Digoxin intoxication is a life-threatening condition that may result in a refractory atrioventricular block and ventricular arrhythmias. Digoxin-specific antibody fragments are safe and effective in managing severe toxicity. Although digoxin poisoning is very rare, the likelihood of a severe digoxin overdose occurrence in a setting where the expensive Fab fragments are not available is very high. We report a case of chronic oral digoxin intoxication resulting in symptomatic bradycardia. Due to the severity of the intoxication and no digoxin-specific antibody fragments in this patient setting, we performed intermittent hemodialysis. After intermittent serial hemodialysis, symptomatic bradycardia was improved and there was a reduction in digoxin serum concentration.

Idiopathic Necrotizing Autoimmune Myopathy (INAM) is a rare form of inflammatory myopathy characterized by necrosis and regeneration of myocytes without significant inflammation. Concurrence of inflammatory myopathy and Myasthenia Gravis (MG) is very rare. Here we present a rare case of INAM and MG after thymectomy.

A hospital's Central Sterile Supplies Department (CSSD) is a service department that manages, processes and distributes sterile supplies to all hospital departments. It can be characterized as the hospital service that provides sterile supplies to all departments, including ordinary wards, outpatient departments and specialist units. In an ideal world, CSSD would be a separate department with facilities for receiving, packing, disinfecting, sterilizing, storing and distributing instruments in accordance with clearly defined regulations. Correct design, adequate equipment, skilled personnel and efficient workflow are vital to this area. The objective of CSSD is to provide consistently sterilized items for any agreed-upon use in the hospital at the required time and location as affordably as possible. It collaborates with the Infection Control Committee and other hospital programmes to create and oversee guidelines for cleaning and decontaminating reusable equipment, contaminated equipment, including wrapping methods, in accordance with the type of sterilization and the sterilization circumstances (e.g., temperature, duration, pressure, humidity). The present case study described in detail about CSSD department of Indira Gandhi Medical College, Shimla, Himachal Pradesh.

Patient with prosthetic heart valves prove to be a challenge for an anaesthesiologist for management as these patients have risk of developing Infective Endocarditis, bleeding and thrombosis and MACE. Patients especially with mechanical valves are prone for thrombosis and complications if anticoagulation is not maintained properly. When these patients are planned for any major surgery, it is best to normalize the coagulation profile right before the procedure and continue anticoagulation as soon as possible. Management of patients with prosthetic heart valves undergoing non-cardiac surgery entails cardiac evaluation for valvular function, residual pathology, infective endocarditis and functional status; assessment of the anticoagulation status, any risk of bleeding, preparation for reversing anticoagulants intraoperatively if necessary and neurological evaluation for identifying any neurological impairment caused by thromboembolism. We present the effective anaesthetic management of a patient who was a known case of Rheumatic Heart disease and had prosthetic mitral and aortic valves with history of craniotomy and was posted electively for cranioplasty.

The Rod of Asclepius connects medical toxicology with critical care. Moses Maimonides' late-12th-century Treatise on Poison and Their Antidotes provides this evidence. Poisoned individuals should be examined and managed by intensive care physicians. Poisoning with authorised or illegal chemicals can cause a variety of symptoms. Thus, a poisoned patient's medical history and physical examination are crucial. The patient should be stabilised and supported until the offending medicine is found. Supportive care, toxin avoidance, antidotes and improved excretion are the goals. Critical care physicians often treat poisoned patients. These patients seldom suffer toxicity and only need monitoring. However, severe side effects require rapid care. First, stabilise the airway, breathing and circulation. Medical history, toxidrome and laboratory tests may help clinicians identify the toxin. Antidotes can be used after identifying the hazardous substance. The Poison Control Programme's National Poison Information Centre (NPIC) provides clinicians with 24x7 telephone access to important information. The NPIC will provide a probable diagnosis, emergency treatment recommendations, the antidote and if possible, its source after detailing the medication the patient consumed.

SARS-CoV-2 is responsible for a raging pandemic, most commonly affects the respiratory system. However, multisystem involvement and atypical clinical manifestations are not uncommon. Moreover, little is known about the clinical characteristics of kidney-related complications, including hematuria, proteinuria and AKI. Here, we present a case report of a 11 years old Indian adolescent male presenting with features of nephritic syndrome concurrent with SARS-CoV-2 infection, with no antecedent history of any chronic disease or any similar past history, who eventually recovered after receiving supportive treatment.

