Background: Allergic conjunctivitis (AC) represents one of most the common condition presented in a paediatric age group. It is usually underdiagnosed and undertreated, especially in the non-verbal group of patients. However, in some cases the presenting age can become the reason patients were undertreated, coupled with a lack of verbal complain and parents’ role in the management, can lead to a poorer prognosis. Case: A 7-year-old girl whos is under investigation for alopecia areata and failure to thrive was referred at the age of 5-year-old after non-improving of bilateral eye redness and tearing. Initially presented, to a different medical center, at age of 4-month-old with complaint of only tearing. Examination under anaesthesia shows she has bilateral eye (BE) allergic conjunctivitis and BE cornea scarring after multiple visit and undertreatment Conclusion: However, in some cases the presenting age can become the reason patients were undertreated, coupled with lack of verbal complain and parents’ role in the management, can lead to a poorer prognosis.

Marburg Virus is a contagious virus belonging to the family Filoviridae, which is shared by Ebola Virus. It leads to a disease which is typically characterized by viral haemorrhagic fever (VHF). The infection can get systemic during the late organ phase, which eventually leads to multi-organ dysfunction, thereby making it a deadly disease. An important factor contributing to its tissue tropism is the Marburg Virus glycoprotein (MARV GP), while a host of nucleocapsid-associated as well as matrix-associated proteins contribute to its features of immune evasion and viral spread. Till now, all of the major outbreaks have been traced to African origins and efforts are being made to raise awareness regarding this emerging infectious disease. Prevention is dependent on early diagnosis or detection, which relies upon RT-PCR, Antigen ELISA, Antibody ELISA, etc., as well as protection against the natural reservoirs, the Egyptian fruit bat, and their droppings. Adequate protection and distancing from the infected vectors, the non-human primates (NHPs) is also crucial. This review discusses some key aspects of Marburg Virus and the disease that it causes, while also throwing light on prevention and control strategies, in the backdrop of the recent outbreak in Ghana. The review concludes by drawing a parallel between MARV and other bat-borne as well as RNA viruses, integrated with the selection pressure on this virus to delineate the potentiality of a future large-scale outbreak of MVD.

Background: Ankylosing spondylitis (AS) is a seronegative inflammatory disease that progressively affects the spine and sacroiliac joints. It can also predispose patients to several other pathologies. Renal stones have been rarely reported in patients with AS. Case Presentation: In this case, we describe a 54 years old gentleman who presented with acute renal colic as well as unstable angina posing a dilemma over the management strategy. We also discuss our management strategy where we carried out simultaneous an-aortic off-pump beating heart CABG as well as retrieval of ureteric stone with a satisfactory outcome. Conclusions: Though AS increases the risk of adverse outcomes after CABG it is not significantly associated with poorer overall mortality and long-term outcomes. Therefore, patients should not be denied surgical revascularization. Awareness of issues around intubation, choice of conduits, access to the aorta, sternal closure, and mobilization are important for a satisfactory outcome. The aortic OPCAB approach, where possible, can ameliorate some of these issues, improve outcomes and minimize future reoperation in this challenging subset of patients.

Strokes are a common presentation to emergency departments all over the world. Early recognition of strokes is essential which is followed by ruling out stroke mimics, going for a radiologic investigation and decision making for thrombolysis. To create a fully functioning Neuro emergency stroke team in assisting in stroke thrombolysis, a dry run was done for a month in the emergency department which saw the common challenges and pitfalls to tackle before the actual thrombolysis is started to prevent or minimize the risk of complications of stroke management.

Stimulants abuse is a global issue. Acute myocardial infarction, heart failure, and arrhythmia have all been linked to stimulants misuse and its synthetic variants but are rather uncommon. Herein, we present a case of a young patient presented with atrial fibrillation that did not respond to digoxin therapy. A suspicion of drug toxicity was later confirmed with a bedside urine screening. Following administration of benzodiazepines, the patient's clinical condition gradually improved, and he was eventually discharged with a prescription of lifelong warfarin. Therefore, patients with a low-to-intermediate risk of coronary artery disease presenting with atypical symptoms may benefit from a full substance use history and urine drug screening to ensure prompt institution of appropriate treatment.

Mental health screening is an important parameter to measure and treat in the emergency department. Though it may not be as acute or life and limb threatening as other illnesses, it may pose danger to the patient if risk assessment is not done adequately that can lead to mortality and morbidity. Recognition of common mental health disorders in the emergency department is important and early, quick screening methods must be applied to assess the severity and improve recognition. A quick treatment method must also be applied and proper disposition and referral system must be applied for the patient to get adequate help they need.

Objectives: This study aimed at evaluating and comparing the values of Endothelial Cell Density (ECD) and Central Corneal Thickness (CCT) among Type 2 Diabetic cases and Non-Diabetics. It also aimed at finding the correlation between ECD and CCT with the diabetes duration, Random Blood Sugar (RBS) levels, and more severe stages of Diabetic Retinopathy (DR) in the diabetic subjects. Design: Comparative Cross-sectional. Study Setting and Duration: The data was collected from the General Outdoor Patient Department (OPD) of Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan within duration of 8 months from January to August 2021. Methodology: After taking the informed consent, a complete history of each subject was taken. ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart was used to evaluate Visual acuity and subjective refraction and then a complete slit-lamp anterior and posterior segment examination was performed followed by Specular Microscopy to measure the ECD and CCT. The diabetic subjects were checked for their RBS immediately after Specular Microscopy (TOMEY Specular Microscope EM-4000) using a digital glucometer and the readings were carefully recorded. Results: Results showed ECD to be significantly lower (p = 0.000) while CCT to be significantly higher (p = 0.000) in type-2 Diabetics than in Non-Diabetics. On correlation analysis, ECD was negatively correlated (p<0.05) while CCT was positively correlated (p<0.05) with diabetes duration, RBS, and severity of DR. Conclusion: This study concluded that the ECD and CCT were significantly different among diabetics and non-diabetics.

The presentation of a paediatric patient with shortness of breath can be a common occurrence in the pediatric population presenting to the emergency departments with the majority of the illnesses in paediatric population can be attributed to shortness of breath. Recognition of life-threatening illnesses in a pediatric patient presenting to the emergency can be a challenge and thus having a low threshold of suspicion. Early recognition and treatment can be crucial and life-saving with the involvement of the right teams and the appropriate disposition of patients. In this case, we share a rare cause of shortness of breath in a child presenting to the emergency department.

Background: Vacuum-assisted wound dressing consists of a vacuum/suction machine, a conduction hose, a suction portal, foam/gauze, and an air-tight membrane, a method that is more technical but needs proper user training prior to application of the dressing. Methods: The population (P), intervention (I), and outcome (O) frameworks were used in this search strategy with keywords. The data extraction technique used the PRIMA guidelines with inclusion and exclusion criteria guided by the PIO framework. The quality of studies was assessed using appraisal tools for randomised controlled trials. A forest plot was used to illustrate the overall outcome in a random effect model. Out of 66 total articles extracted from databases, only five studies were used. Conclusion: Vacuum-assisted wound dressing showed no significant improvement in healing time compared to normal saline dressing (1.0).

The emergency department of Malaysia has been greatly affected by overcrowding, longer waiting times, and longer admission times ever since the world was hit by the COVID-19 pandemic. Thus, it is essential for the emergency department to obtain an accurate diagnosis early and provide earlier treatment for better outcomes for patients. The use of bedside lung ultrasound is useful in these scenarios in differentiating different causes of respiratory symptoms, and further management and definite treatment can be provided accordingly.