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Since the COVID-19 outbreak has started, many reports showed that COVID-19 does not affect only the respiratory system but can alter multiple organs including kidneys. Anti-glomerular basement membrane disease (anti-GBM) is a systemic disease affecting mainly kidneys and lungs. It can sometimes be triggered by a respiratory infection such as influenza however the mechanism is not clear yet. We describe a novel case of Anti-GBM disease possibly complicating COVID-19. We report a case of a 63-year-old man who was admitted to our hospital for fever and myalgia and was found to have COVID-19. During hospitalization, he developed kidney injury along with pulmonary hemorrhage and was found to have anti-GBM antibodies. Our patient was treated as a case of Anti-GBM disease potentially triggered by COVID-19. Hence, the anti-GBM disease could be a potential complication of COVID-19.Objective This study aimed to evaluate the outcome of high-resolution esophageal manometry (HRM) in the diagnosis of esophageal motility disorders in a Pakistani population. It also evaluates the outcomes of management of patients with esophageal dysphagia and no structural abnormality on endoscopy. Methods This is a cross-sectional study. Patients with symptoms of dysphagia with normal endoscopy were subjected to esophageal manometry and to barium swallow as a part of routine workup. Esophageal motility disorders diagnosed by HRM were compared to barium swallow findings. A follow-up of these patients was done after a one-year interval to evaluate improvement in their symptoms. Results A total of 202 patients underwent HRM. There were abnormal findings in 160 patients (79.2%) with achalasia being the most common diagnosis in 35.6% of the total patients. WS6 Out of 72 patients diagnosed to have achalasia on HRM, only 46 (32.6%) had similar findings on barium esophagram and this difference is statistically significant, p 50% in their symptoms. Patients with motility disorders other than achalasia were treated with a combination of proton pump inhibitors (PPIs), calcium channel blockers and selective serotonin reuptake inhibitors (SSRIs). Conclusion Achalasia was the most common esophageal motility disorder in our population. HRM can diagnose significantly more patients with achalasia compared to barium swallow. Likewise, HRM was helpful in detecting other esophageal motility disorders and planning their management.

This article seeks to evaluate and outline the changes made to the trauma and orthopaedic department in a district general hospital in the United Kingdom during the COVID-19 pandemic. We detail the approach in relation to surgical management, workforce optimisation and our general reflections as a department.

We interviewed, collated and have subsequently described the adaptations implemented by our department. We have collected their shared strategy and reflections on how the COVID-19 pandemic affected our department.

Alterations were implemented to mitigate the effects of the COVID-19 pandemic. A strategy focused on ensuring the workforce remained healthy, and patient care pathways were altered as minimally as possible.

As a unit, a sense of heightened vigilance needs to remain for the foreseeable future. Decisive action by departmental leadership, alongside a cohesive and open, has allowed for our trauma service to continue largely unchanged.This analysis serves as an important aide-memoire for future periods of extreme uncertainty.

