Unexpected reach of a leech.

Vaginal bleeding as the result of a leech infestation is rare. Here we present two cases of hypovolemic shock with severe anemia requiring blood transfusion due to leech infestation. We also briefly review sparse literature available on this entity.

Repeated snake bite for recreation: Mechanisms and implications.

Snake venom use for recreational purposes has been documented earlier. Willfully subjecting oneself to repeated lethal snake bite as a source of getting relieved of stress and recreation observed in two healthy software engineers, without any underlying psychiatric ailments or comorbidities along with probable mechanisms, are reported. Emergency physicians and practitioners have to be aware of novel methods of exposure to snake venom so as to recognize such cases and treat them accordingly.

Pseudothrombocytopenia in perioperative patient: A significant laboratory artifact.

Pseudothrombocytopenia secondary to ethylenediaminetetra-acetic acid induced platelet aggregation observed in a healthy perioperative male patient is reported in order to create awareness among anesthesiologist and laboratory personnel. The mechanisms for such changes have been highlighted.

Severe hypertension in elapid envenomation.

Snakebite is not an uncommon medical emergency in India; however, symptoms of autonomic dysfunction in snakebite are rare. The elapid snake envenomation is a frequent occurrence in India, and the krait bite is prevalent in the south Indian region. Here, we present three cases of snakebite with severe hypertension and requiring intravenous nitroglycerin (NTG).

Paradise nut paradox: alopecia due to selenosis from a nutritional therapy.

Selenium is a micronutrient. It presents a nutritional conundrum because of its twin status as an essential as well as a highly toxic trace element. Here, we report a case of acute non-intentional selenium toxicity due to increased ingestion of "paradise nuts" (Lecythis ollaria) which resulted in massive alopecia.

Tension pneumocephalus: a case report with review of literature.

Tension Pneumocephalus (PC) was described 50 years ago. A case of pneumocephalus (PC) following cervical epidural injection in a 50-year-old male worsened by air travel and manifested as tension pneumocephalus, confirmed by advanced neuroimaging, is reported for the first time along with literature review. The patient underwent emergent frontal burr hole evacuation and air gushed under pressure.

Isolated thigh pain in myocardial infarction.

The referred pain of angina to upper half of the body is well known. However, isolated pain in the thigh as a presenting symptom in myocardial infarction is neither considered nor discussed at all. Here, we report a middle-aged man without demonstrable risk factors who presented to the emergency department for isolated bilateral anteromedial thigh pain.