Gastrointestinal tuberculosis accounts for nearly 3 % of the total extra pulmonary cases. Tuberculous appendicitis is a rare type of gastro intestinal tuberculosis, seen only in 0.1 to 0.3% of cases. Here we present a tuberculous appendicitis case in a 20 year old female.

Introduction: Paraneoplastic hypoglycemia unrelated to insulinoma is a rare cause of hypoglycemia and is due to paraneoplastic secretion of either IGFI, IGFII, or more rarely insulin Observation: We report a case of paraneoplastic hypoglycemia in a patient with metastases of an unknown primary. This is a 60-year-old patient admitted to the ward for recurrent hypoglycemia, the first of which was discovered following an apyretic coma. He has a history of hepatic and gluteal metastases from an undifferentiated carcinoma, the primary of which is unknown, followed in the oncology department and treated by chemotherapy. The biological assessment shows microcytic hypochromic anemia, hypoinsulinism <0.1mIU / l associated with a collapsed C peptide <0.15ng / ml (RV: 1.1- 4.4) with a concomitant glycemia of 21 mg/l. In view of the clinical context and the paraclinical explorations, the diagnosis of paraneoplastic hypoglycemia was retained after the elimination of the factitious origin and the insulinoma. The patient was put on diet, infusion of 5% glucose serum from which he was weaned after the introduction of prednisolone corticosteroid therapy: 60 mg per day with good tolerance and disappearance of hypoglycemia. Discussion/Conclusion: Paraneoplastic hypoglycemia is hypoglycemia most commonly caused by the overproduction of insulin-like growth factor 2 (IGF-2) and its precursors which can activate the insulin receptor. In general, large mesenchymal and epithelial tumors may be the cause. The diagnosis is confirmed by the discovery of an elevated IGF-2 / IGF-1 ratio. The basic treatment is surgical excision. Glucocorticoids are among the drugs that can be used in cases where surgery is not possible as a first line followed by other alternatives in case of failure.

Introduction: Ganglioneuroma is a rare, benign neurogenic tumor that develops from sympathetic ganglionic cells. It is mainly located in the retroperitoneal region. Observation: This is a 39-year-old patient with no pathological history who has been seen for right back pain. Abdominal CT showed a right adrenal tumor with diameters of 40mm×22.5mm, a spontaneous density of >10 HU before injection, and > 31.5 HU after injection with a wash-out at late time < 40%. The hormonal balance reversed the secreting character of the mass, surgical treatment was indicated, histological analysis came back in favor of adrenal ganglioneuroma. Conclusion: Although benign, the ganglioneuroma may present malignant aspects, including scanographic that can mislead the clinician. Therefore, histology remains the examination of choice to make the diagnosis.

Perforation of the gallbladder during laparoscopic cholecystectomy is common and results in the spillage of stones into the abdominal cavity. Most of these buried gallbladder stones are clinically silent, but a small percentage can develop complications such as infections, abscesses, and fistulas months or years after surgery If these stones are ignored and not removed from the abdominal cavity. This review presents a 59-year-old woman who was complicated by chronic supra-umbilical discharge from the camera site port, after six months of surgery. The patient had a previous history of multiple abscess drainage, and the radiological examination revealed abdominal gallstones in the abdominal cavity and attached to the abdominal wall with no connection to the abdominal organs. This study discusses our case and reviews the literature on the prevention and treatment of spilled gallstones after laparoscopic cholecystectomy.

Introduction: The changes of the operative program lead to inefficient use of available operating ranges, and waste of resources. Objective: This study was conducted to evaluate the incidence, causes in the changes of the operating program and any consequences in order to find appropriate solutions for better patient management. Materials and Methods: It was of a study conducted in the potential services of anesthesiology of the Mohammed V military hospital in Rabat. Was included in the study changes the operating program (refusal, addition). Were excluded all the changes in the other operating sites. For any changes was completed farm return. The collected parameters were: age, sex, ASA, categories, the service concerns by adaptations, causes, the timing of the change and patient’s outcomes. Results: From November 2020 to May 2021; 3620 were scheduled for elective surgical operations. Of these, 320 (8, 8 %) patient’s operations were cancelled and 252 (7%) were added. The Urology department had the highest rate of cancellations (23, 4%). Causes related to patients represented 50 % of cancellation’s rate, followed by causes related to the surgery 40% and finally those related to anesthesia in 10% of all cancellations. The absence of the patient during the intervention was the most common patient-related reason for cancellation (78.1 %), the most common surgery reason was not a sufficient time frame (55.5 %) and finally the non-availability of blood and up ICU (25% each), were those related to anesthesia. Conclusion: Changes in the operating program rate were high in comparison with reported rate worldwide. Efforts should be made for planning, programming and coordination between the different actors involved in the operational planning.

