A 79-year-old man presented to our emergency department with sudden back pain. Laboratory results showed CK 2836 U/L (normal range 30-160), CK-MB 393 U/L (<25), D-dimer 1.4 µg/ mL (<1), BNP 37.9 pg/mL (<19.5), cTnl 0.133ng/mL (<0.028) and electrocardiogram showed ST elevation in V1~6. Acute myocardial infarction (AMI) was suspected. Because of the back pain, acute aortic dissection (AAD) and pulmonary thromboembolism (PE) needed to be ruled out and contrast-enhanced computed tomography (CECT) was performed.

The inadvertent swallowing of foreign bodies is common, but results in perforation of the gastrointestinal tract in less than 1% of cases [1]. Because any site of the gastrointestinal tract may be perforated by a foreign body, the clinical presentation may vary and mimic diverse medical conditions.

Objective: To evaluate testicular volume, varicocelle, hydrocelle, microlithiasis, semen parameters and measure serum FSH, LH, and Testosterone concentrations in young male thalassemic patients. Design: Prospective study. Setting: Tertiary care hospital. Patients and Method: This study investigated 62 young adults with beta thalassemia (47 major, 15 intermedia), aged 18–41 years who underwent different chelation therapies. The patients’ serum ferritin levels range was from 182 to 11053 ng/mL (mean 2067 ng/mL) at the time of study. Results: The mean size of right testis was 11.4 ml and the mean size of left testis was 11.7 ml. In 3.2% of patients the testes volume was under 4 ml. Varicocele was seen in 11.3% of patients. Microlithiasis was detected in 4.8% of patients. Hydrocele was seen in only in 1.6% of patients. Hypogonadism was seen in 22.6% of patients. Conclusion: This study suggests that in thalassemic men, testicular volume in ultrasound has significant correlation with concentrations of serum Testosterone, LH, FSH and sperm parameters.

Eight year-old child presented with two year history of dyspnoea on exertion. Clinical examination revealed a continuous murmur peaking in diastole. Two dimensional transthoracic echocardiography revealed a dilated left circumflex artery (LCX) in parasternal short axis view with enlarged right atrium (RA) and right ventricle (Figures 1A,B). Apical four chamber view demonstrated fistulous flow from LCX to RA (Figures 1C,D, arrows); flow travelled initially in left atrioventricular groove and then along inter-atrial septum before opening into RA near its superior wall (Movie 1).

Placement of a ventriculoperitoneal shunt is an established procedure for treatment of hydrocephalus, however, complications can occur. The most common causes of shunt malfunction are catheter obstruction and infection. The incidence of Ventriculoperitoneal shunt related abdominal complications has been reported to be from 5% to 47% [1]. The most common distal ventriculoperitoneal shunt complications include shunt infection, subcutaneous collection of CSF, peritoneal pseudocyst, bowel perforation, intestinal volvulus, mesenteric pseudotumor, migration of the catheter into the pleural cavity and heart, and development of an incision hernia [2].

The patient is a 5 year-old male child, product of the second gestation, in a 36 year old mother without comorbidities. During pregnancy, risk of abortion was presented since the third month of gestation and was managed with obstetrical care and rest. The product was obtained by vaginal birth at 40 weeks of gestation, presenting hypoactivity and secondarily generalized partial seizures. It was decided to initiate treatment with phenytoin. During his neurological evolution, he presented backwardness in the psychomotor development, right hemiparesia that progressed to spasticity (spastic hemiparesia), language and communication limitation, subsequently he recurred with convulsive crisis. Currently the patient is treated with levetiracetam and clonazepam, presenting appropriate control.

Human tissues and organs could be affected depending on pathological condition of diseases. Proteins are basic functioning molecules of cells accordingly to modification intensities. Protein modification can be different in cellular interaction, localization, activity, protein concentration, and co-/posttranslational. Protein biomarker discovery has covered some subtitles or points such as differentially expressed proteins disease specific protein isomers and abnormal protein activity [1,2].

The patient was a 15-year-old girl with an established diagnosis of Alagille syndrome (AS) since early life. Her medical history was significant for systemic manifestations of AS including liver transplantation and pulmonary artery balloon dilation. She had an unusual triangular facies characterized by a broad overhanging forehead, deep set, hyperteloric eyes and small pointed chin. Her bestcorrected visual acuity was 1.0 in both eyes. Slit-lamp examination was positive for posterior embryotoxon in both eyes. Funduscopy revealed diffuse choroidal hypopigmentation with increased visibility of the choroidal vessels and symmetric, well-circumscribed macular discoloration (Figure 1). A circumferential chorioretinal atrophy was also detected in the peripheral retina (Figure 1). Fundus autofluorescence (FAF) imaging clearly defined hypofluorescent areas in the peripapillary regions that extended along the macula and had a sleep mask appearance (Figure 2). Peripheral circumferential chorioretinal atrophy was also clearly etected (Figure 2).

Energy drinks have become readily available and are being utilized globally. However, the potential side effects of their use are not well understood. Most consumers use these beverages with the goal of increasing energy. However, unintended ramifications of energy drinks may include increased sympathetic drive, endothelial dysfunction, and mitigation of coronary blood flow. A few reports have brought to light the rare phenomenon of myocardial infarction occurring secondary to energy drink consumption. We present this case of a young healthy man who suffered a myocardial infarction requiring emergent coronary intervention to contribute to the limited literature available on this topic. The increasing popularity and use of energy drinks necessitates further investigation into their unintended cardiac complications.

Objective: Cardiopulmonary bypass (CPB) induces a systemic inflammatory response which is thought to be a significant cause of postoperative organ dysfunction and mortality. In this study we aimed to investigate the effect of ITGA2B (integrin alpha 2b, platelet glycoprotein IIb of IIb/IIIa complex) gene polymorphism on the magnitude of inflammatory response after CPB Methods: Twenty patients undergoing coronary artery bypass grafting were included. Blood samples were taken at the three different times for analyses of Interleukin-6, Interleukin-10 and Nuclear Factor Kappa B by ELISA (t1: before operation, t2:10 minutes after removal of aortic cross clamping and t3: 24 hours after operation. ITGA2B gene polymorphisim, c.2621T>G, resulting missense alteration, p.Ile874Ser (rs5911) was studied in patients and 27 healthy volunteers by targeted polymerase chain reaction (PCR) and restriction enzyme digestion. Perioperative organ dysfunction was evaluated by cardiac surgery scorring (CASUS) system.

An elderly male presents to orthopedic clinic with severe back pain for fifteen days. He is unable to sit or stand. The pain remains persistent even while lying supine. He also complains of nausea, anorexia and cough with blood tinged sputum since ten days. He gives past history of grade II benign prostatic hyperplasia with nodule under prostate specific antigen monitoring. Examination reveals no significant finding.

Kp community-acquired pneumonia is rarely encountered. Its prevalence is higher in Asia, where a higher strain virulence was demonstrated [1,2]. It’s a pyo-pneumothorax, which usually occurs on debilitated or immuno-compromised patients. It is a severe disease associated with high mortality. Here, we report the observation of a Kp community-acquired pneumonia occurring in a genetic disorder context.