Articles

An entrapped rotablator burr is a rare but severe complication of Rotational Atherectomy (RA), and surgical removal is invasive and takes several hours. Therefore, a less invasive measure is necessary for this complication. A 54-year-old man with Diabetes Mellitus (DM) and hypertension revealed chronic total occlusion in the proximal LAD In-Stent Restenosis (ISR). The left coronary ostium was engaged with 7Fr EBU.

Palisaded Neutrophilic And Granulomatous Dermatitis (PNGD) is a rare inflammatory cutaneous eruption associated with underlying systemic disease, commonly Systemic Lupus Erythematosus (SLE), rheumatoid arthritis, or Anti-Neutrophilic Cytoplasmic Autoantibody (ANCA)-associated vasculitis. Appropriate diagnosis is challenging, requiring coordination of care between medicine, dermatology, pathology, and rheumatology.

Mini-gastric bypass is a common procedure for bariatric surgery. This procedure creates and excluded gastric remnant and this part can’t be accessed easily. Some complications of this gastric remnant has been reported but there is not a reported case of acute bleeding from there. Our report presents and 37 year old woman who had undergone bariatric surgery 6 years ago.

Multiple myeloma is a relatively common type of plasma cell dyscrasia, in which monoclonal plasma cells proliferate. This frequently leads to anemia, renal failure, hypercalcemia and bone lesions. Primary plasma cell leukemia is a much rarer type of plasma cell dyscrasia, with measurable plasma cells in the blood circulation and usually more acute presenting signs.

Peritoneal Tuberculosis is an abdominal form of Tuberculosis that affects the peritoneal cavity and enclosed organs. Clinical presentation of this rare form of extrapulmonary tuberculosis resembles that of advanced ovarian cancer and may results in unnecessary extensive surgery especially in resource limited setting.

Stroke is among the common emergency department presentations in Tanzania at large. In the developing world, still there are challenges in diagnosis, management and monitoring of these cases hence high morbidity and mortality. A one month case series is presented here, from Pwani region Tanzania, to demonstrate the encountered challenges.

The pelagic sea snake, “Serpiente Marina,” Hydrophis Platurus, shows a wide-range distribution in the Indo-Pacific Ocean, reaching the Pacific coast of the Americas. Although the snake bite accidents caused by sea snakes are rare, Costa Rica occasionally presents large quantities of sea snakes stranded in the shore, mainly during the dry season.

Repeated intrathecal application of the sustained release steroid Triamcinolone Acetonide (TCA) is beneficial in progressive Multiple Sclerosis (MS) patients. Particularly, patients with spinal lesions often show a distinct benefit with a three fold increase of the maximum walking distance.

A rare condition is temporary but recurrent onset of involuntary motion sequences in the abdominal region. They demands for an extensive diagnostic workup. Therapeutic options are limited. The successful treatment of this spinal myoclonus or abdominal involuntary movements resembling syndrome prompted this report.

Calcitonin is one of the most important hormones in human body which regulates calcium homeostasis. It binds with Calcitonin Receptor (CALCR) and reduces serum calcium level by inhibiting bone resorption and proximal renal reabsorption. Alteration in calcium homeostasis promotes diseases like osteoporosis, urolithiasis etc. An interesting finding of reduced CALCR protein expression.

Neurological diseases are much often due to our stressed daily life, and epilepsy is considered as a second cause of hospitalization in neurological illness. It is about 30% of epileptic cases where medicine would not stop or control seizure; hence, a surgical intervention is required to delineate abnormal hyperexcitable cortical tissue. Defining these epileptogenic zones is a challenge that require physiological and anatomical acquisition.

2-[18F]-FDG embolism artifact is a PET pitfall that may cause misinterpretation as lung metastasis. This rare phenomenon results from clumping of the radiotracer with platelet aggregates during intravenous administration. It should be considered, especially if there is no corroborating anatomic correlate for focal pulmonary FDG activity and if the radiotracer is administered through a central venous catheter.

The traumatic event is a core requirement in the diagnosis of Post-Traumatic Stress Disorder (PTSD), and is defined in the Diagnostic and Statistical Manual's (DSM's) criteria of PTSD as Criterion A. This remains the case, despite opposing views from prior literature that the trauma response can occur without Criterion A. This article explores a definition for psychological trauma.