In sickle cell anaemia (SCA), continuous activation of the vascular endothelium by inflammatory cytokines leads to increased elaboration and secretion of von Willebrand Factor (vWF), a potent mediator of adhesive interactions involving the endothelium and circulating blood cells. Non-O blood groups are associated with the elevation of vWF concentration. Thus, SCA and non – O blood groups are determinants of increased levels of vWF, which plays a pivotal role in the pathophysiology of vaso-occlusive crisis (VOC). To determine the influence of plasma vWF:Ag levels, ABO and Rh (D) blood groups on the risk of occurrence of sickle cell vaso-occlusive crisis. We conducted a prospective study of frequencies of VOC with respect to plasma vWF:Ag levels, ABO and Rh (D) blood groups of 50 SCA patients. In comparison with blood group O, patients with non – O blood groups had significantly higher mean vWF concentration (4.17+3.16 IU/l vs 3.46+3.69 IU/l, p< 0.001), with a significantly higher mean number of VOC episodes per patient (3.2 vs 1.3, p<0.001). The relative risk of VOC for patients with non- O blood groups was 1.87 (95% confidence interval 1.5 - 2.2, p<0.001). However, the association of Rh (D) blood group of the patients and their plasma vWF:Ag levels on the risk of occurrence and frequency of VOC was not statistically significant (P = 0.155). SCA patients with non – O blood groups had more episodes and higher risk of VOC that were likely due to the effect of higher plasma vWF concentration. These results indicate that the non- O blood group is a risk factor for frequent VOC and an unfavourable prognostic marker in SCA. We hereby recommend that a large multicentre prospective study be carried out to definitely determine the impact of ABO, Rh and other blood groups on the overall clinical course of SCA.

Background: Cancer diagnosis can have an extensive impact on mental health and comfort. Depression and anxiety may hamper cancer treatment and recovery, as well as quality of life and survival. Cancer is an important incident in one's life which has substantial outcomes for patients and their families as well. The major psychological significance in cancer patients is depression that often takes less attention. Objective: The objective was to determine the prevalence of anxiety and depression among cancer patients and whether these conditions were associated with certain sociodemographic factors. Methods: It was a cross-sectional study. By convenient sampling technique, a total of 150 samples were selected. The patients were studied after histopathological confirmation of diagnosis of cancer. Sociodemographic and other data was collected by face-to-face interview using semi structured questionnaire. Data analysis was done by Statistical Package for Social Sciences (SPSS) version 26.0 and results were presented with appropriate graphs and texts. Results: The mean age was 46.5±9.5 years. 65.3% were male and 34.7% respondents were female. Male: female ratio 1.9:1. Moderate depression was higher in-service holder 53.8%. Among agriculture worker, 38.6% had mild depression symptom, within house wife 63.2% had mild to moderate depression symptom. No significant relation was found occupation with depression symptom (p>0.05). While moderate anxiety symptom was higher in-service holder 42.3%. Among agriculture worker, maximum 54.5% had moderate to severe anxiety symptom, within house wife 47.4% had moderate to severe anxiety symptom. No significant relation was found occupation with anxiety symptom also (p>0.05). Significant relation was found among income group with level of depression and anxiety symptom (p<0.05) as study showed both depression and anxiety were found more among higher income group population than lower income population. Conclusion: In this study both higher education and higher socioeconomic status were found to be predictors of depression and anxiety.

