting, with very few cases of ileocecal knotting being reported. Intestinal knotting causes severe bowel obstruction, resulting in reduced mucosal perfusion, progressive ischemia, and peritonitis, leading to high mortality. X-ray findings of multiple air-fluid levels are non-specific, and for definitive diagnosis, laparotomy is required. Assessing bowel viability before definitive surgery is essential. Despite positive outcomes, extensive resection can lead to malabsorption and ileus, with potential risk for developing short bowel syndrome. Conclusion: Despite its rarity, the possibility of ileocecal knotting should be considered in cases of small bowel obstruction due to its potential for rapid deterioration. Prompt resuscitation followed by emergency laparotomy is necessary to prevent mortality.

Social media influenced self-application of cyanoacrylate for double chin reduction in an adolescent girl: an unusual case of post-inflammatory hyperpigmentation.

Introduction: Cyanoacrylate, used as a topical adhesive for wound closure in clinical settings, can result in poor cosmetic outcome on application to skin. Lack of formal medical or dermatological training among social media influencers poses risks of improper diagnosis, incorrect treatments, ineffective home remedies, and potential self-injury or long-term skin effects, especially among adolescents. Case presentation: The authors present a case of a young girl with a persistent post-inflammatory hyperpigmentation after using cyanoacrylate on her chin as a home remedy to reduce her double chin problem after learning from a video on social media. Biopsy findings were consistent with post-inflammatory hyperpigmentation in dermis. Clinical discussion: Application of cyanoacrylate over skin can result in allergic reactions, burn injuries, infections, itching, skin blistering, and aesthetic issues. Persistent post-inflammatory hyperpigmentation can be a poor cosmetic outcome on application of cyanoacrylate over skin. Conclusion: Inadequate social media safety regulations require healthcare professionals to be aware of social trends among adolescents and to encourage them for open conversations and professional help-seeking during times of distress in this digital era.

Neonatal giant mastauxe: a case report.

Giant mastauxe is an uncomplicated physiological enlargement of the breasts in newborns, characterized by a breast bud diameter greater than 3 cm. While most newborns have some degree of breast enlargement, giant mastauxe is rare, which may be unnecessarily intervened upon. Case presentation: A 13-day-term male neonate presented with bilateral breast enlargement and milky nipple discharge, which worsened upon breast massage. The mother had an uneventful pregnancy, and neither the mother nor the baby had a history of drug intake. The examination revealed soft, non-tender, non-erythematous bilateral breast swellings measuring 3.6×3.8 cm on the right side and 3.2×3.4 cm on the left side. Ultrasonography confirmed their hypoechoic nature with minimum vascularization. The white blood cell count, C-reactive protein levels, and culture of nipple discharge yielded normal results. The baby was discharged, and upon follow-up after 2 weeks, it was observed that breast swellings had spontaneously reduced in size. Discussion: Neonatal breast enlargement can occur as a result of either the transplacental transfer of maternal estrogens or declining levels of estrogens toward the end of pregnancy, leading to hyperprolactinemia. However, the exact reasons behind the occurrence of giant mastauxe in some newborns remain incompletely understood. It may be due to increased sensitivity of the breast tissue to estrogens. Conclusion: Proper clinical examination, along with the use of ultrasonography and/or laboratory investigations if required, is essential to differentiate giant mastauxe from neonatal mastitis or breast abscess. Treatment primarily involves observation and providing reassurance to parents.

Poor Glycemic Control in Type 2 Diabetes Mellitus Patients in Two Tertiary Care Centers during COVID-19 Lockdown: A Descriptive Cross-sectional Study.