As a unit, a sense of heightened vigilance needs to remain for the foreseeable future. Decisive action by departmental leadership, alongside a cohesive and open, has allowed for our trauma service to continue largely unchanged. This analysis serves as an important aide-memoire for future periods of extreme uncertainty.Statins are widely prescribed medications to prevent cardiovascular events such as myocardial infarction and stroke. Both myalgia and myopathy are well-known potential side effects of statins. However, a rare and severe form of statin-induced necrotizing autoimmune myopathy (SINAM) has recently been described and can lead to debilitating weakness, often requiring immunosuppressive therapy. We report a case of a 73-year-old male who made a complete recovery from SINAM following a three-month course of prednisone monotherapy.Attention deficit hyperactivity disorder (ADHD) is one of the most common treatable psychiatric illnesses that affect all age groups from children to adults. Most commonly it is diagnosed in childhood or during teenage years. It can affect the mental and physical health of an individual and disrupt normal academic, career, and social functioning. The quality of life of the individual is affected; thus if diagnosed and treated, the results are good. Obesity and eating disorders are one of the comorbidities associated with ADHD and can lead to various other health problems. This study was done to find out the association between ADHD, obesity, eating disorders, and the effect of medication. We collected data from various studies through multiple electronic databases such as PubMed and Google Scholar. We found 8610 relevant articles and finally narrowed it down to 30 using various criteria. An association was found between ADHD, obesity, and eating disorders, although the mechanism linking ADHD, obesity, and eating disorders still remains unclear according to most studies. Some studies say ADHD medication helps in losing gained weight; some say they do not affect the weight.During the current coronavirus pandemic, significant emphasis has been placed on the importance of mitigating nosocomial spread of coronavirus disease 2019 (COVID-19). One important consideration involves the appropriate use of effective personal protective equipment (PPE), which may reduce a healthcare provider's likelihood of becoming infected while simultaneously minimizing exposure to other patients that they care for. This may reduce demands placed on the healthcare system and help to preserve the workforce. First, the importance of PPE design cannot be underestimated, as the manufacturing process must strive to maximize protection of the user while ensuring adequate comfort. Second, it has been demonstrated that inadequate education and training can significantly impact compliance with PPE recommendations. Technique regarding donning and doffing of PPE is crucial to the protection of those who don it. link2 The purpose of this technical report is two-fold first, to describe some important considerations in the manufacturing and design process of face shields to maximize protection for healthcare providers, and second, to describe a simulation scenario that may be used to train healthcare workers in the appropriate donning and doffing of PPE.Fabry disease is an X-linked lysosomal storage disorder caused by a mutation in the alpha-galactosidase A (GLA) gene, leading to the deficiency of alpha-galactosidase A enzyme. The natural history of the affected patients (both males and females) includes neurovascular complications, such as cerebrovascular disease at a relatively young age. The pathophysiology behind the vascular involvement is primarily attributed to the accumulation of globotriaosylceramide and its derivatives in the vascular endothelium and vascular smooth muscle cells. MRI is the gold standard radiological investigation to detect the white matter lesions characteristic of Fabry disease's neurological involvement. More studies should focus on the utility of universally screening patients with young stroke for Fabry disease and the effectiveness of enzyme replacement therapy to prevent stroke. This review offers a synopsis of the current knowledge of the pathophysiology, neuroradiology, treatment, and prognosis of cerebrovascular disease in Fabry patients.Remote cerebellar hemorrhage (RCH) is a rare complication following cranial or spinal neurosurgical procedures. Traditionally, RCH has been associated with frontal or frontotemporal craniotomy with supine patient positioning. Though the exact etiology is unknown, theories have described patient positioning and excessive cerebrospinal fluid (CSF) drainage intra-operatively as contributing factors to cerebellar displacement (cerebellar sag), obstruction of venous flow, and pathogenesis of RCH. We report two cases of RCH following a prone, suboccipital craniotomy-C1 laminectomy and a temporal burr hole evacuation of a subdural hygroma. In each case, a large volume of CSF was rapidly evacuated intra-operatively. To the best of our knowledge, both instances represent relatively rare settings for RCH. Additionally, we conducted a comprehensive literature review of PubMed, EMBASE, and Web of Science for all cases of RCH in which peri-operative CSF leakage was explicitly detailed. Although RCH is thought to be a rare complication of frontotemporal and frontal craniotomies, this case report signifies that RCH may occur in the setting of sub-occipital craniotomy or even after minimally invasive burr hole procedures. For these procedures, careful symptomatic monitoring and follow-up imaging remain essential in diagnosis. Controlled CSF drainage may be useful in mediating dramatic alterations in intracranial pressure (ICP) and cerebellar sag contributing to RCH.Background Adolescent pregnancy is a high-risk condition that can potentially lead to adverse perinatal and obstetric outcomes. It is a growing concern in developing countries including Sri Lanka. The main objective of this study was to evaluate obstetric and perinatal outcomes amongst adolescent pregnancies and compare them with outcomes of pregnancies of average maternal age (AMA) women. Method This was a prospective, cross-sectional study conducted at a tertiary care hospital in the Eastern province of Sri Lanka. A total of 795 primigravidae who had singleton pregnancies and delivered their live babies over a period of three months from February to April 2019 were selected for the study. The data were retrieved from Bed Head Tickets (BHTs) of those patients upon discharge from the postnatal ward. link3 Results The majority of primigravida was AMA women and accounted for 83.4% (n=663) of the study population while primiparous adolescents comprised 16.6% (n=132). Among the 132 adolescent pregnancies, 81.1% (n=107) two babies depressed at birth and developed respiratory distress. Conclusion Adolescent pregnancy carries a significant risk of obstetric complications including LBW and prematurity that should draw public and healthcare providers' attention. The effectiveness of a comprehensive antenatal and community-based program to prevent adolescent pregnancy and related adverse outcomes should further be evaluated.Chloromas are an atypical cellular infiltrate of immature granulocytic cells that can occur specially in patients with acute myelogenous leukemia (AML), but can be present in nonleukemic patients. Its clinical course will be dependent on its size and location, from asymptomatic to simulating a malignant gastrointestinal neoplasia. Definitive diagnosis is made upon an immunoprofile that is similar to that present in the blasts and precursor cells of acute myeloid leukemia. Endoscopic and CT images are variable being only part of the protocol panel. Treatment is the same as to AML, but surgery and radiation must be used in order to maintain low relapse and better overall survival.