A 24-year-old Caucasian male presented with low GCS, seizures, severe vomiting and hypokalaemia initially admitted under the physicians through the Emergency Department and later shifted to the Intensive care unit (ICU). The initial diagnosis was Acute Kidney injury with metabolic hypochloraemia and hypokalaemic alkalosis with a background of Chronic Kidney disease treated under the Nephrologist in the past. In ICU, Patient was intubated and resuscitated with intravenous fluid resuscitation and correction of electrolyte abnormalities. The patient also had aspiration pneumonia in ICU and was treated with intravenous antibiotics Total parental nutrition (TPN) for nutritional support and Pabrinex due to the risk of refeeding syndrome. The patient also developed swelling right arm and an Ultrasound of the right Arm showed right-sided jugular vein thrombosis and was treated with anticoagulants. He had a CT (Computer Tomography) scan of the head for low GCS, which did not reveal any abnormality, Lumbar puncture and CSF analysis were normal. CT scan of the abdomen and pelvis with contrast revealed a diagnosis of superior mesenteric artery syndrome. He responded well to conservative treatment in ICU and was discharged with a referral to a tertiary center for further management.

Phyllodes tumors are uncommon fibroepithelial tumors of the breast. These tumors are graded based on the World Health Organization criteria into benign, borderline, and malignant subtypes. While benign phyllodes tumors are by far the most common presentation, borderline and malignant tumors have important clinical implications, as they are more likely to locally recur and metastasize. The most common sites of distant metastasis include the lung, bone, heart, and liver. Rare spread to the small intestines, kidney and pelvis have also been reported. We report a case of a 71 year-old woman with a history of locally recurrent phyllodes tumor of the breasts found to have retroperitoneal and intraperitoneal metastases. The retroperitoneal mass was just below the left kidney, extending into the pelvis, and overlying the psoas and iliacus. The second mass involved the second portion of the duodenum, the proximal transverse colon, and the overlying mesentery. This case of delayed metastatic spread of phyllodes tumor to two sites, seventeen years after first presentation, represent a rare case.

Acquired ichthyosis is a known paraneoplastic sign of lymphoproliferative malignancies, with histopathologic findings that are nonspecific, revealing no insinuation of the underlying neoplasm. Mycosis fungoides (MF) is a skin malignancy of T helper lymphocytes with a wide clinical spectrum. Among the atypical variants of MF, there is an ichthyosis- like presentation. However, to date, rare cases of ichthyosiform MF has been reported. We report here the clinical and histopathological features of patient with IMF.

Nurses are hired to care for drug dependents who undergone rehabilitation. These nurses do not have sufficient training to care for the drug dependents. Having exposed to an environment where nurses are not competent in drug-dependent care may cause the drug-dependent persons to react and behave differently. Hence, this study is would like to explore live experience of drug-dependent persons cared by nurses in drug rehabilitation centers. Utilizing qualitative research design specifically the descriptive phenomenological approach, the investigation revealed the following interpretive themes which aroused from their lived experiences: (a) concerned/thoughtful nurse emanates from counselling, instructing, and solicitous nurse, (b) upholding professionalism that stems from safeguarding care, warranting care, and comforting care, (c) depicting a robust behaviour that derives from reinforcing, ranting and raspy behaviour, and (d) dedicated nurse that comes from devoted, steadfast, and warm-heartedness. These lived experiences of drug-dependents shows the significant essences that may convey drug-dependent persons being cared by jail nurses.

Smoking may be directly and/or indirectly responsible of fiscal disequilibrium with independence of the net relation between incomes and spends of fiscal authorities attributable to smoking. In general way the use of tributary policy focused in reduce the tobacco consumption has mainly a preventive effect. Nevertheless, the useful of this policy is better while the intensity of the tobacco consumption is less. That’s why the efficacy of the fiscal policy for the smoking control is given by the less representatives of the tributary policy front of the no tributary policy while increase the intensity of the tobacco consumption. The main objective of the efficacy fiscal policy for the smoking control must be the higher reduction of the tobacco consumption. That’s why this fiscal policy must be multi-dimensional agreeing with the multi causality from smoking.