Introduction: Lockdown enforced to control the rapid transmission of novel coronavirus has resulted in the confinement of people in the home and restrictions of movement. This may have altered the lifestyle and glycemic control of type 2 diabetes mellitus patients. This study aimed to find the prevalence of poor glycemic control in type 2 diabetes mellitus patients in two tertiary care centres during COVID-19 lockdown. Methods: A descriptive cross-sectional study was conducted among 259 type 2 diabetes mellitus patients in selected hospitals from 1st September to 30th September 2020 after receiving ethical approval from the Departmental Research Unit, Biochemistry under Institutional Review Committee (Reference number: DRU/01/2020). A convenience sampling method was used. Data analysis was done by using Statistical Package for the Social Sciences version 26.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 259 patients with type 2 Diabetes Mellitus, 183 (70.65%) (65.10-76.20 at 95% Confidence Interval) had poor glycemic control during the lockdown period. Mean fasting and post-prandial blood glucose among these patients were 164.16±49.30 mg/dl and 246.76±69.86 mg/dl respectively. Conclusions: Our study depicts that the majority of the type 2 diabetes mellitus patients had poor glycemic control during the lockdown period which was similar when compared to other studies. Keywords: COVID-19; glycemic control; healthy lifestyle; lockdown; type 2 diabetes.

Plasmablastic lymphoma of the colon in HIV negative patient; a case report with literature review.

Introduction: Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B cell lymphoma characterized by weak or absent expression of conventional B cell markers and strong expression of plasma cell markers. Very few cases of PBL of the colon have been reported in HIV negative patients. Case presentation: A 57 years female with HIV negative serology, a known case of hypertension under medication presented with right lower abdominal pain associated with vomiting and significant weight loss. On abdominal examination, soft, tender, and globular lump was palpable. Contrast enhanced computed tomography of abdomen and pelvis revealed asymmetrical enhancing mass like wall thickening involving ileocaecal region, caecum, and ascending colon, which on colonoscopy was found to be ulceroproliferative in nature. Open right hemicolectomy was performed and postoperative histopathology and immunohistochemistry results confirmed plasmablastic lymphoma as the final diagnosis. She was treated with nine cycles of chemotherapy. Clinical discussion: Although PBL is commonly found in the oral cavity, and HIV positive patients, it can rarely occur in extra-oral sites, and HIV negative patients. Due to its rarity, no optimal therapeutic approach has yet been defined for the treatment of PBL. It has a poor prognosis, and the overall survival rate has been correlated with international prognostic index score and achievement of complete remission. Conclusion: As plasmablastic lymphoma is rare and highly aggressive, its delayed diagnosis will lead to poor outcome. Thus, awareness about its clinical presentation, histopathological features, and immunophenotype is essential.

Metastases after mastectomy for ductal carcinoma in situ of the male breast; A case report.

Introduction: and importance: Male breast cancer is a rare entity. Ductal carcinoma in situ (DCIS), constituting 10% of all male breast cancer, is confined within the breast ducts and lobules, rarely metastasizing and even less so after mastectomy. Case presentation: A 71 years old male with no history of trauma presented with pain, swelling, and deformity of the left arm. He had continuous back pain for 6 months and a history of mastectomy of the right breast. Fracture of shaft of the left humerus was detected on X-ray. Computed tomography (CT) showed multiple vertebral metastases later confirmed to be metastasized from the breast by biopsy. Tumor cells were progesterone receptor (PR) positive, estrogen receptor (ER) negative, and human epidermal growth factor receptor 2 (HER2) negative. The fracture was treated and the patient was kept on Tamoxifen. On follow-up after four months, the patient is doing well with relief of back pain. Clinical discussion: Despite mastectomy and the histopathological diagnosis of pure DCIS, distant metastases can occur even in absence of locoregional recurrence. Therefore, the aggressive phenotype of DCIS rather than diagnostic or treatment variables can be thought to bring worse outcome in the form of metastases. Early hormonal status identification and hormone therapy could result in a better outcome. Conclusion: Skeletal metastases should be strongly suspected in patients presenting with bone pain and having a history of DCIS of the breast, even after mastectomy. Even though distant metastasis after mastectomy is rare, regular follow-up and surveillance is necessary.