Background: White coat hypertension (WCH) is a condition in which people exhibit an elevation in blood pressure (BP) in a clinical setting, although they do not show such elevation in other settings. This study aims to provide new insight into determining the prevalence of WCH amongst patients with or without any cardiovascular risk. Method: This is a cross-sectional study of convenience sampling study design where 300 patients were involved based on their consultation to a Tertiary Healthcare Unit between November 2021 to March 2022 in Erbil city. Patients were classified according to the ESC into different categories of BP patterns by comparing the first BP reading that was taken at clinic with their average AMBP readings which were taken at home. Results: A total of 300 patients were included in the study where 58% of the population was male and 42% of the population was female. Of the population, 16% had WCH, 12.3% had sustained HTN, 59.3% were considered to be normotensive (NT), and 12.3% among them were categorized as masked hypertension. From the total of 47 patients that were diagnosed with WCH, 55.3% were male and 44.7% were female patients. The overall average Systolic Blood Pressure in WCH was 125.79±15.30 mmHg, and in Hypertensives it was 147.70±17.15 mm Hg with a P-value of <0.001. The Mean Arterial Pressure in WCH was 94.63±8.87 mmHg and in Hypertensives it was 112.16±13.62 mmHg with a P-value of <0.001. The average Pulse Pressure in WCH was 75.27±9.42 mmHg, and in Hypertensives it was 76.35±9.11 mmHg with a P-value of 0.001. Conclusion: WHC is significantly prevalent in Erbil city; therefore AMBP monitoring should be performed for those with certain indications to limit the prescription of unnecessary long-term medications with possibly significant side effects to patients with WHC.

Introduction: The current global pandemic due to SARS-CoV-2 has resulted in a large literature on associated comorbidities, including diabetes. COVID 19 infection in a diabetic child can be complicated by severe ketoacidosis. The aim of this study is to determine the effect of COVID-19 infection on a diabetic child. Observations: The first case involved a 12-year-old Congolese child from a diabetic mother who was hospitalized for febrile respiratory distress and a consciousness disorder. Biological examinations showed the first diabetic ketoacidosis. Chest radiography showed radiological images suggestive of COVID-19 involvement, which was confirmed by a PCR and a thoracic CT. The evolution was marked by the appearance of a left pleurisy of medium abundance, which regressed after treatment. Second, a 16-month-old infant with no prior history was admitted to the hospital for febrile dehydration with impaired consciousness. Biological tests were consistent with diabetic ketoacidosis. Multiplex PCRs were performed showing infection with SARS-CoV-2 and other viruses (adenovirus, rhinovirus and enterovirus). Chest radiography was normal. The evolution was favorable under treatment with insulin therapy, rehydration, and antibiotic therapy. Conclusion: After discussing the role of decompensation or the triggering of diabetes in children with SARS-CoV-2 infection, the authors insist on the polymorphism of the clinical presentation and the need to perform a PCR in a diabetic child with ketoacidosis.

Background: More disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA) in the presence of enthesitis is associated with higher disease activity. Objective: To find out the co-relation between disease activity and quality of life among patients with peripheral spondyloarthropathy. Methodology: From March 2021 to February 2022, the Department of Physical Medicine and Rehabilitation at BSMMU, Dhaka, performed a cross-sectional research. A total of 105 individuals diagnosed with pSpA who were included in the trial were chosen on purpose. Excluded from the research were patients with concomitant systemic inflammatory rheumatic diseases such as RA, SSc, lupus, and Dermatomyositis. The validated Bengali version of The Ankylosing Spondylitis Disease Activity Score (ASDAS), including C-reactive protein (ASDAS-CRP), was used to measure disease activity, while the validated Bengali version of the Short Form Health Survey (SF) 12v2 was used to evaluate health-related quality of life. Results: The participants' mean age was 38.8(±9.8) years, and 68(64.8%) were male. The mean duration of sickness was 4.3(±3.3) years, with 55.4% of cases lasting less than 3 years. The mean ASDAS-CRP was 3.9(±0.08), with 69(65.7%) individuals having a very high Disease Activity Score. 100% of the individuals in the research experienced arthritis and inflammatory back pain. The majority of research subjects had the HLA B27 gene (N=101, or 96.2%), and 99(94.3%) had enthesitis. Physical Component Summary (PCS) and Mental Component Summary (MCS) mean scores were 34(±7.8) and 41(±7.7), respectively. A slight negative association existed between age and PCS scores on the SF-12 (r=-0.233, p=0.017). There was a negative connection between illness duration and PCS (r=-0.339, p=0.001) and MCS (r=-0.290, p=0.003) SF-12 scores. Again, there was a moderate negative connection between ASDAS-CRP and the PCS and MCS scores of the SF-12 (r=-0.406, p=0.001) and the MCS scores of the SF-12 (r=-0.461, p0.001). Conclusion: The Disease Activity Score of the majority of individuals with peripheral spondyloarthritis was very high. The psychological health of these patients was superior to their physical health. Both physical and mental health components were negatively linked with illness duration. There was a moderate inverse connection between ASDAS-CRP and the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF-12.