Introduction: KCNQ2 related disorders comprise both benign seizure disorders and early onset epileptic encephalopathies. Especially within the latter group, patients suffer from refractory seizures to standard antiepileptic drugs and developmental delay. Case: we present here the case of a 5 month old child who presented with gross developmental delays and intractable seizures refractory to multiple anti-epileptic treatments. Conclusion:KCNQ2 screening should be included in the diagnostic workup of refractory neonatal seizures of unknown origin.

Fractures occur more often in the paediatric age group than in healthy adults. Adolescents and youngsters have less developed risk assessment skills, which contributes to this. Skeletal development also occurs at a time when bone is less stable, albeit more elastic, than in adulthood. These characteristics account for the greater prevalence of fractures and the faster recovery seen in children and adolescents. Fracture treatment in children and adolescents calls for expert understanding of the unique radiographic architecture, growth features of healthy and injured bones and fracture dynamics of this age group. But youngsters are often handled as if they were little adults. An abnormally high number of complaints are made about the treatment of fractures that occur throughout the time of skeletal development. The goal of this article is to review juvenile fractures and help them realise when these injuries require specialised care.

GABRB3 gene mutations are known to cause early infantile epileptic encephalopathy (EIEE). We report a male infant who presented at 2 months of age with feeding difficulties, intractable seizures and developmental regression. Genetic testing revealed a likely pathogenic GABRB3 (c.860C>T; p.Thr287Ile) mutation along with biotinidase deficiency and G6PD deficiency. Despite multiple antiepileptic drugs, seizures remained frequent until biotin supplementation was started, after which seizure frequency decreased and skin/hair changes improved. This case highlights the importance of genetic and metabolic evaluation in infants with early-onset refractory epilepsy.

The buildup of fatty deposits within your artery walls is caused by excessive lipids, particularly LDL cholesterol, which reduces or blocks the flow of blood and oxygen to your heart. When total cholesterol levels are markedly elevated, the risk of cardiovascular disease increases significantly. LDL cholesterol is removed from the arteries by HDL cholesterol and returned to the liver for excretion. An abundance of HDL appears to guard against cardiovascular disease. We report this interesting case to emphasize that the patient with extremely high serum HDL and high total cholesterol has not developed any signs and symptoms of coronary heart disease. The patient is completely asymptomatic despite having extreme cholesterol deranged for 2 years.

Syringomyelia is a rare case with very varied clinical symptoms involving the motor, sensory and autonomic systems, which have a clinical symptom similar to other disorders of the spinal cord. This disorder is rare or following congenital abnormalities such as the Arnold-Chiari malformation. The management of this patient with surgery and medication according of clinical condition, causes and other supporting examinations.

Monophasic synovial sarcoma is a rare tumor with only a few cases reported in the young age group. We report a case of monophasic synovial sarcoma in a 16 years old male which initially presented with mass in the anterior compartment of the left thigh. On MRI, a large lobulated heterogeneously enhancing altered SI mass below the vastus medialis not involving the underlying bone. Excision biopsy was done by the department of Surgery and sent to department of Pathology, IGMC Shimla. The tumour cells were immunoreactive for Vimentin, CD99, TLE1, Bcl2. A diagnosis of Monophasic Epithelial Synovial Sarcoma was made.

Though rhabdoid tumors have been described in extra renal locations, their occurence in gastrointestinal tract is rare. Their occurence in stomach is extremely rare with only 17 cases reported in literature till date. We report an additional case in stomach in a 67 year old female which revealed extensive areas of rhabdoid tumor cells with only a few foci of well differentiated adenocarcinoma. The rhabdoid tumor cells were positive for both vimentin and cytokeratin. Recognition of the rhabdoid phenotype in gastrointestinal tract neoplasms is important because this feature is associated with poor prognosis and unresponsiveness to conventional therapy.

Basaloid Squamous Cell Carcinoma (BSCC) is an unusual variant of Squamous Cell Carcinoma (SCC) with a predilection for the upper aerodigestive tract. Their occurrence in the tonsil is rare. Their histological features are well described. However their cytological features are not very well described. We describe the cytological features of a case of BSCC of tonsil metastatic to submandibular lymph node. The presence of variably sized hyaline stromal globules and finger like cords of hyaline stream fragments along with pleomorphic basaloid tumor cells in the lymph node mimicked metastatic adenoid cystic carcinoma. However histopathological examination and immunohistochemistry confirmed the BSCC of the tonsil with metastatic deposits in the submandibular lymph node. We also discuss the diagnostic pitfalls in the cytological diagnosis of BSCC.