Acute primary angle closure glaucoma may masquerade a systemic condition. Proper differential diagnosis is requisite. A 52-year-old female visited the general practitioner due to her progressively worsening headache accompanied by gastrointestinal symptoms. This condition presented acutely while reading a book at semiprone position in a not well illuminated room.

Congenital aniridia is caused by a mutation in the PAX6 gene and is characterized by partial or complete absence of iris tissue. Apart from the hypoplasia of iris tissue, other ocular features such as foveal hypoplasia, nystagmus, aniridia-related keratopathy, Peters anomaly, Axenfeld-Rieger anomaly and glaucoma are seen in these eyes. Cases have been reported with persistent pupillary membranes and iris strands.

There is huge potential in using targeted Next Generation Sequencing (NGS) gene panels to improve diagnosis of congenital cataract, however the many difficulties in incorporating it into routine clinical care are explored. Treatment options for children with congenital cataract are described.

Periapical Cemento-Osseous Dysplasia (PCOD) is one of the classified lesions of cemento-osseous dysplasia that generally consisted in middle aged black women. This article reported a case of a 36-year-old woman who was incidentally recognized with PCOD on the basis of panoramic radiograph. According to the clinical and radiographical findings of the patient, diagnosis of PCOD was done.

There is increased demand by the general dentist and oral surgeon's for Nuclear Medicine (NM) imaging procedures both for initial diagnosis and follows up of patients with different dental and facial disorders. There are several procedures in NM including bone scan, gallium scan and PET scan which can offer important diagnostic information complementing the information obtained from other imaging modalities.

To investigate the association between premature birth and Early Childhood Caries (ECC) experience, while secondarily evaluating factors that may influence development of caries. Data collected from patients enrolled at the University of Iowa's Infant Oral Health Program consisted of prenatal history, child's demographics, neonatal history, oral hygiene, dietary habits, and clinical findings (visible plaque, enamel defects, and caries).

Since 2007, over 15.2 million Voluntary Medical Male Circumcisions (VMMCs) have been performed in 14 sub-Saharan African countries for partial prevention of transmission of HIV. In South Africa, close to 4 million VMMCs have been conducted since the onset of the national VMMC program in 2010. Within this context, the occurrence of notifiable adverse events related to peri-operative bleeding occurs commonly.

Familial aggregation of COVID-19 cases suggest transmission occurs by contact but can also be evidence of a genetic component to the disease presentation. The goal of this work was to evaluate the disease pattern in families that many individuals have been affected by the disease. A case series analysis of six families that had many individuals affected by COVID-19 and the pattern of the severity of the disease is reported.

In this review, images during surgical excision of Deep Infiltrating Endometriosis (DIE) were correlated to preoperative Magnetic Resonance Imaging (MRI) findings. MRI is known to be the best tool for mapping DIE, it displays a high accuracy in the diagnosis and the characterization of endometriosis lesions. Recent studies showed also that MRI findings can be correlated to the length of operating time.

The extrusion of a sebaceous gland through a follicular infundibulum is a rare dermatopathology image that raises two fundamental questions: Is it an artifact?. Can a full gland be expelled just as its secretion does?. The answer is not easy and there are no bibliographic references to help us solving the doubt.

Esophageal carcinoma is one of the most lethal cancers worldwide. Patients with stage IV esophageal adenocarcinoma have a mean survival of five months. The metastatic sites may vary, but the most frequent tend to be non-regional lymph nodes, the liver and lungs. Bone metastases from esophageal cancer most commonly involve the spine.

Gastrointestinal Stromal Tumors (GISTs) are rare neoplasms but they represent the most common type of mesenchymal tumors found in the Gastrointestinal (GI) tract. GISTs arise from the interstitial cells of Cajal, "Pacemaker Cells", that play a neuromotor role in normal gut motility. They account for < 1% of gastrointestinal tumors with an estimated annual incidence of 10 to 20 cases for one million of the general population.

We report a healthy-appearing 7-month-old girl of non-related ancestry, uneventful pre - and postnatal development and past medical history, who was investigated for lung Tuberculosis (TB) in her mother. Tuberculin skin test was highly positive (20 mm induration, normal range 0-5 mm in unvaccinated children).

A 56-year-old man was admitted for severe COVID-19 pneumonia. He did not smoke and was on treatment with valsartan 80 mg daily for hypertension. Body mass index was 32.7. Symptoms (Cough and Fever) started 8 days before hospital admission. Nasopharyngeal RT-PCR swab was positive for SARS CoV-2.

