Acid-related disorders such as gastric and duodenal ulcers and gastro-oesophageal reflux disease have a high prevalence. Traditionally, acid suppression has proved to be the most effective means by which to heal these disorders, but relapse rates are high after cessation of treatment. Recently, Helicobacter pylori infection has been shown to modify several aspects of gastric function. Eradication of H. pylori infection virtually abolishes duodenal ulcer recurrence, implicating this organism in the pathogenesis of peptic ulcers and initiating a whole new strategy in the management of these acid-related disorders. More

No abstract

The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious patient. Many reported cases of locked-in syndrome following neurotoxic snake-bite mimics brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming. His condition deteriorated, and was intubated and ventilated in the emergency department. He received a total of 33 vials of the Ophiophagus hannah monospecific antivenom and subsequently recovered well with no neurological deficit. Retrospectively, he was able to recall the events and while he was lying paralysed and intubated under minimal sedation in the intensive care unit. He described it as a terrifying and painful experience. This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming lock-in syndrome from brain dead. Patients are unable to respond to physical pain and require adequate analgesia. A patient suffering this highly distressing experience may require psychological support.

Eventration of the diaphragm is caused by weakened musculature of the diaphragm. This can occur in one or both hemidiaphragms. Symptoms may be minimal and it is usually detected incidentally on chest radiograph which would show an elevation of the diaphragm. We report and discuss a case of eventration of right diaphragm in a patient presented with a lobulated lung mass on chest radiograph.

No abstract