Restless leg syndrome (RLS) is a sleep disorder characterized by the sudden urge to move the lower limbs during periods of rest accompanied by an unpleasant sensation like tingling or burning in the legs. Often, this urge is partially relieved by the movement of legs. However, it causes disturbance of sleep leading to daytime fatigue. Herein, we present an unusual case of new-onset of restless leg syndrome in a COVID-19 infected patient who presented three weeks after an uncomplicated delivery via caesarean section. The patient was managed with sleep hygiene measures, oral iron and vitamin C tablets apart from general COVID-19 management medications, subsequently leading to significant improvements. Here we have discussed possible associated factors, pathophysiological mechanisms and management of RLS in the case of COVID infected individuals.

Wilkie's syndrome, also commonly known as superior mesenteric artery (SMA) syndrome, is an infrequent and rare cause of small bowel obstruction. It is caused by extrinsic compression of the duodenal segment of the intestine between the aorta and SMA, causing significant post-prandial abdominal pain and vomiting. The literature suggests the incidence of 0.01% to 0.3%. We present here an atypical presentation of SMA syndrome in which a young patient presented to our tertiary set-up with unusually constant abdominal pain and weight loss requiring invasive interventions.

Breastfeeding is known to be beneficial for the health of both the child and the mother. The primary aim of this study is to assess the effect of lactation on the development of gross motor milestones. The evaluation of breastfeeding practices and the frequency of lactation among mothers living in the urban city of Karachi, Pakistan, is the secondary aim of this study so that interventions can be made to improve breastfeeding practices. A cross-sectional study was conducted using a well-designed questionnaire. A population of 360 mothers living in Karachi, Pakistan, with children aged between two and six years, was selected. The questionnaire included demographic data, the duration of breastfeeding, the age of milestone development, and the educational and financial status of the mothers. The relationship between the duration of breastfeeding and the development of gross motor milestones was analyzed using the Pearson chi-square test via Statistical Package for the Social Sciences (SPSS) version 22.0. A p-value < 0.05 was rendered significant. Descriptive statistics were applied to calculate the frequency of the varying duration of breastfeeding among mothers with respect to their socioeconomic status and educational class. The study revealed that 68.6% of children were breastfed for four months or more with supplementary feed or solids started at four months or later (prolonged exclusive). Along with this, 6.4% were breastfed only before two months (short duration), 5.6% had been breastfed beyond two months but ceased before four months (intermediate duration) while 14.7% were breastfed for four months or more with supplementary feed or solids started before four months (prolonged partial). Mothers belonging to low (67.7%), moderate (67.5%), and higher (72.2%) socioeconomic status (SES) preferred to breastfeed for a prolonged exclusive duration. With respect to education, uneducated mothers (72.6%), mothers with primary education (63.6%), secondary education (65.90%), and tertiary education (68.6%) also breastfed for a prolonged exclusive duration. No statistically significant correlation was found between gross motor milestone development and the duration of breastfeeding (p-value > 0.05). Breastfeeding was found to have an insignificant impact on the development of gross motor milestones despite the fact that mothers, irrespective of educational background and socioeconomic status, were found to be breastfeeding for a prolonged exclusive duration.

The development of spontaneous pneumomediastinum and subcutaneous emphysema are few of the rare clinical manifestations observed in coronavirus disease-19 (COVID-19) patients which are yet to be fully understood. Most cases of spontaneous pneumomediastinum arises due to factors causing high intra-alveolar pressure. Herein, we report a case of a COVID-19 positive elderly male, who presented with spontaneous pneumomediastinum and subcutaneous emphysema unrelated to high-pressure ventilatory measures, detected on chest computed tomography (CT). Despite acute medical care, the patient progressed towards a more serious clinical course. Male gender and diffuse alveolar damage caused by COVID-19 seems to be the most relevant association in this case. However, we have enlightened other possible pathological mechanisms and their association with severity index of COVID-19.

The risk of acute respiratory tract infections is particularly pronounced in patients deficient in 25-hydroxyvitamin D (25(OH)D). With respect to COVID-19, there are conflicting evidence on the association of 25(OH)D levels with disease severity. We undertook this study to evaluate the 25(OH)D status in COVID-19 patients admitted in Karachi, Pakistan, and associated vitamin D deficiency with primary outcomes of mortality, length of stay, intubation, and frequency of COVID-19 symptoms. A total of 91 patients were evaluated for 25(OH)D status during their COVID-19 disease course. 25-hydroxyvitamin D levels were classified as deficient (< 10 ng/mL), insufficient (10–30 ng/mL), or sufficient (> 30 ng/mL). The study population comprised 68.1% males (N = 62). The mean age was 52.6 ± 15.7 years. Vitamin D deficiency was significantly associated with intensive care unit (ICU) admission (RR: 3.20; P = 0.048), invasive ventilation (RR: 2.78; P = 0.043), persistent pulmonary infiltrates (RR: 7.58; P < 0.001), and death (RR: 2.98; P < 0.001) on univariate Cox regression. On multivariate Cox regression, only death (RR: 2.13; P = 0.046) and persistent pulmonary infiltrates (RR: 6.78; P = 0.009) remained significant after adjustment for confounding factors. On Kaplan Meier curves, vitamin D deficient patients had persistent pulmonary infiltrates and a greater probability of requiring mechanical ventilation than patients with 25(OH)D ≥ 10 ng/mL. Mechanical ventilation had to be initiated early in the deficient group during the 30-day hospital stay (Chi-square: 4.565, P = 0.033). Patients with 25(OH)D ≥ 10 ng/mL also demonstrated a higher probability of survival than those with 25(OH)D concentrations < 10 ng/mL. 25-hydroxyvitamin D deficient population had longer hospital stays and worse outcomes.

Background: Duplication of the vas deferens, a rare congenital anomaly of the pelvic anatomy, is often an incidental finding during surgeries involving the spermatic cord, such as inguinal hernia repair, varicocelectomy, orchidopexy, and vasectomy. Case Report: A 25-year-old male presented to our surgical outpatient clinic with bilateral swelling in the inguinal region. A diagnosis of bilateral inguinal hernia was established. While performing spermatic cord dissection during hernioplasty, a duplicated vas deferens was revealed within the left spermatic cord. Doppler ultrasonography confirmed the absence of waveforms in both vasa deferentia, differentiating them from adjacent vessels. The hernia repair was performed without complications. Conclusion: Our case highlights the importance of radiologists’ and surgeons’ ability to recognize a duplicated vas deferens to avoid possible iatrogenic injury.