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A 27-year-old woman presented with a history of excessive hair loss, loss of appetite, loss of weight, amenorrhoea and loss of axillary and pubic hair for 6 months followed by fever and vomiting for 5 months and abdominal pain for 1 month. During the course of her illness, the patient developed intravascular haemolysis as evidenced by a drop in haemoglobin, indirect hyperbilirubinaemia, raised lactate dehydrogenase (LDH) and haemoglobinuria. Examination revealed severe pallor, mild icterus, elevated jugular venous pressure, generalised lymphadenopathy and hyperpigmentation. Investigations revealed severe anaemia, indirect hyperbilirubinaemia, raised LDH and negative Coombs test. Antinuclear antibody and anti-dsDNA, anti-Sm and anti-SS-A/Ro antibodies were positive and complement C3 was low. The patient was diagnosed to have systemic lupus erythematosus and immune-mediated intravascular haemolysis and was treated with prednisolone and hydroxychloroquine. Haemolysis resolved following steroid therapy, and during follow-up, there were no further episodes of haemolysis.

A 40-year-old male patient reported to medical outpatient department with bilateral pedal edema of 15 days duration which was progressive, bilaterally symmetrical, pitting and with minimal pain and redness. Examination revealed pallor and bilateral pitting pedal edema with mild tenderness. Investigations revealed dimorphic anemia with reduced vitamin B12 levels. All other biochemical and radiological including radiograph of the chest, ultrasonography of abdomen, color doppler of the both lower limbs, and two dimensional echocardiography were normal. For the next one month, the patient showed significant improvement and was discharged. Fifteen days later, the patient was again readmitted with progressively worsening breathlessness with orthopnea and increasing pedal edema of two days duration. Clinically and radiologically, patient had features of congestive cardiac failure which was corroborated with markedly raised levels of NT pro brain natriuretic peptide. He also had other organ involvement with raised serum creatinine (1.9 mg/dl) and elevated transaminases of >300 IU/L. Patient was managed with high flow oxygen, ventilatory support, intravenous loop diuretics, low-dose angiotensin-converting enzyme inhibitors, and supportive care. The next day, patient's son and wife also reported with bilateral pedal edema and breathlessness. Based on this history, the diagnosis of epidemic dropsy was suspected. Mustard oil from their kitchen tested positive for nitric oxide test which was later confirmed at Public Health Laboratory. The index case showed progressive downhill course and died after 3 days. Both son and wife recovered over the next few months.

The article states that the new coronavirus disease (COVID-19) is characterized by a range of clinical manifestations, the development of various complications, inconsistency of clinical, laboratory and instrumental data of the patient’s state, which the authors have observed so far according to the results of our previous studies. A review of the literature is presented on the symptoms, laboratory blood tests of critically ill patients who recovered and those who died of a new COVID-19. Among the hospitalized seriously ill patients, there were mostly men, a signifi­cant number had comorbidities. According to the literature, hospitali­zed critically ill patients with confirmed new COVID-19 in most cases had cough, fever, chills, shortness of breath, lymphopenia. Other symptoms include sputum, headache, dizziness, rhinorrhea, anosmia, dysgeusia, sore throat, abdominal pain, ano­rexia and vomiting, diarrhea, nausea, and muscle pain. The study concluded that doctors, especially after 3 days of illness, when assessing the state of the patient, should pay attention to the following data or their severity, a combination of several symptoms that may suggest the need for hospitalization, particularly in the intensive care unit: the age of the patient; the pre­sence of concomitant pathology (cardiovascular, cerebral, chronic respiratory diseases, diabetes, obesity), especially in the stage of decompensation; the presence and extent of impaired consciousness (Glasgow Coma Scale); cyanosis, pallor of the skin, mucous membranes; acrocyanosis or central cyanosis; duration of fever (> 38 °C) more than 3 days, especially > 39 °C; manifestations of dyspnea (chest tightness, shortness of breath or tachypnea, shortness of breath during exercises), respiratory rate > 24 beats per minute or < 10; heart rate ≥ 125 beats per minute (measured when the patient is sitting); systolic blood pressure 2; CURB-65 score > 2; the presence of signs of emergencies (acute respiratory distress syndrome, acute renal failure, bleedings and others); SpO2 10 • 109/l, lymphopenia, thrombocytopenia, serum C-reactive protein > 10 mg/l; an increase in prothrombin time (> 16), in the levels of D-dimer (> 1.5 ng/ml), ferritin (> 300), lactate dehydrogenase (above 360 U/l), procalcitonin (≥ 0.5 ng/ml), lactate (> 2 mmol/L), NT-proBNP (≥ 400 pg/ml), high-sensitivity cardiac troponin (> 5 pg/ml), changes on the electrocardiogram; lung damage more than 25 % according to computed tomography.