Over the last century, Autism has undergone considerable diagnostic evolution. It is only in the past eight years that autism has been identified not as a single disorder but as a "Spectrum" of developmental disabilities inclusive of "Autistic Disorder, Pervasive Developmental Disorder not Otherwise Specified (PDD-NOS), and Asperger's Disorder".

To report the results of our clinical study on the efficacy of a 'Lateral Sliding Flap': A one-step technique for lower or upper eyelid reconstruction. Retrospective analysis of a consecutive case series of patients treated with a 'Lateral Sliding Flap' following tumour removal by horizontal block excision.

Myelodysplastic Syndrome (MDS) with an isolated deletion of chromosome 5q [del(5q)] is a relatively rare MDS variant (5%) characterized by a moderate to severe anemia and normal or elevated platelet count with modest neutropenia. These latter features, in addition to its excellent response to lenalidomide, are likely what contribute for its favorable prognosis.

We present the case of a 59-year-old female patient with severe Coronavirus Acute Respiratory Distress Syndrome (CARDS) admitted to Intensive Care Unit (ICU). Prior to the SARS-CoV-2 infection she had no other medical problems besides chronic arterial hypertension. Endotracheal intubation became necessary.

Coronary disease has long been associated with different behavioral patterns (Pattern A,D) and denial mechanisms. Denial mechanisms can take various and unexpected forms that put the coronary patient at risk during the whole course of his illness. This case shows to what extent denial mechanisms can interfere in the relationship between some coronary patients and their caregivers.

We report two weightlifters, presenting with progressive atrophy and weakness of the medial portion of pectoralis major muscle. We discuss possible differential diagnoses and propose a clinical and neurophysiological approach. Our cases highlight that the syndrome may be unilateral or bilateral, probably due to anatomical susceptibility and hyper-training.

SARS-CoV-2 is a virus which promoted a worldwide pandemic outbreak in 2020. The virus is highly infectious and is able to contaminate a lot of people in a short time period. The disease promoted by the virus, named COVID-19, can cause different symptoms such as fever, cough, muscle pain, headache, prostration, diarrhea, neurological complications, dermic manifestations, pulmonary impairment, dyspnea, coagulopathies, organ failure, and death.

Cerebrovascular complications of Oral Contraceptive Pills (OCPs) are recorded in literature. We present a case series of 4 women who were admitted in the Department of Physical Medicine and Rehabilitation after having cerebrovascular complications. The only risk factor which was identified was the history of OCPs intake. The cerebrovascular accident ranged from arterial stroke to cerebral venous thrombosis (CVT-3, arterial stroke-1).

Coronavirus-specific antibodies decline fast and allow reinfection starting 6 months post infection. Knowledge on reinfection is very important for SARS-CoV-2. Here we report a reinfection with SARS-CoV-2 of a 23 years old female health care worker 177 days after the onset of the first episode. The second episode was clinically more severe as the first episode.

Blood flow to the brain is in parallel with brain metabolism in almost all brain disorders except in brain tumors and therefore regional cerebral blood flow can be used as a marker of metabolic brain activity and hence it is closely linked to neuronal activity, the activity distribution is presumed to reflect neuronal activity levels in different areas of the brain.

Advanced pancreatic ductal adenocarcinoma represents one of the most challenging oncologic diseases nowadays for many reasons: it is burdened by one of the poorest prognoses, it is often diagnosed when in an advanced stage and it demands a multimodal approach which is necessary to assign the proper patient-specific treatment.

The declaration of COVID-19 as a pandemic on March 11, 2020, marked a life-changing disaster. In one-year people have started living a new normal, however, healthcare setups are still struggling to fight against coronavirus. On 26 Feb 2020, Pakistan confirmed its first case of the coronavirus when a student tested positive upon returning from Iran.

It remains unidentified why this patient has an extremely high Rapid Plasma Reagin Titer (RPR) 1: 2048. A false positive result was ruled out by a Treponemal test. To ensure accuracy, repeat tests were requested for both the Non-Treponemal and Treponemal Tests in the same laboratory, and the results came back the same.

Primary ovarian carcinoid tumors are extremely rare. Ovarian strumal carcinoid is usually derived from mature cystic teratoma, an ovarian germ cell tumor composed of two distinctive components characteristic thyroid tissue intermixed with a carcinoid tumor. The incidence of stromal carcinoid tumor is accounting for 0.3-1% of all ovarian tumors and 3% of all mature teratomas. Herein, we report a 25-year-old female presented with severe abdominal pain.

