Introduction: The aim of this investigation is to evaluate the possibilities of the method of cardiography from the coronary sinus (ECG-CS) in optimization of stenting bifurcation lesions (BL) of coronary arteries (CA). Materials and Methods: 43 patients with stable CHD with pseudo-BL of the anterior descending artery (ADA) were included in this investigation. We placed a 10-canal electrode into their coronary sinus at the beginning of percutaneous coronary intervention (PCI). Ischemic guidance was done with the WorkMate electrophysiological recording system. Results: In 11 patients (25%) out of 43 with CHD, the diagonal branch (DB) comprometation and ischemia dynamics (p<0.05) in intracardiac lead (CS 3-4) after ADA stenting were discovered according to ECG-CS. Nine patients (20.9%) underwent successful provisional-T-stenting, while a second stent was required for the other 2 patients. Conclusion: ECG-CS provides the possibility to optimize coronary intervention in the area of CA bifurcation.

Acute intermittent porphyria (AIP) is a rare autosomal dominant hereditary metabolic disorder having protean manifestations. It usually presents with short duration of gastrointestinal symptoms followed by rapidly progressive fulminant neurological syndrome. It is a neurological emergency and mimics many other psychiatric and medical disorders and can be fatal if it remains undiagnosed and untreated. Further, speci?c treatment in the form of Heme arginate is not universally available and very costly, so high clinical suspicion and early diagnosis and management of acute attack and prevention of further attacks are very important. Here, we report a 23 years old married female nurse presenting with recurrent acute abdomen requiring frequent hospital admissions along with convulsion during her last attack. The presence of porphyrins in urine confirms the diagnosis of AIP.

Background Adult-onset Still’s disease (ASD) is a rare systemic auto-inflammatory condition that often poses a diagnostic dilemma due to nonspecific clinical signs and symptoms. We report a case of ASD that dramatically improved after a short course of steroids. Case presentation A 23-year-old women from Ghana presented with a two-week history of fever, sore throat, right-sided neck swelling and an evanescent, pruritic rash on her extremities. On exam she was febrile to 103 F, tachycardic, tachypneic, had tender, right-sided cervical lymphadenopathy, and diffuse joint tenderness with decreased range of motion. She was admitted to the ICU for possible sepsis and started on broad-spectrum antibiotics. Extensive work-up for possible infectious and auto-immune etiologies, including a bone marrow biopsy was negative. The diagnosis of Still’s disease was made based on the Yamaguchi criteria. The patient was started on methyl-prednisolone and significantly improved within 24 hours. Conclusion Patients presenting with ASD often represent a diagnostic challenge. Clinicians should be aware of this rare disorder, exclude other more frequent diseases and start early anti-inflammatory therapy to avoid poor outcomes.

In December 2019, unexplained cases of pneumonia were reported in Wuhan, China. A novel coronavirus named Severe Acute Respiratory Syndrome coronavirus-2 (SARS CoV-2) was isolated from respiratory tract of patients, and the resultant disease was termed as COVID-19 (Coronavirus Disease 2019) (Jin YH 2020). COVID-19 has spread throughout china and across the world and it was declared as a pandemic by March 11th 2020 (Ng OT 2020). Running Title: COVID-19 is a systemic disease that could affect almost all parts of the body but it primarily affects the respiratory system. There is very limited data in the literature about the dermatological manifestations of COVID-19. An interesting case of skin rash in a patient who was critically ill with COVID-19 is presented here. The skin rash improved after short course of treatment with steroids. It is recommended that clinicians have a high index of suspicion to COVID-19 disease in patients who develop unexplainable rash.

Aims & Objectives: Acute Diarrhea (AD) is a highly prevalent condition that causes significant morbidity and mortality worldwide. Conventional therapies include oral Rehydration Solutions (ORS), Antibiotics and Zinc Products. Emerging data suggest that Probiotics use in the treatment & control of AD cases in children may help supplement current therapies for further control. Methods Herein, we review the evidence of several Probiotics modalities for AD treatment. We describe the Clinical Impact & prevalence of Acute Diarrhea in children and its complications, provide an overview of current treatments, and finally, discuss recent emergent Gut approaches to AD management. Specifically, we will describe - in a Comparative study - on the utility of different kinds of Probiotics known & used and common natural products in the treatment of Acute cases of AD and focus on recent, high-quality studies. Adverse effects and potential interactions of each therapy will be highlighted where applicable.