Background. Trichobezoar is a dense compound in the human stomach, consisting of swallowed hair, food particles, and gastric mucus. Sometimes it passes into the initial part of the small intestine. Its clinical picture is very similar to that of a tumor, so it is necessary to conduct a thorough diagnosis. Materials and me­thods. The article deals with a case of severe protein-vitamin-iron deficiency anemia in a 5-year-old girl on the background of trichobezoar. Results. The child’s condition is severe due to the clinical picture of iron-protein-deficiency anemia of a very severe degree. During her stay in the hospital, the girl’s condition deteriorated sharply due to the rapid increase in weakness and pallor of the skin, anasarca. Due to the critical growth of the anemic syndrome, the question of the need for blood transfusion and further surgery arose. Conclusions. The peculiarity of this case is a critical increase in anemia in the absence of classic signs of hemolysis on the background of chronic eating and psychosomatic disorders. Thus, it is necessary to form vigilance in pediatricians to trichobezoar and increase the level of knowledge about the correct diagnostic algorithm in such cases., Актуальність. Трихобезоар — це щільне утворення в шлунку людини, що складається з проковтнутого волосся, частинок їжі і шлункового слизу. Іноді воно переміщується в початковий відділ тонкого кишечника. За своєю клінічною картиною дуже схоже на пухлину, тому необхідне проведення ретельної діагностики. Матеріали та методи. Наведено випадок тяжкої білково-вітаміно-залізодефіцитної анемії у дівчинки 5 років на тлі трихобезоару. Результати. Стан дитини тяжкий, обумовлений клінікою білково-залізодефіцитної анемії надтяжкого ступеня. Під час перебування в лікарні стан дівчинки різко погіршився через швидке наростання слабкості і блідості шкірних покривів, анасарки. У зв’язку з критичним наростанням анемічного синдрому постало питання про необхідність гемотрансфузії та подальшого оперативного втручання. Висновки. Особливістю наведеного випадку є критичне наростання анемії за відсутності класичних ознак гемолізу на тлі хронічного порушення харчування та психосоматичних розладів. Таким чином, слід формувати настороженість у педіатрів щодо трихобезоару та підвищувати рівень знань про правильний діагностичний алгоритм у таких випадках.

Total occlusion of the abdominal aorta is an uncommon but potentially devastating event. Clinical symptoms are usually sudden and may vary depending on the level of the aortic occlusion. Associated morbidity and mortality remain substantial with high rates of limb loss, acute renal failure, rhabdomyolysis, and death. We report a case of a bedridden 91-year-old woman with history of hypertension, hyperlipidemia, anemia and dementia, carried to the emergency department because of bilateral lower limb pallor. She had been at the same department the week before because of the same problems and high blood pressure (BP), but had been discharged after administration of hypotensive drugs and a short period of observation. No attention was paid to those perfusion alterations, or the global picture at all. The physical examination revealed cooling of the lower limbs and significant BP differential between upper and lower limbs (ankle-brachial index of 0.173), leading to the suspicion of bilateral acute limb ischemia. Abdominal, pelvic and lower limb CT was conducted, revealing calcification and important atheromatosis of the thoracic-abdominal aorta and a mural thrombus beginning above the origin of the celiac trunk, with complete occlusion below the origin of the renal arteries. After discussion with Vascular Surgery Department, given the advanced age, known co-morbidities and the timing of diagnosis, the patient was considered not eligible for revascularization surgery and comfort measures were honored. This case highlights the importance of stablishing a timely and correct diagnosis, even in the very elderly, emphasizing that they too benefit from secondary and tertiary prophylaxis, in order to prevent devastating outcomes as this.

BACKGROUND: To determine risk factors for postradiation optic atrophy (PROA) after plaque radiotherapy for uveal melanoma. METHODS: A single center, retrospective cohort study of patients diagnosed with uveal melanoma involving choroid and/or ciliary body treated with plaque between January 1, 2008, and December 31, 2016. Outcomes included development of PROA with pallor alone or with concomitant neuroretinal rim thinning (NRT). Cox regression analysis was performed to identify risk factors for PROA. RESULTS: Of 78 plaque-irradiated patients, PROA developed in 41 (53%), with concomitant NRT in 15 (19%). Risk factors for PROA of any type included presentation with worse visual acuity (odds ratio [95% confidence interval] 5.6 [2.3–14.1], P < 0.001), higher baseline intraocular pressure (IOP; 14 vs 16 mm Hg) (1.1 [1.0–1.2], P = 0.03), shorter tumor distance to optic disc (1.3 [1.2–1.5], P < 0.001) and foveola (1.2 [1.1–1.3], P < 0.001), subfoveal subretinal fluid (3.8 [2.0–7.1], P < 0.001), greater radiation prescription depth (1.3 [1.1–1.6], P = 0.002), dose to fovea (point dose) (1.01 [1.01–1.02], P < 0.001), and mean (1.02 [1.02–1.03], P < 0.001) and maximum dose to optic disc per 1 Gy increase (1.02 [1.01–1.03], P < 0.001). On multivariate modeling, dose to disc, baseline IOP, and subfoveal fluid remained significant. Subanalysis revealed risk factors for pallor with NRT of greater mean radiation dose to disc (1.03 [1.01–1.05], P = 0.003), higher maximum IOP (17 vs 20 mm Hg) (1.4 [1.2–1.7], P < 0.001), and subfoveal fluid (12 [2–63], P = 0.004). CONCLUSION: PROA may result in NRT in addition to optic disc pallor. Risk factors for PROA included higher radiation dose to optic disc, higher baseline IOP, and subfoveal fluid. Higher maximum IOP contributed to concomitant NRT.

