Heparin-induced Anaphylaxis shock.

Introduction: Anaphylaxis is a fatal condition that can be easily managed if discovered early. Only a few examples of anaphylaxis-like reactions caused by heparin have been documented, and immediate-type hypersensitivity reactions to heparin are extremely uncommon. Case Presentation: We report a case of a 53-yearold gentleman known to have an End Stage Renal Disease (ESRD) on Hemodialysis for two years, who went to the dialysis facility in his usual state of health. After two hours of dialysis, a new lock of taurolidine/heparin was installed; one minute later, the patient started to vomit and became restless, blood pressure dropped to 60/47 mmHg, and urticarial hives and a reddish rash developed on his skin, covering his trunk and limbs. He was immediately given three doses of epinephrine intramuscularly, which he did not respond to. Therefore, an epinephrine infusion was started. IV hydrocortisone and diphenhydramine were given for symptomatic relief. The patient was shifted to the emergency department, where he became vitally stable and returned to baseline. Heparininduced anaphylaxis was assumed based on the quick response to the above medications. Conclusion: This case can be added to the growing literature regarding this rare reaction, and more studies should be done to understand the nature of the reaction better. We recommend that the healthcare team becomes vigilant of heparin as a possible cause of anaphylaxis.

A Case of Necrotizing Pneumonia Complicated by Hydropneumothorax.

We present a case of a 58-year-old man who had asthma and developed necrotizing pneumonia (NP). The Computed Tomography (CT) scan of his chest showed cavitating consolidation with hydropneumothorax. Despite chest tube insertion and antibiotics, the patient did not improve. Therefore, surgical intervention was considered, and he underwent a right posterior-lateral thoracotomy, with middle lobe lobectomy, and decortication. As a result, the patient's condition started to improve, and he was discharged in good health.

Lhermitte-Duclos disease in a 51-year old patient.

Lhermitte-Duclos disease (LDD) is a rare, slow-growing neoplasm that develops in the brain's posterior fossa. It can appear as a single lesion or as part of Cowden's syndrome. We report the case of a 51-year-old female with a history of diabetes, hypertension, and a previously treated neuroendocrine tumor, who presented to the hospital after experiencing a generalized tonic-clonic seizure. Except for a tongue laceration, the neurological examination was unremarkable. Brain magnetic resonance imaging (MRI) showed a T2 left cerebellar hemisphere pseudomass lesion with iso-hyperintense signals suggestive of Lhermitte-Duclos disease. This case describes a unique presentation of LDD and its various radiological manifestations, emphasizing the importance of neuroimaging in its diagnosis. Additionally, it contributes to the expanding literature on the varied manifestations of LDD.

Arachnoid Cyst: A Sudden Deterioration.

Arachnoid cysts are relatively rare and usually asymptomatic. It can only be diagnosed through radiological imaging modalities. Some patients may develop symptoms such as seizures, headache, dizziness, or psychiatric symptoms. We present a case of a 25-year-old male, previously healthy, who presented with sudden, repetitive episodes of seizure without regaining his consciousness. Computed tomography (CT) head scan showed a large cystic lesion that showed a rightward midline shift. Treatment was done surgically via endoscopic fenestration, and the patient remained symptom-free for one year. Most arachnoid cysts tend to remain asymptomatic throughout a patient's life span, allowing them to lead everyday normal lives; however, when these symptoms surface, they tend to be of a sudden nature requiring urgent surgical intervention. Our report follows the case of a young patient whose symptoms appear suddenly with triggers that led to status epilepticus. Our patient continued to suffer from multiple seizure attacks despite being on multiple anti-convulsive medications, and his symptoms eventually subsided via surgical intervention.

Unmasking the Underlying Causes: A Cross-Sectional Analysis of Mortality From Intentional and Unintentional Injuries in the United Arab Emirates.

The United Arab Emirates (UAE) has experienced substantial development in infrastructure and transportation in the last few decades. Although available evidence suggests that the incidence of injuries has considerably increased in the previous few years, there is a scarcity of literature that comprehensively analyzed the mortality due to different types of injuries in the UAE. Therefore, the current study was designed to report mortality due to various intentional and unintentional injuries in the UAE. Secondary data was obtained from the World Health Organization (WHO) mortality database. We targeted injuries-specific mortality datasets. We applied a filter (UAE) to retrieve mortality data from unintentional and intentional injuries in the UAE. The latest data in the WHO mortality database was for 2020-21. A total of 10,357 death records from the UAE were present in the WHO mortality database. The percentage of injury-specific deaths out of total deaths was 8.69% (n=900). Injury-specific mortality rate per 100,000 population was 9.09. The percentage of injury-specific deaths was higher for males (87.3%, n=786) and the age group 25-34 years (n=323, 35.9%). Of the 900 injury-specific deaths, 449 (49.9%) were due to unintentional injuries, 216 (24.0%) were due to unintentional injuries, while the remaining (26.1%, n=235) deaths occurred due to Ill-defined injuries. More than half (53.7%, n=241) of unintentional injuries were because of road traffic injuries (RTIs) followed by fall (14.7%, n=66), exposure to mechanical forces (6.5%, n=29), drowning (6.0%, n=27) fire (1.1%, n=5), poisonings (1.1%, n=5), natural disasters (n=1, 0.2%) and other unintentional injuries (16.7%, n=75). More than three-quarters (83.3%, n=180) of intentional injuries were because of self-inflicted injuries while the remaining (16.7%, n=36) intentional injuries-specific deaths occurred due to violence. Many deaths in the UAE occur due to unintentional and intentional injuries. RTIs and falls are the leading causes of unintentional injury-specific deaths, while self-inflicted injuries and violence are the leading causes of intentional injury-specific deaths.

Paraphenylenediamine (PPD) Poisoning Mistaken for an Anaphylactic Reaction.

Paraphenylenediamine (PPD) is commonly used in parts of Africa and Asia in combination with Lawsonia alba leaves (also widely known as henna) or as a substitute to dye the hair, palms, soles, or arms for wedding ceremonies or spiritual events. At the same time, it is quickly trending as an agent for suicidal attempts through ingestion. Toxicity is dose-dependent and can lead to serious complications both locally, such as angioedema and airway swelling, or systemically such as acute kidney injury, fatal arrhythmias, and acute hepatitis. We present a case of a 26-year-old pregnant female patient, with no known underlying medical history or known allergies. She ingested PPD-based dye in an attempt to end her life. She initially presented asymptomatically but started developing delayed toxicity symptoms including angioedema and acute liver failure. Her initial diagnosis was an anaphylaxis reaction, and her workup and management were conducted accordingly. We discuss the appropriate course of action in terms of investigations and management in cases of PPD poisoning, and what measures should have been taken in this patient to provide the best healthcare outcome.

Bilateral Elbow Dislocation After Trauma in a Healthy Adult Female.

Bilateral elbow dislocation is a rare injury. We report a rare case of a simultaneous bilateral traumatic elbow dislocation in a 28-year-old previously healthy Kenyan female. Initial clinical assessment and plain radiographs showed the possibility of an associated fracture at the right capitulum. CT scan demonstrated bilateral fractures at the capitulum simultaneously. This case was managed conservatively through a closed reduction under procedural sedation as a joint effort of orthopedics and the emergency department. Three days later, the left above elbow backslap was removed and the patient was discharged on analgesics and referred to the outpatient clinic for regular follow-up and physiotherapy. At seven weeks, the patient reported improvement of pain bilaterally and mild stiffness at the right elbow that is continuing to improve with physiotherapy.