Trichobezoars are concretions of retained, undigested material, mostly hair or hair-like fibers in the stomach. Rapunzel syndrome is the condition when trichobezoars extend into the small bowel, leading to various complications including bowel obstruction, and perforation due to pressure necrosis. We present an interesting case of trichobezoar in a 15-year-old female patient, who presented with abdominal pain for one month duration. The exam was notable for a firm palpable mass in the epigastric area associated with localized tenderness and guarding. Contrast-enhanced CT of the abdomen showed a distended stomach with the bezoar, dilated duodenal loops, and clumping of proximal jejunal loops. Upper gastrointestinal endoscopy showed a trichobezoar extending from the oesophagogastric junction to the pylorus. Endoscopic removal of the trichobezoar was not successful. An elective laparotomy was performed, during which the stomach, duodenum, and proximal jejunum were dilated. The trichobezoar, measuring 35 cm in length, extended from the body of the stomach to the proximal jejunum and caused jejunal perforation due to pressure necrosis. The trichobezoar was removed and primary closure of jejunal perforation with diversion gastrojejunostomy and jejunostomy was done. There were no postoperative complications. The patient followed up with psychiatry in the clinic after discharge, she was diagnosed with trichotillomania and started on fluoxetine, with improvement in her behavioral symptoms. In young female patients with nonspecific chronic abdomen pain and a palpable mass, trichobezoar should be considered in the differential diagnosis. Contrast-enhanced abdomen CT is the preferred imaging modality and removal of the trichobezoar with an appropriate endoscopic or surgical procedure is the treatment of choice. It is essential to diagnose and treat the underlying behavioral condition to prevent recurrent episodes.

Introduction: Augmented reality (AugR) is becoming a widely recognized and innovative platform in global healthcare. AugR has revolutionized cardiology by enhancing the understanding of cardiac structure and function. This review highlights its applications in diagnosis, surgical planning, cardiac procedures, training, rehabilitation, and the future impact of AugR-related technology.Methods: This review compiles original research and review articles on AugR in cardiology from PubMed till 2024.Results: Advancements in visualization and image processing techniques facilitate the development of AugR tools using holographic displays, enhancing diagnostic accuracy and pre-surgical planning. Current AugR tools offer 3D heart imaging for diagnostic procedures, such as assessing Left Ventricular Ejection Fraction (LVEF). AugR enables real-time visualization for congenital and structural heart diseases, aiding in catheter navigation, transcatheter valve procedures, and arrhythmia treatments. Its effectiveness extends to cardiac resynchronization therapy, ventricular tachycardia ablation, and ultrasound-guided catheterization. AugR surpasses standard 2D fluoroscopy in surgical interventions by optimizing fluoroscopic angles, improving pacemaker placement, reducing X-ray exposure, and increasing procedural accuracy. It also enhances medical training by providing immersive experiences for residents and fellows, improving emergency response training. User-friendly AugR technologies effectively engage patients, promote physical activity, and enhance outcomes in cardiac rehabilitation. Further testing of AugR could serve as a pivotal surgical navigation tool in cardiac transplantology. Mixed reality enhances procedural planning and intraoperative navigation in cardiac electrophysiology by providing real-time 3D visualization and spatial orientation. Holographic visualization techniques combined with 3D and 4D printing hold future potential in cardiac care, particularly for designing patient-specific prosthetics. However, widespread clinical adoption of AugR in many healthcare institutions is limited by technical challenges and high costs related to specialized hardware, software, and maintenance.Conclusion: AugR holds great promise in transforming cardiac care, but its clinical integration depends on rigorous trials to validate its effectiveness. While much research remains theoretical, increased human testing is essential for real-world applications. Advancing AugR, alongside technologies like 3D/4D printing and holography, could pave the way for a safer and more precise future in cardiology.

Background: By 2023, COVID-19 had caused 6.8 million deaths in the United States. COVID-19 presents more severely in leukemia compared to solid tumors (OR 1.6, p<0.05). However, data on Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS) are limited. We investigated the mortality in AML and MDS patients with COVID-19.Methods: Data from the 2020-2021 National Inpatient Sample was used to conduct a cross-sectional analysis. We identified AML and MDS patients with COVID-19 hospitalizations through ICD-10 codes. Analysis was done by propensity matching and multivariate regression with a p-value of ≤0.05.Results: Of 28,028 AML admissions, 336 (1.2%) were admitted for COVID-19. AML-COVID-19 cohort had a lower hospitalization risk (aOR 0.3, p=0.000) and higher mortality (21.7% vs 8.7%; aOR 1.6, p=0.023) than AML patients admitted for other causes. AML patients post-HSCT (Hematopoietic Stem Cell Transplantation) had a higher risk of COVID-19 (20.2% vs 9.8%; aOR 2.6, p=0.000) and increased mortality (19.1% vs 6.7%; aOR 4.1, p=0.000) compared to other causes. Similarly, of 28,148 MDS patients, 769 (2.7%) were admitted for COVID-19. The MDS-COVID-19 cohort had a lower hospitalization risk (aOR 0.59, p=0.000) and higher mortality (19.6% vs 6.6%; aOR 2.2, p=0.000) compared to other causes. In MDS, HSCT did not alter the risk of COVID-19 hospitalizations (3% vs 3.9%; aOR 0.9, p=0.662), but these patients had higher mortality (17.4% vs 5.1%; aOR 4.0, p=0.032).Conclusion: COVID-19 hospitalization was low in AML and MDS but carried a high mortality risk. Post-HSCT, the mortality is high, warranting research into understanding the underlying factors.