Heme oxygenase-1 (HO-1), an inducible stress-response protein, exerts anti-oxidant and anti-apoptotic effects. However, its significance in forensic diagnosis of acute ischemic heart diseases (AIHD) such as myocardial infarction (MI) is still unknown. We examined the immunohistochemical expression of HO-1 in the heart samples to discuss their forensic significance to determine acute cardiac ischemia. The heart samples were obtained from 23 AIHD cases and 33 non-AIHD cases as controls. HO-1 positive signals in cardiomyocyte nuclear were detected in 78.2% of AIHD cases, however, that were detected in only 24.2% control cases with statistical difference between AIHD and non-AIHD groups. In contrast to HO-1 protein expression, there was no significant difference in the appearance of myoglobin pallor regions and leukocyte infiltration in the hearts between AIHD and non-AIHD groups. From the viewpoints of forensic pathology, intracardiac HO-1 expression would be considered a valuable marker to diagnose AIHD as the cause of death.

Many potential causes of optic nerve inflammation exist, including typical and atypical causes, which require different management strategies.The objective of this study is to identify red flags that help differentiate typical from atypical optic neuritis (ON).This prospective study included 66 patients (100 eyes) with immune-mediated ON from January 2016 to June 2019, carefully excluding the nonimmune causes. The clinico-radiological features, investigations, therapy, and outcome were analyzed.We evaluated 33 cases each of typical and atypical ON. The typical group included 29 idiopathic ON and four associated with multiple sclerosis. Atypical ON included 19 neuromyelitis optica (NMO), seven MOG-associated ON (MOG-ON), and others due to Sjogren's syndrome, granulomatous polyangiitis, sarcoidosis, and IgG4 disease. Atypical ON occurred significantly and more frequently with extremes of ages (10 or70 years), bilateral simultaneous or severe vision loss with early disc pallor, multiple attacks, symptoms/neuro-imaging indicating non-MS disease e.g., long segment ON/myelitis, large confluent lesions, the involvement of optic tract, chiasma, area postrema or diencephalon, and (pachy) meningitis. Systemic involvement and poor outcomes despite steroids and second-line immunosuppression were observed more often in the atypical ON.The red flags indicating atypical ON are onset at extremes of age, multiple attacks, bilateral simultaneous or severe to very severe vision loss, early disc pallor, neurological symptoms, or imaging abnormalities suggesting non-MS disease, systemic involvement, and poor steroid responsiveness. The awareness might help the clinician promptly identify and escalate therapy to ensure a better outcome.

Introduction: Systemic diseases such as leukemia can manifest on the periodontium. The symptoms of this disease can be varied such as gingival enlargement, bleeding, oral ulceration, petechiae, mucosal pallor, noma, and trismus, but most clinicians are unaware of these conditions. This literature study purposed to review the literature concerning the oral manifestations and periodontal managements consideration of patients with leukemia. Review: The most frequent oral manifestations associated with leukemia are represented by the paleness of oral mucosa or abnormal color of the gum, petechiae, ecchymosis, bleeding associated with painless gingival hyperplasia, hemorrhage, ulcerative necrotic lesions, and buccal infections. Clinicians should take precautions when encountering those symptoms, such as referring the patient to specialized professionals. Besides that, clinicians should have a certain protocol to maintain the oral health of patients and to prevent complications that may occur from dental procedures. Patients with leukemia have a bleeding tendency and increased risk of infection which required special attention on periodontal and dental management to prevent the development of opportunistic infections and other complications. However, many patients are unaware of their disease and clinicians hold a pivotal role to identify leukemia through oral manifestations and giving feasible dental management. Conclusion: This review describes the oral manifestation of leukemia, which might be useful in early diagnosis. By knowing the diagnosis, clinicians should concern about special considerations in providing dental treatment to patients with leukemia.

Purpose Synthetic MRI (SyMRI) enables to quantify brain tissue and morphometry. We aimed to investigate the WM and myelin alterations in patients with unilateral hippocampal sclerosis (HS) with SyMRI. Methods Adult patients with isolated unilateral HS and age-matched control subjects (CSs) were included in this study. The SyMRI sequence QRAPMASTER in the coronal plane perpendicular to the hippocampi was obtained from the whole brain. Automatic segmentation of the whole brain was processed by SyMRI Diagnostic software (Version 11.2). Two neuroradiologists also performed quantitative analyses independently from symmetrical 14 ROIs placed in temporal and extratemporal WM, hippocampi, and amygdalae in both hemispheres. Results Sixteen patients (F/M = 6/10, mean age = 32.5 ± 11.3 years; right/left HS: 8/8) and 10 CSs (F/M = 5/5, mean age = 30.7 ± 7 years) were included. Left HS patients had significantly lower myelin and WM volumes than CSs (p

Acute lymphoblastic leukaemia (ALL) is the most frequent childhood cancer. Children usually present with signs of bone marrow failure like recurrent or prolonged fever, pallor, lethargy, bleeding tendencies, bone pain and others. Occasionally they may present with sign of infiltration of leukaemic cells into other organs such as testicular and central nervous system, rarely to the periorbital or orbital region. Similarly in relapse cases, they typically presented either in bone marrow, central nervous system relapse or testicular but rarely orbital involvement. Here we report the clinical case of a five-year-old boy who developed relapsed B-ALL, presented to us with unilateral right eye swelling without other clinical findings and absence of blast cells in the peripheral blood film as well as bone marrow aspirate specimen.

