Diabetic foot complications represent a substantial health burden and are the foremost cause of hospitalization in patients with diabetes. Diabetes mellitus (DM) is known to cause several other problems. Diabetes is rapidly becoming the leading cause of illness and death worldwide. Diabetic foot ulcers (DFU) are one of the most painful complications of diabetes. These complications cause problems in blood vessels, nerves, and other organs throughout the body. DFU pathophysiology is attributed to a triad of neuropathies, trauma with secondary infection, and arterial occlusive disease. This review aims to identify the types of wounds that diabetics can develop. Owing to the complexity of their disease pathology, diabetics are susceptible to a variety of wounds, such as diabetic ulcers due to trauma (DUDT); neuropathic, ischemic, neuroischemic, arterial, venous, and mixed wounds; and diabetic bullae, furuncles, cellulitis, and carbuncles. Therefore, it is essential for healthcare providers to recognize the specific classification of a diabetic wound based on its distinctive attributes to provide appropriate wound care and therapeutic interventions. In the context of individuals with diabetes, it is of paramount significance to precisely identify the types of wounds during the initial evaluation to provide appropriate care and treatment, thereby enhancing the probability of favorable outcomes.

Neurological complications during and after SARS-CoV-2 infection have been frequently described. The detection of either SARS-CoV-2 RNA or specific antibodies against SARS-CoV-2 in cerebrospinal fluid in the context of concomitant neurological manifestations indicates neuroinfection. This is a retrospective descriptive analysis of cerebrospinal fluids and serum samples from 2 hospitalized patients and autopsy findings from 2 patients who died at home. Samples were analysed by 3 independent enzyme-linked immunosorbent assays. Specific antibodies against SARS-CoV-2 were detected in cerebrospinal fluids and paired serum in all 4 cases. Levels of antibodies in cerebrospinal fluids were highest in samples from a deceased man with critical progression of COVID-19 and detectable SARS-CoV-2 viral RNA in cerebrospinal fluid, serum, 4 brain biopsies and 15 additional tissue samples, though immunohistochemical staining for SARS-CoV-2 in brain tissue did not detect the virus. Detection of SARS-CoV-2 antibodies in paired serum and cerebrospinal fluid may support the presence of SARS-CoV-2 neuroinflammatory disease in patients with COVID-19 and neurological manifestations.

Objective:Hyperargininemia due to Arginase 1 deficiency is a rare inborn error of the urea cycle with an incidence estimated at 1:950 000. It has typical severe and progressive abnormal neurological features with biochemical findings of hyperargininemia and hyperexcretion of orotic acid. The aim of our study is to review the clinical and biochemical presentations of 4 children diagnosed with Arginase 1 deficiency in Malaysia and compare with the literature review.Design and Methods:We retrospectively reviewed the medical records of 4 patients with molecularly confirmed Arginase 1 deficiency. Patients were identified from a selective high-risk screening of 51 682 symptomatic patients from January 2006 to December 2020.Results:Our patients exhibited heterogeneous clinical presentations with acute and progressive neurological abnormalities and varying degrees of plasma arginine and urine orotic acid excretions. Interestingly, an unusual hyperexcretion of homocitrulline was found in 3 patients.Conclusions:Hyperargininemia due to Arginase 1 deficiency can present acutely and hyperexcretion of homocitrulline can be an additional biochemical feature of Arginase 1 deficiency.

Introduction and Objectives:The study was conducted to assess the association of neutrophil lymphocyteratio (NLR) in COVID-19 and to identify the cut-off value that predictsmortality, need of respiratory support and admission to high-dependency orintensive care.Methods:A retrospective observational study was conducted to collect demographicdata, clinical variables, the neutrophil-lymphocyte ratio on-admission andthe outcome of confirmed COVID-19 patients admitted to a tertiary carecenter in Sri Lanka.Results:There were 208 patients with a median age of 56 years (IQR 43-67) and 98(47.1%) males. The median neutrophil count was 4.07 × 103/µL (IQR2.97-6.79) and the median lymphocyte count was 1.74 × 103/µL (IQR1.36-4.75). The calculated NLR ranged from 0.12 to 48.28 with a median valueof 2.32 (IQR 1.37-4.76). A NLR value >3.6 predicted development of severedisease requiring respiratory support, transfer to a high-dependency or anintensive care unit and/or succumbing to the illness with a sensitivity 80%and specificity 80% (area under the curve 0.8, 95% CI 0.72-0.88,P < .0001). The adjusted odds ratio of NLR > 3.6on predicting severe disease was 11.1, 95% CI 4.5- 27.0,P < .0001.Conclusions:A NLR > 3.6 is a useful variable to be included in risk prediction scoresin Sri Lanka.