Introduction: Extrapulmonary tuberculosis (EPTB) adds to India’s significant economic burden, with pericardial effusion being a potentially fatal complication. This case report highlights the need for early diagnosis and the feasibility of shorter-duration treatment for EPTB in developing countries. Presentation: This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy. Conclusion: This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.

Background Patients with hematological malignancies face a substantially increased mortality from COVID-19. Although the peak of the COVID-19 pandemic has passed, the virus remains common, and understanding its impact on vulnerable groups such as those with hematologic malignancies remains crucial. Limited research exists on mortality patterns in leukemia and lymphoma patients during the pandemic. Studying these outcomes provides important insights into how different waves of COVID-19 affected immunocompromised individuals and supports the development of strategies for prevention, patient care, and risk reduction, which are essential both for managing emerging variants and preventing future pandemics. We aimed to identify the mortality risk of COVID-19 in leukemia (LekCov-19) and lymphoma (LymCov-19) in the United States and the mortality trends between each quartile from 2020 to 2021. Methods We analyzed the National Inpatient Sample database (2020-2021) to include adults (≥18 years) having leukemia and lymphoma admitted for COVID-19. Descriptive analysis, propensity matching, and multivariate regression were performed, with the p-value at ≤0.05 considered statistically significant. The risk of mortality was compared between each outcome. Results Among 8,191 LekCov-19 patients, 1,200 (14.7%) experienced mortality, whereas 507 out of 2,578 LymCov-19 patients (19.7%) experienced mortality. Multivariate regression showed a two-fold increase in mortality among LekCOV-19 and LymCOV-19 (p < 0.001). In both cohorts, several organ dysfunctions, including pulmonary, renal, and cardiac dysfunctions, were associated with increased mortality (p ≤ 0.0001). Similarly, in both cohorts, signs of bone marrow dysfunction, such as pancytopenia and thrombocytopenia, showed increased odds of mortality (p < 0.01). Both cohorts exhibited varying mortality trends, peaking during October-December 2020, January-March, July-September, and October-December 2021 (p ≤ 0.01). Hematopoietic stem cell transplantation recipients had lower odds of mortality in both cohorts, but did not attain statistical significance (p > 0.05). Conclusion COVID-19 was associated with increased mortality in leukemia and lymphoma patients. Surges in COVID-19-related mortality were identified from October 2020 to March 2021, and these trends could be pivotal in forecasting future mortality risks in cancer patients. Clinicians should refine treatment regimens and prioritize advancing clinical trials to address the effects of COVID-19 and the multiple comorbidities associated with hematological malignancies.

Multiple cranial nerve palsies frequently accompany hypoglossal nerve palsy, potentially indicating malignancy, such as lymphoma, nasopharyngeal carcinoma, or metastases. However, when solely the hypoglossal nerve is affected, the causes may involve Chiari malformation, arachnoid cyst, or infectious mononucleosis, suggesting a positive prognosis. Craniocervical junction tuberculosis (TB), is an uncommon cause of isolated hypoglossal nerve palsy and has been reported infrequently in the literature. Craniocervical junction tuberculosis accounts for only 0.5% of TB cases overall and 6% of extra-pulmonary TB cases. We present here one such case of a 17-year-old male of Indian origin with a subacute history of tongue deviation and neck pain. Additionally, the patient reported loss of weight and appetite. The patient had significant posterior cervical lymphadenopathy. Neurological examination revealed findings suggestive of right peripheral hypoglossal nerve involvement. Blood investigations showed lymphocytosis along with an elevated erythrocyte sedimentation rate of 45 mm/hr and elevated lactate dehydrogenase levels of 325 U/L. Tuberculin skin testing was positive and sputum acid-fast staining confirmed acid-fast bacilli. Magnetic Resonance Imaging of the cervical spine revealed a soft tissue component in the prevertebral space measuring 3.5 x 4.8 cm with a right paraspinal component adjoining the hypoglossal canal with peripheral contrast enhancement. Histological findings on the lymph node showed granulomatous lymphadenitis, suggestive of tuberculosis. The patient was started on 4-drug anti-tubercular therapy consisting of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol for a period of 18 months. He was subsequently followed up for 6 months till the resolution of palsy. This case emphasizes the importance of thorough evaluation and a meticulous workup to identify the underlying cause of hypoglossal nerve palsy and the importance of considering tuberculosis as a potential cause of isolated hypoglossal nerve palsy in everyday practice.