To evaluate the common etiologies and bleeding manifestations in patients of thrombocytopenia and its clinical presentation, methods of investigation, and impact of various modes of management. Total 104 patients with platelet count less than l00,000 per cu.mm. with age, more than 12 years admitted to hospital between January 2010 to October 2011 were included in this study. Platelet count on automated cell counter less than 100,000 per cu.mm. and confirmed in peripheral smear were included in the study. All EDTA samples were processed in Abacus junior 5 hematology Analyser. Peripheral blood smear review was done for all cases. Clinical history and physical examination were collected from patients and medical record files.The present study included 56 male patients and 48 female patients. The most common bleeding manifestation was petechial rash 8.6%, hemoptysis and traumatic bleeding account for 1.9 % each, whereas 74% of patients did not present with any bleeding issues. Total 66 patients presented with symptoms of fever, 73 had signs of pallor, 22 patients had splenomegaly, 16 patients had hepatomegaly. Total 37.5% of patients were diagnosed with malaria and 1 patient (0.96%) was diagnosed with plasma cell leukemia. Chronic liver disease, megaloblastic anaemia, ITP (Idiopathic thrombocytopenia) and chronic renal failure account for 9.6%, 13.4%, 5.7% and 3.8% respectively. Total 16 patients had platelet counts less than 20000/cu.mm. and 37 patients had platelet count between 60000-80000/cu.mm. Malaria (39 patients) was the major cause of thrombocytopenia. Out of 39 patients with malaria 10 patients had P. Falciparum, 27 had P. Vivax and 2 patients had both. Patients with a platelet count less than 100,000/cu.mm have very high chances of bleeding manifestation. Cutaneous bleed is the most common manifestation. Malaria can be present with signs of thrombocytopenia. Timely and accurate diagnosis is the key to the management of thrombocytopenia.

Leptospirosis in pregnancy is often underdiagnosed and not commonly reported due to its unusual appearance and rarity. It looks like HELLP syndrome, obstetric cholestasis, viral hepatitis & pregnancy-related acute fatty liver. Miscarriages in the first trimester, stillbirths, and neonatal leptospirosis are serious complications that necessitate a high degree of concern, heightened sensitivity, and prompt diagnosis and treatment. We have one such incidence of leptospirosis in a COVID-19 positive pregnant female. A 21-year-old Primigravida with a predisposition of serious anaemia & thrombocytopenia, presented with fever, haematemesis, malena and sore throat at 38 weeks and 2 days gestation, during the COVID-19 pandemic. She had pallor, oedema, and haematuria on catheterization, rest all investigations were within normal limits. Proteinuria, haemolysis, low platelets, and elevated bilirubin were discovered during the investigation. Due to the lack of hypertension and elevated transaminases, the working diagnosis was atypical haemolysis, low platelets (HELLP) syndrome. The patient was tested for COVID-19 RT-PCR, came out to be positive and the fever spikes continued, leading to further investigations for Dengue, Malaria, Scrub Typhus, and Leptospirosis due to the ongoing Covid-19 pandemic. After the EIA (Enzyme Immunoassay) IgM antibody (confirmatory for Leptospirosis) tested positive for Leptospirosis, the decision to start Doxycycline was made. Meanwhile, the patient's CTG (Cardio tocograph) revealed signs of foetal distress, and a decision for an emergency LSCS was taken (Lower Segment Caesarean Section). The histology of the placenta after the section revealed normal findings. Doxycycline was initiated with a neonatal feeding regimen that was acceptable. On day two of life, the newborn had no indications of inherited leptospirosis and was removed from Neonatal Intensive Care. Within one week, the patient's symptoms had disappeared, and her biochemistry had went back to normal within 2 weeks.

