Unusual trajectory of a bullet from the shoulder to the brain: an emergency department perspective on finding a missing bullet.

Terminal ballistics continues to struggle with bullet trajectory reconstruction and interpretation. This is a case of a young man presented with a very unusual trajectory of a bullet from the left shoulder to the brain parenchyma. The single wound and altered mentation prompted a CT head and neck scan, which revealed a retained bullet in the brain parenchyma, traversing from the left shoulder, across the neck and into the brain without causing significant damage to vital organs.

Acquired hyperkalaemia leading to periodic paralysis: an emergency department perspective.

Hyperkalaemia is one of the common electrolyte imbalances dealt with in the emergency department and is caused by extracellular accumulation of potassium ions above normal limits usually greater than 5.0-5.5 mmol/L.

Life-threatening complication: the development of necrotising fasciitis in a preterm neonate with omphalitis.

Omphalitis is a mild medical condition that can turn severe in exceptional situations leading to necrotising fasciitis. The most common cause of omphalitis is umbilical vein catheterisation (UVC) where the cleanliness measures can be compromised. The treatment options for omphalitis include antibiotics, debridement and supportive care.

Compliance to donning and doffing of personal protective equipment among dental healthcare practitioners during the coronavirus pandemic: a quality improvement plan, do, study and act (PDSA) Initiative.

Introduction: With the emergence of SARS-Cov-2, the Centers for Disease Control and Prevention (CDC) defined mandatory guidelines for donning and doffing personal protective equipment (PPE) among dental healthcare professionals. The study's objective was to improve the compliance of the donning and doffing protocols for PPE among dental practitioners by the Plan, Do, Study, and Act (PDSA) cycle.

Materials And Methods: A quasi-experimental study was conducted on a sample of dental healthcare professionals using the non-probability purposive technique.

Managing dental unit waterlines: a quality improvement programme.

The presence of bacterial biofilms within dental unit waterlines (DUWLs) can cause secondary bacterial infections in immunocompromised patients. As a result, the management of biofilms within waterlines has always concerned medical and dental professionals. In February 2020, an internal audit identified the high bacterial counts within the DUWLs at the Aga Khan University Hospital, Karachi and this paper discusses a pragmatic approach to improving the water quality of DUWLs.

Cushing syndrome due to ectopic ACTH secreting pheochromocytoma.

In this case report, we present a case of a woman in her late 30s who presented with bilateral motor weakness, headache, hyperglycaemia and hypertension. Investigations revealed very high 24-hour urine cortisol of 90 524, ectopic adrenocorticotropic hormone secreting pheochromocytoma, normal metanephrine levels and empty sella, which has never been reported. CT chest and abdomen revealed enlarged left adrenal gland with large necrotic mass 4.

Distal transradial artery access for coronary angiography in a patient having rheumatoid arthritis-related severe arthropathies.

Conventional radial access has become the default access for coronary angiography. Sometime, it is difficult to take a conventional radial access, especially in patients having severe arthropathies leading to limited wrist joint mobility. In such scenarios, distal transradial access (dTRA) can be adopted.

Mucormycosis in a patient with COVID-19 with uncontrolled diabetes.

A wide range of bacterial and fungal coinfections may be associated with COVID-19. We report a case of rhino-orbital mucormycosis in a patient with COVID-19. A 67-year-old man, known case of diabetes, hypertension and ischaemic heart disease, was being treated for COVID-19 pneumonia when he developed right cheek eschar and ophthalmoplegia.

Comparison of antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of chronic apical periodontitis: a randomised controlled trial study protocol.

Introduction: Various intracanal medicaments have been used in cases of chronic apical periodontitis for appropriate disinfection of the root canal system to eliminate microbes especially from the inaccessible areas. Calcium hydroxide is the most common intracanal medicament available in various forms, but its effectiveness with or without iodoform using microbial culture is unknown. Therefore, our aim is to compare the antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of teeth presenting with chronic apical periodontitis by assessing the bacterial load reduction.