Diabetes Mellitus (DM), is a malignant disease that has impacted the globe in astronomical proportions. Chronic hyperglycemia is a major condition suffered by patients with DM. Currently, the cost of managing DM is highly exorbitant and poses a significant obstacle to many living with the disease in developing countries. Thus, the need for affordable alternatives with optimum potency and minimal side effects is justified.

Some meta-analyses have shown the broad benefits of the ultrasound visualization for arterial cannulation, such as the increases of the first-attempt success rate, mean attempts, mean-time, and reduction of hematoma incidence. The advantages over the palpation technique, promote the inclusion of ultrasound guide as part of the recommendation for arterial cannulation.

We report this case to highlight clinical and pathological features of this rare entity. It is about a 48 year-old woman with an osteolytic lesion of the lower extremity of the left femur. A biopsy of the lesion showed densely cellular malignant mesenchymal proliferation. It was made by bundles of smooth muscle cells with nuclei of moderate to severe atypia.

The Koebner Phenomenon (KP) is the appearance of new skin lesions on previously unaffected skin secondary to trauma. This phenomenon is given the fact that the new lesions that appear are clinically and histologically identical to the patient's underlying cutaneous disease. Psoriasis is a chronic inflammatory disease characterized by this phenomenon.

Frontal sinus mucoceles are mucous secretory lesions within the sinus, presenting a slow growing pattern, mostly behaving like a space-occupying mass with subtle symptoms until a bone erosion of the surrounding structures takes place. Intracranial and intraorbital expansion are regarded as the most considerable complications, demanding adequate surgical management in order to avoid recurrence.

Intestinal loop Evisceration (VE) complicates the 35-67% Of Vaginal Cuff Dehiscence (VCD), constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. 94-year-old patient with VE after VCD, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy.

A 30-year-old Arabic woman of low socio-economic status, without medical history of HIV infection, presented to our department for neglected giant mass of the face evolving for 2 years. She was treated for long time with herbal traditional treatments, which explains the delay of consultation. Physical examination revealed a bulky tumor, of reddish-brown color, occupying the entire face below the franc, more lateralised on the left side.

Thyroglossal duct cysts are the most common congenital abnormality in the neck, accounting for 70-75% of midline neck masses in children. Late in the 4th week of gestation, the thyroid anlage develops as a small, solid mass of endoderm proliferating at the foramen cecum. As the thyroid anlage descends caudally in the neck, it maintains an attachment to the site of origin at the level of the foramen cecum of the tongue via the thyroglossal duct.

Anaemia during childhood adversely affects mental, physical and social development of the children, therefore morphological patterns of anaemia in under- five children are considered essential for classification, diagnosis and management. This study aimed at assessing morphological patterns, the prevalence and associated factors of anaemia among under-five children on Prevention of Mother-To-Child Transmission (PMTCT) programmes in Masogo sub-county hospital, Kisumu County, Kenya.

Intravenous Immunoglobulin (IVIG) has been increasingly used in managing a variety of immune-mediated conditions. While patients benefit from this treatment, the infusion of IVIG has transmitted large variety of antibodies and biological agents from donors to patients, and transiently interfered a broad spectrum of clinical laboratory tests covering the fields of infectious and autoimmune serology, biochemistry, haematology and blood bank, delivering spurious results that could potentially cause extensive evaluation and inappropriate clinical interventions.

Tooth avulsion in children and adolescents demands urgent treatment to enhance the chances of successful re-implantation. This case report describes the treatment of an 11-year-old girl who suffered an avulsion of the maxillary right central incisor followed by delayed re-implantation after the tooth was stored in a dry medium for 4 days.

We report a case of 63-year old female who presented to breast imaging unit with multiple bilateral breast masses. Her past history was significant for left thigh mass. Mammogram and breast ultrasound revealed multiple bilateral breast masses. Ultrasound guided true-cut biopsy from right breast mass was consistent with myeloid sarcoma.

Herpes Simplex Virus (HSV) type 1 and type 2, is transmitted via sexual or non sexual routes, leading to oral, genital or anal infections. HSV type 1 presents with oral lesions rather than genital lesions in small children. Therefore, in a child with type 1 infection in genital or anal region, the probability of auto-inoculation from oral lesion should be considered.

