A middle-aged woman presented with a mechanical fall. Physical examination revealed a massive purulent ulcerated lesion spanning her entire back and axilla, which had reportedly been brewing for over a decade. Punch biopsy revealed infiltrative basal cell carcinoma. She was treated with Vismodegib, with a remarkable decrease in the size of the cancer. However, surveillance imaging after 6 months of treatment revealed new bone metastases. In the setting of progressive disease, medical therapy was switched to cemiplimab instead. Basal cell carcinoma is commonly known as a benign tumour of the skin, rarely larger than 5 cm. Here, we discuss the entity of metastatic super giant basal cell carcinoma; this case is one of the largest reported lesions. As locoregional therapy, such as surgery is sometimes not appropriate for such advanced lesions, we discuss the current forefront of therapy including oral hedgehog pathway and check point inhibitors.

Pediatric arrhythmias represent around 55.1 per 100,000 patients assessed in pediatric crisis divisions. Patients with intrinsic coronary illness are at deep rooted hazard for the advancement of arrhythmias. The point of this investigation is to assess the rate and kinds of early postoperative arrhythmias after pediatric cardiovascular medical procedure. Strategies: The current investigation included 227 pediatric patients with intrinsic heart maladies made arrangements for careful repair.All patients will be exposed to Demographic information, Complete cardiovascular conclusion, Preoperative treatment,Operative system, Post-usable boundaries (electrolyte levels, oxygen immersion, blood pH, serum calcium, sodium, and potassium levels), and Electrocardiogram (ECG) , Echocardiography (ECHO). Results: there was slight female power in which female patients represented 52.9% of the complete accomplice, yet rate of arrhythmia was higher in male patients. the examination between the arrhythmic and non-arrhythmic gathering of patients uncovered a measurably critical distinction as respect of sexual orientation, with higher danger of arrythmia in male patients. There was a marginal relationship between more youthful age at activity and arrythmia too (p =0.055). In like manner, the examination between the arrhythmic and non-arrhythmic gathering of patients uncovered a measurably critical distinction as respect of BSA, with lower BSA in arrythmia gathering. End: Lower age, male sexual orientation, lower body weight, longer ACC time, longer mechanical ventilation, longer ICU remain, electrolyte irregularities, and biventricular physiology all are hazard factors for postoperative arrhythmias.Thus, specialists must consider these components preoperatively to have the option to recognize in danger populace and plan the postoperative consideration as needs be.

Glioblastoma multiforme (GM) is the most common type of aggressive malignant glioma in the brain or spinal cord and represents 15% of all primary brain tumors among adults. Although ischemic strokes in the setting of an underlying glioma is a rare occurrence, its diagnosis is usually challenging due to the overlapping neurological manifestations with the underlying brain tumor. We report a case of a 58-year-old white male who presented with subacute worsening symptoms of expressive aphasia with focal neurological symptoms, including right-sided extremity motor weakness and intermittent vision spots. Magnetic resonance imaging (MRI) of brain revealed a large 9.5 cm infiltrating mass in the left frontal and temporal lobes, strongly indicative of a primary glioma. The patient underwent resection to confirm diagnosis and remove part of the tumor mass. Pathological examination revealed GM. Expressive aphasia was markedly improved following the surgery; however, on postoperative day 3, the patient developed acute onset of right-sided weakness and sensory deficit. MRI revealed acute left posterior, frontal, and parietal infarct. Unfortunately, recent brain surgery would not allow for intravenous thrombolysis, and, therefore, he was discharged with a plan for outpatient radiation treatment and oral temozolomide chemotherapy.

A main feature of coronavirus disease 2019 (COVID-19) pathogenesis is the high frequency of thrombosis, predominantly pulmonary embolism (PE). Anticoagulation therapy is a crucial part of the management. Heparin use for anticoagulation could increase the risk of heparin-induced thrombocytopenia (HIT), a potentially fatal complication that presents with thrombocytopenia with or without thrombosis. We present a 69-year-old unvaccinated female patient with severe COVID-19 pneumonia. Initial laboratory investigation was significant for thrombocytopenia and low D-dimer levels. She was initially started on enoxaparin followed by unfractionated heparin. On hospital day 8, she developed left facial droop and dysarthria and was found to have non-occlusive thrombus in proximal middle cerebral artery as well as bilateral pulmonary emboli. She received intravenous thrombolysis followed by heparin infusion. On day 13 of hospitalization, platelet count dropped from 120,000/mm 3 to 43,000/mm 3 , raising suspicion of HIT. Heparin was stopped and fondaparinux was started. After 3 days, HIT antibody testing returned positive, then a positive serotonin release assay confirmed the diagnosis. On discharge, she was transitioned to apixaban to complete 3 months of anticoagulation for provoked PE. This case represents the diagnostic challenge of HIT in COVID-19 patients. Thrombocytopenia after heparin infusion should raise clinical suspicion of HIT, which allows appropriate discontinuation of heparin products and initiation of alternative anticoagulants to limit devastating complications. To our knowledge, this is the first case report of a COVID-19 patient presenting with venous thrombosis as well as arterial thrombotic event in the context of underlying HIT.