Autoimmune hemolytic anemia is a heterogeneous group of diseases that are associated with decompensated acquired hemolysis. Autoimmune hemolytic anemia in children is most commonly observed after a viral illness. However, it is quite a rare disorder with the incidence of less than 0.2 cases per 100,000 of pediatric population. That is why the purpose of the article was to present a clinical case of autoimmune hemolytic anemia. A case of autoimmune hemolytic anemia in a 4-year-old boy is presented. On admission, he was diagnosed with acute viral infection with bilateral pneumonia and abdominal syndrome. While at hospital, the boy’s condition has worsened dramatically: weakness and pallor of the skin increased rapidly. Complete blood count revealed progressive hemolytic anemia (Hb 57 g/l, erythrocytes 2.58 × 1012/l, Ht 0.16, leukocytes 13.88 × 109/l, erythrocyte sedimentation rate 69 mm/h, platelets 400 × 109/l). There was a moderate increase of bilirubin due to unconjugated fraction (31.3 and 21.2 µmol/l, respectively). The issue of hemotransfusion was raised, but as a result of the crossmatching compatibility test, 20 packages of same-group blood were rejected due to incompatibilities. Aggressive immunosuppressive therapy (integrated administration of high-dose corticosteroids combined with intravenous immunoglobulins at a dose of 2 g/kg/day) allowed hemolysis to be stopped, and patient’s condition has improved, the issue of blood transfusion was rejected. The peculiarity of the presented case is a critical increase of anemia in the absence of classical signs of hemolysis, impossibility of hemotransfusion and a positive dynamics at prescription of high doses of corticosteroids and immunoglobulin. Thus, pediatricians should be aware of autoimmune hemolytic anemia, and it is important to increase their knowledge about the correct diagnostic algorithm in these cases. The drugs of choice for the treatment of autoimmune hemolytic anemia are intravenous immunoglobulins in immunosuppressive doses and a short course of glucocorticoids. In cases of resistance to such treatment, perftoranum transfusion is indicated., Аутоиммунная гемолитическая анемия (АИГА) — это группа заболеваний, в основе которых лежит декомпенсированный приобретенный гемолиз. АИГА у детей чаще всего наблюдается после вирусного заболевания. Это достаточно редкое состояние с частотой менее 0,2 случая на 100 000 педиатрического населения. Целью статьи было представить клинический случай больного АИГА. Представлен случай гемолитической анемии у ребенка 4 лет на фоне острой вирусной инфекции с пневмонией и диспептическим синдромом. Во время пребывания в больнице состояние мальчика резко ухудшилось за счет быстрого нарастания слабости и бледности кожных покровов. Общий анализ крови выявил прогрессирующую гемолитическую анемию (Hb 57 г/л, эритроциты 2,58 × 1012/л, Ht 0,16, лейкоциты 13,88 × 109/л, СОЭ 69 мм/ч, тромбоциты 400 × 109/л). Наблюдалось умеренное повышение билирубина за счет неконъюгированной фракции (31,3 и 21,2 мкмоль/л соответственно). В связи с критическим нарастанием анемического синдрома встал вопрос о необходимости гемотрансфузии, но в результате теста на индивидуальную совместимость 20 пакетов крови одной группы было отклонено из-за несовместимости. Интенсивная иммуносупрессивная терапия (комплексное введение высоких доз кортикостероидов в сочетании с внутривенными иммуноглобулинами в дозе 2 г/кг/день) позволила остановить гемолиз и улучшить состояние пациента, вопрос о переливании крови был отклонен. Особенностью представленного случая было критическое нарастание анемии при отсутствии классических признаков гемолиза, невозможность проведения гемотрансфузии и положительная динамика при назначении высоких доз кортикостероидов и иммуноглобулина. Осведомленность об АИГА должна присутствовать у педиатров, и важно расширить их знания о правильном алгоритме диагностики в таких случаях. Препаратами выбора для лечения АИГА являются внутривенные иммуноглобулины в иммуносупрессивных дозах и глюкокортикоиды коротким курсом. В случаях резистентности к такому лечению показано переливание перфторана., Автоімунна гемолітична анемія (АІГА) — це група захворювань, в основі яких лежить декомпенсований набутий гемоліз. АІГА у дітей найчастіше спостерігається після вірусного захворювання. Це досить рідкісний стан з частотою менш ніж 0,2 випадки на 100 000 педіатричного населення. Метою статті було представити клінічний випадок хворого на АІГА. Надано випадок гемолітичної анемії у дитини 4 років на тлі гострої вірусної інфекції з пневмонією та диспептичним синдромом. Під час перебування в лікарні стан хлопчика різко погіршився за рахунок швидкого наростання слабкості і блідості шкірних покривів. Загальний аналіз крові виявив прогресуючу гемолітичну анемію (Hb 57 г/л, еритроцити 2,58 × 1012/л, Ht 0,16, лейкоцити 13,88 × 109/л, ШОЕ 69 мм/год, тромбоцити 400 × 109/л). Спостерігалось помірне підвищення білірубіну за рахунок некон’югованої фракції (31,3 і 21,2 мкмоль/л відповідно). У зв’язку з критичним наростанням анемічного синдрому постало питання про необхідність гемотрансфузії, але в результаті тесту на індивідуальну сумісність 20 пакетів крові однієї групи було відхилено через несумісність. Інтенсивна імуносупресивна терапія (комплексне введення кортикостероїдів у високих дозах у поєднанні з довенними імуноглобулінами в дозі 2 г/кг/добу) дозволила припинити гемоліз і покращити стан пацієнта, питання щодо переливання крові було відхилено. Особливістю наданого випадку є критичне наростання анемії за відсутності класичних ознак гемолізу, унеможливлення проведення гемотрансфузії та позитивна динаміка при призначенні високих доз кортикостероїдів і імуноглобуліну. Таким чином, слід формувати настороженість у педіатрів щодо АІГА та підвищувати рівень знань про правильний діагностичний алгоритм у таких випадках. Препаратами вибору при лікуванні АІГА є внутрішньовенні імуноглобуліни в імуносупресивній дозі та глюкокортикоїди коротким курсом. У випадках резистентності до такого лікування показана інфузія перфторанів.