Although adrenal cortical tumors are rare in children, pediatricians should be very cautious about it. Neoplasm is a rare but significant cause of Cushing's syndrome. Unfortunately, they can be missed very easily, as there is often a time lag between the onset of the symptoms and final diagnosis. Here, we present a case of adrenal adenoma in a six-year - old Egyptian boy who regrettably misdiagnosed twice as exogenous Cushing syndrome and simple obesity.

Hepatoid adenocarcinoma is a very rare disease and usually occurs in the stomach, ovaries and lungs. The term hepatoid adenocarcinoma was first introduced by Ishikura et al. in 1985 to describe a rare aggressive malignant neoplasm in the urinary bladder. A 59-year-old male patient with hematuria was admitted to our emergency department with the complaint of deterioration of the general condition.

Glutaric acidemia type 1 (GA1) is an inborn error of metabolism caused by the deficiency of the enzyme glutaryl-CoA dehydrogenase, with consequent accumulation of the aminoacids lysine, hydroxylsine and tryptophan. About 1 in every 100,000 individuals are affected by the disease. Neurological manifestations are variable and include acute and chronic encephalopathic crises, dystonia, motor and cognitive deficits, as well as neuroimaging findings such as brain hypoplasia, striatal, white matter and subdural effusions.

Hydatid disease, mostly caused by Echinococcus granulosus, is a common parasitic infestation of the liver. In this type of infectious disease, humans are an intermediate host. Although most common sites are liver(70%) and lungs (25%), this parasitic tapeworm can be seen at any region of the body. Intraperitoneal cysts are usually secondary to the rupture of primary cysts, but primary hydatid cysts of the mesentery are very rare (%2).

Our patient was a 41-year-old African American male who came in with a cough, hemoptysis, and body aches for two days. He was vitally stable and physical examination did not reveal any abnormality. A Chest CT revealed a lung abscess at base of the right lower lobe. He was initially treated with ampicillin-sulbactam which was then converted to amoxicillin-clavulanate and he completely recovered on this regimen.

An incisional hernia is usually a defect in the scar of an abdominal surgery. The natural history is intestinal obstruction with the risk of strangulation. We report a case of a long-term conservative management of an incisional hernia with an abdominal corset. This resulted in fistulation from pressure necrosis that required an en-bloc excision of the incarcerated fistulating bowel with the hernia sac.

Patient is a 77 year old female who presented to the outpatient dermatology clinic due to progressive massive leg swelling. Physical exam demonstrated bilateral lower extremity chronic lymphedema with stasis dermatitis changes with the left more significant than the right. The patient was diagnosed with elephantiasis nostras verrucosa (ENV) and was treated with leg elevation and arranged for follow-up with a chronic lymphedema clinic.

Skin cancers are common in head and neck region particularly Basal cell carcinoma and Squamous cell carcinoma. Treatment options includes wide local excision with neck dissection followed by adjuvant radiation/chemo/chemoradiation. We report a case of a huge skin cancer of the neck about 8.5 cm in its greatest dimensions and reconstructive techniques of the defect using pectoralis major flap in a 61-years old.

A COVID-19 is a recently infectious pandemic disease caused by a newly detected coronavirus. It is mostly presented with mild, moderate, or severe pneumonia. Interestingly, the presentation of COVID-19 infection with a newly ischemic heart disease have a risk impact on both morbidity and mortality of COVID-19 patients. The Movable-weaning phenomenon or Yasser's phenomenon is a novel electrocardiographic phenomenon in hypocalcemia.

R31 year old female presented with abdominal pain and respiratory distress in the third trimester of her second pregnancy. Her blood workup revealed a lipemic sample due to markedly elevated serum triglycerides of 8178 mg/dl. Total cholesterol and Low Density Lipoprotein were elevated at 1701 mg/dl and 788 mg/dl respectively.

This is the fourteenth case of an intracranial and dural-based osteosarcoma in the literature to date. The case involves a forty-year old woman with a previous history of a brain tumour, which was treated with surgery, chemotherapy and radiotherapy six years previously. The hypothesis is that this rare malignancy is secondary to the radiation exposure given the growth of the lesion in the previous radiation field.

Clinical laboratory personnel (CLP) present a unique opportunity to investigate distinct forms of COVID-19 as they are under constant testing for SARS CoV 2 infection. SARS CoV 2 RNA and antibodies were routinely investigated over a 5-month period in 26 professionals from a clinical laboratory in RJ, Brazil.

Ablepharon is a rare, congenital pathology, characterized by the absence of the eyelids. It can be isolated or constitute complex syndromes with significant local changes that can affect the face, bone, genital system and skin.