Coxiella burnetii is an obligate intracellular bacterium thatcauses the zoonotic infectious disease, Q fever. The common clinicalpresentation is fever, hepatitis, and pneumonia; laboratory examination couldreveal pancytopenia, elevated liver enzymes. In bone marrow, many fibrin ringgranulomas, also known as “Doughnut” granulomas can be seen and suggest thediagnosis of Q fever. However, these bone marrow granulomas can also bepresented in infectious diseases by other pathogens such as EBV, CMV, and HBV;therefore, other serology or PCR—based tests are needed to confirm the diagnosisof Q fever. We report the first case of acute Q fever in Vietnam, presented as afever of unknown origin with hepatitis in a 53-year-old male patient. A bonemarrow biopsy was performed and showed various fibrin ring granulomas;therefore, Coxiella was suspected and the diagnosis wasconfirmed by PCR. Some infectious diseases can cause specific changes in thebone marrow, such as Doughnut granulomas in Q fever. These features can helpdirect the diagnosis and decide earlier treatment for the patient.

Introduction:Adenosquamous carcinoma (ASC) is a rare subtype of the conventional adenocarcinoma of the bile duct. The clinico-pathological characteristics of this entity are poorly understood partly due to its rarity.Case Summary:A 67-year-old ASA II male presented with obstructive jaundice subsequently complicated by cholangitis. CT abdomen showed dilatation of the intra and extrahepatic biliary tree. Endoscopic retrograde cholangiopancreatography revealed a stricture with a mucosal growth at the ampulla of Vater. He had a pancreaticoduodenectomy and the distal common bile duct tumour identified in the specimen was on histology an adenosquamous carcinoma (ASC) of the extrahepatic bile duct.Discussion:ASCs are considered to have more aggressive tumour biology compared to adenocarcinomas. The presence of a squamous component at the invasive front relates to its poor prognosis. Surgery is the curative option, but with a high propensity for early recurrence and distant metastases. The scarcity of reports on the clinicopathological course of ASC have resulted in a lack of standardised care pathways.Conclusion:A better understanding of the clinicopathological characteristics, biological behaviour and disease progression of ASC will aid therapeutic options and prognostication.

Meningiomas are tumors arising from leptomeninges. Malignant counterpart of them is knownas anaplastic meningioma which are WHO grade III tumors. Intraventricular location ofthese tumors is rare and is clinic-radiologically challenging. Histopathology andimmunohistochemistry are confirmatory. We present case of a 27-year-old girl, whopresented with usual symptoms of intraventricular mass in emergency. After shunt surgery,clinical diagnosis of ependymoma was formed with differential of high-grade glioma. Squashtissue was difficult to crush displaying tight clusters of spindle cells with necrosis inbackground. Definitive histology revealed high grade spindle cell neoplasm disposed insheets with brisk and atypical mitosis. Only focal whorling pattern was seen. Large cellswith eccentric cytoplasm, reminiscent of rhabdoid cells were also seen.Immunohistochemistry was positive for vimentin and EMA, negative for GFAP. Final diagnosisof Anaplastic meningioma was dispatched. The histological pattern of the present case,young age of presentation and presence of Rhabdoid cells make it unusual. Though rare butintraventricular meningiomas must also be kept in clinical radiological differentialsapart from the usual ependymoma at this location.

In contrast to a robust literature on known pathogenic fungi such asCryptococcus and Aspergillus species that causepulmonary infections, reports of the uncommon genus Sporopachydermiacausing infections are very limited. We present the first case report describing thefungus, Sporopachydermia lactativora as a likely cause of pneumonia in apatient with a history of polysubstance abuse and injection drug use (IDU). The patientrecovered following antifungal treatment. The organism was recovered from a blood culture,3 days post collection. Although CHROMagar was of little value, only yeast-like organismswere observed on cornmeal agar. The organism was not in the matrix-assisted laserdesorption/ionization—time of flight (MALDI-TOF) mass spectrometry database. Definitiveidentification was achieved using the ribosomal DNA (rDNA) sequence analysis by targetingthe ITS1 (internal transcribed spacer 1) region. This case report isintended to promote awareness of this fungus as a potential pathogen, by providing newinformation that has not yet been reported in the literature, and prompts physicianawareness to suspect a fungal infection when managing patients with a history of IDU as apotential source of unique environmental organisms not previously encountered, warrantingmore comprehensive diagnosis and treatment options.