RESUMO
Brugada syndrome is an inherited disorder characterized by a channelopathy of cardiac sodium, potassium, and calcium channel. The pathophysiology of this disorder is not completely elucidated yet, however, most of the reported cases are caused by a pathogenic alteration in the SCN5A gene, leading to the malfunction of cardiac sodium channels. Several stressors are well known to unmask this pathology including fever and electrolytes imbalance. Three ECG patterns are frequently described in the literature, type 1, type 2, and type 3. However, only the type 1 pattern is considered diagnostic of Brugada syndrome in the appropriate clinical context. Therapeutic strategies can range from conservative medical management with antiarrhythmic medications to Automatic Implantable Cardioverter Defibrillator (AICD) placement. Prompt recognition is of utmost importance since this pathology can rapidly evolve into life-threatening arrhythmias and sudden cardiac death. Here we present a case of a 22-year-old male who presented after a syncopal episode and was found to have Brugada syndrome in the setting of Influenza A infection.
RESUMO
Anal fistulae can be a very difficult disease to manage. The management of complex fistulae is even more challenging. The risk to the fecal continence mechanism due to damage to the anal sphincters and refractoriness to the treatment (high recurrence rate) pose the two biggest challenges in the management of this disease. Apart from these, there are several other challenges in the treatment of complex fistulae. The intriguing and uphill task is that satisfactory solutions to most of these challenges are still not known, and there is hardly any consensus on whatever treatment solutions are available. To summarize, there is no gold-standard treatment available for treating complex anal fistulae, and the search for a satisfactory treatment option is still on. In this review, the endeavor has been to discuss and highlight recent path-breaking updates in the management of complex anal fistulae.