Retrorectal hamartoma or tailgut cyst is an uncommon congenital disease of presacral and retrorectal space and is embryologically part of some forms of enteric cysts. The rarity of this disease leads to difficulty in diagnosis and surgical management. Complete surgical excision is the treatment of choice for tailgut cysts.

Myelodysplastic syndromes (MDS) are a diverse group of hematological disorders that affect the blood and bone marrow. Laboratory diagnosis of MDS is almost exclusively based on the morphology of hematopoietic cells observed in smears of peripheral blood and bone marrow and this depends solely on the presence of dysplastic changes observed in the granuloid, erythroid, and megakaryocytic cells.

Idiopathic normal pressure hydrocephalus (iNPH) is a gradually progressive disease affecting the elderly population. The diagnosis of probable iNPH is based on clinical history, physical findings, brain imaging. INPH involves non-obstructive enlargement of the cerebral ventricles combined with one or more symptoms of cognitive decline, impaired gait and balance, and urinary urgency.

Acute promyelocytic leukaemia (APML) is known to present with disseminated intravascular coagulopathy (DIC) but as a Corpus luteal cyst hemorrhage however, it is rarely seen at presentation. This case is the first to describe a patient with APML who presented with ruptured corpus luteum without ovarian tissue infiltration with blasts, leading to hemoperitoneum posing as life threatening acute abdominal emergency in a woman belonging to child bearing age.

Open scalp wounds are often associated with retained foreign bodies and are poorly reported. Despite meticulous radiological evaluations, foreign bodies can still be missed. Complication such as chronic headache, scalp abscess, chronic osteomyelitis, organic personality disorder had been reported. Coupled with the potential for medicolegal concerns, retained foreign bodied in the scalp thus require critical evaluation and management.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the emergence of the immediate and urgent need to develop of therapeutic measure capable of reducing its impact on the health of the population and in health and economic resources. Based on the data provided by these bioassays, in this work propose the implementation of machine learning algorithms based on a Quantitative Structure-Activity Relationship (QSAR) model.

Harlequin ichthyosis is associated with high morbidity and mortality in the past. However, fetal DNA analysis, 3 D facial antenatal ultrasound, and fetal skin biopsy significantly improved the diagnostic capabilities. The current advancement in treating these babies in level 3 neonatal intensive care units with a multidisciplinary team approach and early use of oral retinoids such as Acitretin, have made the outcomes better recently.

Pulmonary embolism is the third leading cause of cardiovascular death after myocardial infarction and stroke. Anticoagulation is the primary choice of treatment for the majority of patients presenting with acute pulmonary embolism. However, a greater risk of mortality in patients with right ventricular (RV) dysfunction may open the door to more aggressive treatment modalities.

Aortoiliac occlusive disease (AOID) usually occurs as atherothrombotic stenosis or occlusion extending from the terminal aorta to the level of bilateral common iliac arteries. We experienced a young male case who had a history of five years of claudication with a tiny toe ulcer. The angiogram showed severely stenotic terminal aorta with two intraplaque collaterals in a multilevel crossing fashion that runs horizontally and vertically.

Morbus Hansen is a chronic infectious disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Morbus Hansen is still a health problem in endemic areas, such as Africa, Southeast Asia and Latin America. Morbus Hansen (MH) is named after the founder of this disease in the 19th century, a doctor from Norway named Gerhard Henrik Armauer Hansen.

Cardiac malignancies presenting in the infancy are rare. Primitive neuroectodermal tumor (PNET), a high-grade malignant tumor is one among them. The most common sites of occurrence of primary PNET are the peripheral nervous system, bone, and deep soft tissues. It is extremely rare in the pericardium. To the best of our knowledge, only three patients with primary PNET of the pericardium have been reported so far in the literature.

Swelling of the tongue usually pose a clinical dilemma, especially when presenting at an early age. Growths from all of these heterogeneous components may occur resulting in a wide variation in clinical features and behaviour, ranging from self-limiting to aggressive lesions. Here we present a case of a 9 year old female child, with complaints of swelling over the tongue and floor of mouth.

The thumb plays a key role in hand function for precise dexterity. The surgical treatment of full avulsions of the digital skin sheath by tearing (ring syndrome) is complex and the management of these lesions is challenging for the reconstructive surgeon. When replantation is not possible, other alternatives are available if the covering tissue is thin and flexible.