Background Canine babesiosis is a common and clinically significant tick‐borne disease caused by obligate haematozoan parasites of the genus Babesia. Purpose To report Babesia canis canis genotype A infection in a dog. Methods A 2‐year‐old female Shih Tzu dog was submitted with the history of anorexia and depression for one week and no prior surgery. Fever, anorexia, depression and vomiting as well as mucosal pallor were noticed on physical examination. Microscopic examination of the Giemsa‐stained blood smear disclosed large form of Babesia, and single to four pear‐shaped merozoites within erythrocytes (RBCs). The specific primers were used for detecting Babesia canis. Results The result of PCR was confirmed by 18S rRNA gene sequence analyzing and has been registered in GenBank under following accession numbers for Babesia canis canis (MW199108). The sequences were compared to those in GenBank, and alignments showed that the B. canis canis isolate belonged to genotype A. Conclusions This is the first description of B. canis canis genotype A in dog from Iran., A dog infected by B. c. canis genotype A. This is the first description of B. canis canis genotype A in dog from Iran.

Background: Acute compartment syndrome of the leg may be a devastating complication of a tibial fracture. Metic-ulous and repeated examinations of the patient who has such a fracture are needed to ensure the diagnosis of acute com-partment syndrome (ACS). A.C.S. remains challenging in many patients although the "5 Ps" of compartment syndrome; pain, pallor, paralysis, pulselessness, and paresthesia. Aim of Study: To measure intra-compartmental pressure in different compartments in the lower leg in tibial fractures and to correlate it with common clinical findings found in acute compartment syndrome in trial to early detect acute compartment syndrome and to decrease its devastating com-plications and rate of fasciotomy. Patients and Methods: This study was conducted on 100 patients referred to the Emergency department having Tibial fracture predisposed to have acute compartment syndrome by measuring intra-compartmental pressure instrumentally using stryker intra-compartmental pressure monitoring system and correlated with clinical picture and detect the percentage of patients need fasciotomy. Results: The Stryker intra compartmental monitoring system (STIC catheter) has accuracy and easy to measure intra-compartmental pressure and helps us to early detect A.C.S. in the lower leg also to decrease rate of fasciotomy and complications but it is expensive and needs proper training to use it. Conclusion: The patient who undergoes fasciotomy re-quires a physical therapy program to regain function. Postop-erative care and rehabilitation are just as important as the procedure itself.

Introduction. According to the latest statistical data analysis, vibration disease (VD) remains the leading pathology in the structure of occupational morbidity in the Russian Federation. The main symptom of VD is peripheral angiodystonic syndrome, which develops as a result of peripheral vessels angiospasm of extremities, which is clinically manifested in the form of pain in hands, temperature decrease and pallor of the skin. Materials and methods. The article presents the results of an ultrasound assessment of the velocity and anatomical parameters of the main arteries of upper extremities in patients with stage 2 VD from exposure to general and local vibration. Results. According to the data of sanitary and hygienic characteristics, in all examined patients with stage 2 VD from exposure to general and local vibration, the class of working conditions was assessed as class 3 (harmful). In contrast, the excess in local vibration along the X, Y, Z axes ranged from 1 to 7 dBA. Ultrasound of the main arteries of upper extremities shows a decrease in the velocity parameters along the radial and ulnar arteries symmetrically, a significant increase in the tone of the wall of the forearm arteries. Discussion. One of the most critical problems in solving expert questions is assessing pathological process severity due to the lack of transparent and objective methods. Ultrasound research is the most affordable and safest method for evaluating the vascular system of upper extremities in stage 2 VD. It also significantly increases the objectification of expert decisions on the connection of this disease with occupation. Conclusion. VD II from the impact of general and local vibration is characterized by decreased pulse velocity on the ulnar and radial arteries symmetrically on both sides with a pronounced increase of peripheral resistance, indicating a severe angiospastic syndrome to generalized. Contribution: Kuprina N.I. — contribution to the concept and plan of the study, contribution to data collection, contribution to data analysis and conclusions, contribution to the preparation of the article; Ulanovskaya E.V. — contribution to the concept and plan of the study, contribution to data analysis, contribution to the preparation of the article; Shilov V.V. — editing. All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version. Conflict of interest. The authors declare no conflict of interest. Acknowledgment. The study had no sponsorship.

