Binder syndrome (BS) is an uncommon congenital disorder affecting the face. The condition, which also goes by the names naso-maxillary hypoplasia (NMH) and maxilla-facial dysplasia (MFD), causes the central face to develop inward and may also affect the upper jaw and the nose. A 19-year-old male with a known case of BS presented with a complaint of poor esthetics since birth. Previously, the patient was admitted to a private hospital where he was operated on for cleft lip and palate in the years 2003 and 2005. In 2017, he visited the dental clinic where the orthodontic treatment started for poor esthetics, and then he was referred to the oral surgery ward for surgical intervention. For about five years, he has been undergoing orthodontic treatment. A physical examination of the oral cavity was done and the physician suggested a CT scan of the brain. Recently, the patient underwent bilateral Le Fort II osteotomy with distraction osteogenesis under general anesthesia which repaired the patient's esthetics.

Neonatal hypernatremic dehydration (NHD) is a common complication in breastfed neonates which if not recognized early can lead to life-threatening complications. Only a few cases of NHD leading to peripheral gangrene have been reported in the literature. We report a case of a 14-day-old neonate with complaints of dyspnoea, poor oral intake, and gangrenous changes in the left leg. There was a 28% weight loss since birth due to inadequate feeding. The baby was diagnosed with severe hypernatremic dehydration with Kidney Disease Improving Global Outcomes (KDIGO) stage 4 acute kidney injury requiring peritoneal dialysis. Ultrasonography of the left lower extremity revealed a distal femoral artery thrombus leading to dry gangrene requiring amputation. There were neurological signs like altered sensorium and drug-resistant seizures which were suspicious for intracranial pathology like cerebral venous sinus thrombosis. Prevention and early diagnosis of NHD are essential to prevent the occurrences of such grave complications. It can be easily achieved by improving the vigilance regarding the adequacy of feeds subjectively by the mother if the baby is at home and objectively by physicians in the hospital setting. These simple interventions have the potential to prevent readmissions due to not only simple feeding complications but grave complications as mentioned above as well and save precious lives.

An ampullary carcinoma (AC) is defined as cancer that arises in the ampulla of Vater (AV). It is a tiny opening in the beginning segment of the small intestine called the duodenum. Pancreatic and bile duct fluids are pumped into the intestines via the AV. There are various factors listed as the causes of AC. A 45year-old male presented to the emergency department with complaints of pain in the abdomen for two months, vomiting for two days, and a history of fever for four days, which was persistent in nature. He had been operated on for endoscopic retrograde cholangiopancreatography (ERCP) stenting two months back due to pain in the abdomen. The patient underwent investigations such as blood tests, histopathology, ultrasonography, abdominal contrast-enhanced computed tomography (CECT), and ampullary mass biopsy, based on which a final diagnosis was made. The patient was operated on by the Whipple surgical procedure and was later treated with antibiotics and analgesics. Surgical management for AC is a novel treatment chosen instead of chemotherapy. Although early-stage AC can be cured with radical surgery, around half of the patients experience tumor recurrence. The prognosis of our patient was good.

A stroke that occurs either in arteries that supply the spinal cord or the spinal cord itself is called spinal cord infarction (SCI). The lower thoracic area is the most typical site for spinal cord infarcts. Spinal infarcts are rare even among people without sickle cell disease, making up only a very less amount of all infarcts to the central nervous system. A 22-year-old female with a known case of SS pattern sickle cell anaemia was brought by her parents to the emergency medicine department with a complaint of pain in the bilateral upper and right lower limbs. The pain progressed to weakness within 15 minutes, which was sudden in onset and associated with faecal and urine incontinence. On physical examination of the client, her Glasgow coma scale (GCS) was E3 VT M5, pupils were bilateral and equally reactive to light, in both upper limbs, the power was 0/5 and 2/5 in the left lower limb, and hypotonia in the upper and right lower limb was noted. Still, the tone was expected in the left lower limb. MRI showed myelopathy extending over three segments from c2 to c4 involving predominantly anterior aspect, most likely cord ischemia. The patient was treated in the neurocritical care unit with tab Ecosprine 150 mg, multivitamins, and rehabilitative therapy. After two months, she showed gradual but consistent improvement in restoring some motor function in her affected limbs. SCIs are uncommon. Although ischemic stroke can be treated with anticoagulants and antiplatelet medicines, viable therapies for SCI have not yet been identified.

Here, we report a case of a nine-year-old boy with chronic juvenile rheumatoid arthritis (JRA) leading to scleromalacia perforans (SP). We rarely see SP with fixed deformities of rheumatoid arthritis in the hands, but not as a starting point of the disease. He reported eye manifestations associated with JRA on further investigation and inquiry. The right globe was preserved on presentation, and the left was perforated. He lost sight in his left eye when he was treated with antibiotics and visited various physicians in his native region.