A rare instance of Wilkie’s syndrome in a young male during the holy month of Ramadan

Introduction and importanceWilkie’s syndrome[SMA(Superior Mesenteric Artery) syndrome or Cast syndrome]) is a unique and rare presentation which may be included in the differential diagnosis especially when a Gastric outlet obstruction is being investigated and there is a history of an associated element of rapid weight loss. The purpose of presenting this case report is its uniqueness given a history of intermittent fasting rather than the usual eating disorders.Case presentationA crescendo worsening of symptoms of intractable vomiting, inability to eat, upper abdominal gas bloating and post meal abdominal pain since one week in a patient during a period of fasting for the first time had been observed.Clinical discussionAfter initial resuscitation, an ultrasound abdomen and an abdominal x ray revealed a distended stomach and a nasogastric tube was immediately introduced to avoid aspiration. A CT scan of the abdomen with contrast revealed the compressed duodenum in the aortomesenteric angle and the diagnosis of SMA syndrome was confirmed. An upper gastrointestinal endoscopy was also done to rule out other causes and it was found to be normal.ConclusionIn an acute presentation, the response to conservative management is remarkable and in the absence of any possible future reoccurrences the surgical options may be avoided. High index of suspicion, appropriate radiological diagnosis and stepwise treatment options may guide the troubled patient towards recovery in this rare presentation. A proper history taking is key in diagnosing such a condition and does not have to be limited to eating disorders, typically.     

Fournier’s gangrene as a rare complication in patient with uncontrolled type 2 diabetes treated with surgical debridement: A case report and literature review

IntroductionFournier’s gangrene is a potentially fatal emergency condition, supported by an infection of perineal and perianal region, characterized by necrotizing fasciitis with a rapid spread to fascial planes. FG, usually due to compromised host, may be sustained by many microbial pathogens.Case reportA 66-year-old man, with a history of uncontrolled type 2 diabetes, obesity with BMI 38, chronic kidney failure and chronic heart failure, was admitted to the Emergency Department with a large area of necrosis involving the perineal and perianal regions.DiscussionFournier’s gangrene is favoured by hypertension, obesity, chronic alcoholism, renal and heart failure. Generally, Fournier’s gangrene needs other procedures in addition to wound debridement such as colostomy, cystostomy, or orchiectomy.ConclusionWe report a case of FG found as complication in a patient with uncontrolled type 2 diabetes, treated with effective combination therapy with surgical debridement and antibiotics infusion.     

Lemierre’s syndrome or re-emerging disease: Case report and literature review

IntroductionLemierre's syndrome is a rare and potentially fatal entity characterized by the spread of an oropharyngeal infection, with secondary suppurative thrombophlebitis of the internal jugular vein and septic emboli.Presentation of caseWe discuss the case of a 52-year-old male who developed Lemierre’s syndrome following peritonsillar abscess. He presented with submandibular and submental swelling extending into the neck. His management included; incision and drainage of the abscesses; and prolonged anticoagulant therapy.ConclusionThe incidence of Lemierre's disease appears to be increasing, perhaps due to ignorance of the disease by many clinicians, and diagnosis is often delayed with potentially fatal consequences.     

Reduced port laparoscopic surgery using umbilical zigzag incision for Meckel’s diverticulitis

IntroductionReduced port laparoscopic surgery using an umbilical zigzag incision is comparable to conventional multiport laparoscopic surgery. This method is associated with improved cosmesis and decreased wound pain.Presentation of caseA 67-year-old man visited our hospital. He presented emergency room with a chief complaint of right lower abdominal pain by walking. The patient was diagnosed Meckel’s diverticulitis by computed tomography (CT). At first, antibiotics therapy and fasting were performed. Three months later, the patient underwent resection of Meckel’ diverticulum with zigzag transumbilical laparoscopic surgery. The patient’s postoperative course was good, and he rarely felt wound pain. The patient started oral intake three days after surgery, and was discharged 10 days after surgery.DiscussionZigzag transumbilical laparoscopic surgery is very useful for resection of the small intestine. This method is associated with improved cosmesis and decreased wound pain. In the case of Meckel’s diverticulitis, we suggest that interval resection of Meckel’s diverticulum was very useful as it was an operation that could be performed easily.ConclusionReduced port laparoscopic surgery using an umbilical zigzag incision is considered to be an excellent technique in terms of operability and aesthetic outcomes.     

广州市海珠区3~12岁儿童身高调查及影响因素分析

目的:了解广州市海珠区儿童身高发育情况,分析其影响因素。方法:随机抽取海珠区904名3~12岁儿童进行体格测量,对家长进行问卷调查,获得儿童身高及其影响因素的相关数据。结果:3~5岁组男、女童,6~岁组男童,7~8岁组男、女童,9~岁组男童的身高均值均低于全国水平(P<0.05)。当前身高低于遗传身高的儿童占21.6%;与遗传身高一致占65%;高于遗传身高的占13.4%。母亲身高,体型是否肥胖,经常吃钙片、喝牛奶,慢性疾病史,每天运动时间为身高的影响因素(P<0.05)。结论:广州市海珠区儿童身高发育的整体水平较低,大部分儿童没有发挥身高的生长潜能,应重视环境因素对身高的影响,采取相应干预措施,促进儿童身高增长。     

2019年东莞市长安镇高血压患者血压控制现状及其影响因素分析

目的:探讨东莞市长安镇社区高血压患者血压控制情况及其相关因素,为干预措施的制定提供依据。方法:选取长安镇参加2019年体检的社区高血压患者,分析血压控制情况及其影响因素。结果:10246例高血压患者中,血压控制未达标6666例(65.00%),达标3589例(35.00%);不同年龄组、性别、体质指数、是否饮酒、是否规律锻炼、是否高脂血症、是否高尿酸血症、服药依从性、是否签约和服务模式的血压控制达标率差异均有统计学意义(P<0.05)。结论:长安镇社区高血压患者血压控制效果不理想,应针对血压控制的影响因素,加强中青年高血压患者的教育,有效落实家庭医生签约服务,提高服务依从性,提高规范管理率,开展更有针对性、更科学和更高效的高血压防治工作。