Background: Pancytopaenia involves reduction in all the three haematological cell lines leading to the clinical manifestations related to anaemia, leucopaenia and thrombocytopaenia. These features can manifest either alone or in different combinations. Treatment depends on the accurate diagnosis for which pathological investigations are mandatory. Aims and Objectives: The study was conducted with the aims and objectives of evaluating the different clinical and haematological parameters in cases presenting with pancytopaenia. Further, the cases were further divided based on their aetiology. Materials and Methods: A total of 64 cases were included in the present study. Detailed clinical, peripheral blood and bone marrow findings were studied. Results: Majority of the patients belonged to the age group of 16-25 years. There was a slight female preponderance in our study in the ratio of 1:1.06 for M:F. The commonest clinical presentation was generalised weakness in 55 (85.9%) cases, followed by dyspnoea in 35 (54.7%) and fever in 30 (46.9%) patients. Pallor was the commonest examination finding observed in 60 (93.8%) cases followed by pedal edema in 19 (29.7%) patients. Among RBC morphology, normocytic normochromic picture was the commonest 18(28.1%), while bone marrow finding of erythroid hyperplasia with megaloblastic maturation was observed in 20 (31.2%) patients. Overall, megaloblastic anaemia was observed in 24 (37.5%) patients. Conclusion: Pancytopaenia is an important haematological manifestation in routine clinical practice. Timely, early and accurate diagnosis can save many morbidity and mortalities. Keywords : Pancytopaenia, Bone marrow, Haematology.

Background: Pancytopenia is a hematological entity which is relatively common. Its evaluation is important for arriving at an early and correct diagnosis, to aid in appropriate management. Materials and Methods: It was an observational study conducted in the Department of General Medicine and Clinical Hematology of our institute from June 2019 to May 2020. Clinical, hematological and biochemical parameters of 100 pancytopenic patients were evaluated and descriptive statistics was used. Results: The age ranged from 18-75 years. The commonest presentation was easy fatigability and fever. Besides pallor, splenomegaly and hepatomegaly were the presenting signs. Megaloblastic anaemia was detected in 64% followed by aplastic anaemia in 12% and acute leukemia in 6% patients. Among infective etiologies, two cases of malaria (P. falciparum). And each case of HIV, tuberculosis and dengue were seen. Lowest Hb% of 1.8 gm/dl, lowest total leucocyte count (TLC) of 500cells/cmm and lowest total platelet count (TPC) of 4000 cells/cmm was noted in a case of aplastic anemia. Macrocytic anemia was predominant blood picture. Hypercellular marrow was noted in 70(70%) cases and common cause was megaloblastic anemia, followed by leukaemia. Hypocellular marrow was noted in 12(12%) patients with aplastic anemia being commonest cause. Conclusion: In our study diagnosis of pancytopenia and its causes were ascertained by hematological investigations. An early and prompt treatment was given according to the cause and severity. Most of the cases had good prognosis due to a treatable cause. Keywords: Pancytopenia, Megaloblastic anaemia, Aplastic anaemia.

Introduction: Innate deficits in the metabolism or transport of vitamin B12 are exceptional. The main cause of vitamin B12 deficiency in infants is secondary to maternal deficiency. Maternal deficiency can have a vegan diet, low socio-economic level (developing countries) and a high level of development with a poor diet) or digestive pathologies responsible for a lack of absorption. The clinical signs are not very specific (developmental delay, pallor, hypotonia, vomiting and diarrhoea), which explains the frequent delay in diagnosis. The pathophysiology of the neurological damage, which is still uncertain, is thought to be secondary to a defect in myelination with altered nerve conduction and cortical atrophy. The aim of this work is to underline the importance of raising awareness of vitamin B12 deficiency in order to avoid its profound neurological repercussions, especially as substitution treatment allows an improvement or a reversibility of the neurological damage and raises the question of the possibility of screening new-borns. Materials and Methods: We report the case of two infants aged 6 months and 10 months with hypotonia and psychomotor regression from an early age, whose biological examination revealed pancytopenia with a collapsed vitamin B12 level in both infants and both mothers.

Introduction : L’objectif était d’étudier les aspects épidémio-cliniques de la drépanocytose chez l’enfant à l’hôpital Nianankoro Fomba (HNF) de Ségou. Methodologie : Il s’agissait d’une étude descriptive transversale allant du 02 janvier 2019 au 28 février 2020 au service de pédiatrie de l’HNF de Ségou. Elle a porté sur tous les cas documentés de drépanocytose chez les enfants de 1 mois à 15 ans, et ceux dont le statut a été confirmé dans le service durant la période d’étude. Les variables étudiées étaient : les caractéristiques sociodémographiques, cliniques, biologiques et thérapeutiques des malades. Les données ont été saisies et analysées sur le logiciel Epi info version 3.5.4. Résultats : Pendant l’étude 7617 patients ont consulté dans le service dont 105 cas de drépanocytose soit une fréquence hospitalière de 1,3%. L’âge moyen des enfants était de 53,64 mois±4ans. Le sex ratio était de 1,4 en faveur des garçons. La notion de consanguinité était retrouvée dans 51,43% des cas. La pâleur cutanéo- muqueuse était le signe physique le plus fréquent avec 83,81%; le phénotype SS de l’hémoglobine représentait 92,38%; la crise vaso- occlusive était la complication aiguë la plus fréquente avec 51,43%. Le taux de létalité était de 0,95%. Conclusion : La drépanocytose est fréquente dans le service de pédiatrie de l’HNF- Ségou avec 1,3%. La prise en charge est difficile du fait du faible niveau du plateau technique et du faible niveau socioéconomique des parents. Mots clés : Drépanocytose - Enfant - Ségou

Rabih Hage,1 Claire Alapetite,2 Hervé Brisse,3,4 Kevin Zuber,5 Augustin Lecler,6 Guillaume Lot,7 Caroline Le Guerinel,7 Catherine Vignal-Clermont,1 Herve Boissonnet7 1Neuro-ophthalmology Department, Hôpital Fondation A. de Rothschild, Paris, France; 2Radiation Oncology Department, and Proton Center Institut Curie, Paris-Orsay, France; 3Imaging Department, Institut Curie, Paris, France; 4Université des Sciences et Lettres, Paris, France; 5Department of Statistics and Clinical Research, Hôpital Fondation A. de Rothschild, Paris, France; 6Radiology Department, Hôpital Fondation A. de Rothschild, Paris, France; 7Neurosurgery Department, Hôpital Fondation A. de Rothschild, Paris, FranceCorrespondence: Rabih Hage Tel/Fax +33148036322Email rhage@for.parisPurpose: Management of optic nerve sheath meningiomas (ONSM) remains challenging. Photon radiation therapy (PhRT) is the most common treatment for sight-threatening ONSM. Proton beam therapy (PBT) is less commonly used because it is more expensive and because there are questions about its efficacy specifically in relation to ONSM. PBT has the theoretical advantage of reducing radiation exposure to adjacent structures. We report the visual outcome of patients with primary ONSM managed at the Fondation Ophtalmologique Adolphe de Rothschild, Paris, France, and treated with PBT at the Centre de Protonthérapie, Institut Curie, Orsay, France.Methods: We conducted a retrospective review of all patients with primary ONSM who received PBT (either by itself or following surgery) between January 2006 and January 2019. Neuro-ophthalmic examinations were performed at presentation and after radiotherapy, and, when applicable, after surgery. Meningiomas were measured at the time of diagnosis and at each follow-up MRI examination.Results: Sixty patients (50 women, 10 men; mean age, 45.2± 11.1y) were included, of whom 29 underwent surgery. At presentation, 52 (87%) of them had decreased vision (average visual acuity: 0.6 logMAR). Fundus examination showed optic disc swelling (n=27; 46.5%), optic disc pallor (n=22; 37.9%), optic disc cupping (n=2; 3.4%), opto-ciliary shunt (n=8; 13.8%), or choroidal folds (n=5; 8.6%). Otherwise, it was unremarkable (n=7; 12.1%). After treatment, visual function was stable overall. Fundus examination showed pallor (n=47; 83.9%), swelling (n=3; 5.4%), or cupping (n=2; 3.4%) of the optic disc, or was unremarkable (n=5; 8.9%). The visual field of 8 patients worsened, while 3 developed asymptomatic retinal hemorrhages. Tumor shrunk significantly in 8 patients at 1 year after PBT and remained stable in size in all others. Patients with opto-ciliary shunts had significantly worse visual outcome than other patients. Retinal abnormalities were observed in 11 patients during follow-up.Conclusion: PBT alone or in association with surgery appears to be a safe and efficient treatment for ONSM, reducing the tumor size and stabilizing visual function. The risk of developing radiation retinopathy seems to be higher when patients had upfront surgery.Keywords: optic nerve sheath meningioma, ONSM, proton beam therapy, PBT, compressive optic neuropathy, brain tumor, visual loss, opto-ciliary shunt, radiation retinopathy, RON

Serum hyperviscosity is a rare laboratory finding. Amongst several causes of serum hyperviscosity, malignant disorders are quite common. Monoclonal gammopathy is a family of disorders in which monoclonal gammopathy of unknown significance (MGUS) and smoldering myeloma are the asymptomatic variants whereas multiple myeloma is the malignant variant showing different signs and symptoms related to bone lesions, renal failure and anemia. Initially during sample preparation, pipetting of a serum sample was found to be cumbersome. This sample during routine analysis in the automated analyser flagged repeated alarms for clot detection indicating a possibility of a hyper viscous sample. Serum was subjected to fibrinogen and D- dimer test. The D-Dimer levels were found to be normal and fibrinogen levels were mildly elevated. Routine biochemistry investigations were normal except grossly reversed A/G ratio. Due to gross reversal of A/G ratio, the possibility of Multiple myeloma was entertained. Physician’s were alerted on telephone. Serum was sent for electrophoresis which showeda M spike. Bone marrow aspirate showed 13% plasma cells. Considering the above lab results the diagnosis of monoclonal gammopathy of smoldering type was considered. The sample was traced to a 77 years old male, who presented to Medicine OPD with the chief complaints of generalised weakness for two months without any history of fever. On physical examination pallor was evident but there was no icterus, cyanosis, clubbing, lymphadenopathy or edema. On haematological evaluation patient was found to be anemic. Careful tracking of hyperviscous patient’s serum followed up by thorough investigation led us to the final conclusion that the case mentioned is a rare case of Smoldering type of multiple myeloma.