This case report stresses the role of depression in the manifestation of a homicideattempted suicide. We report the case of a man who allegedly murdered his partner and then attempted suicide. Previously, he had several failures and rejections in relationships in addition to work-related stress. He was diagnosed with major depressive disorder and treated with antidepressant. The scarcity of homicideattempted suicide as exemplified in this case could give an insight to the Psychiatrist for better understading and possible prevention.
Depression ; Suicide

Right iliac fossa pain can often be misdiagnosed as something sinister or benevolent despite assistance with state of the art imaging techniques. This is particularly more challenging in the female gender whereby the error of managing a right iliac fossa pain may approach forty percent. A 66-year-old lady, ten years postmenopause, presented with a week history of progressively worsening right iliac fossa pain. Malignancy was suspected with a palpable abdominal mass. Computed tomography was suggestive of an abscess collection, but a needle aspirate produced brown faecal material suggestive of a diverticulitis. An exploratory appendisectomy revealed a non malignant appendicular abscess. In conclusion, when clinical and imaging assessments are inconclusive, an exploratory laparotomy for a surgical excision is warranted primarily if malignancy is suspected.
Abscess

Gastro-peritoneal fistula is a rare but serious complication of laparoscopic sleeve gastrectomy with significant morbidity and mortality. We present the case of a 42-year-old man who underwent laparoscopic sleeve gastrectomy for morbid obesity and presented later with a history of chronic epigastric pain and severe reflux. Upper gastrointestinal series showed the presence of a communicating fistula between the stomach and the left hemi-diaphragm and peri-splenic area.
Laparoscopy

cardiovascular diseases

Crab meat is a valuable source of proteins and functional lipids and it is widely consumed worldwide. However, the prevalence of crab allergy has increased over the past few years. In order to understand crab allergy better, it is necessary to identify crab allergens. The aim of the present study was to compare the IgEbinding proteins of raw and cooked extracts of mud crab (Scylla serrata). Raw and cooked extracts of the mud crab were prepared. Protein profiles and IgE reactivity patterns were identified by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) followed by immunoblotting using sera from 21 skin prick test (SPT) positive patients. In SDS-PAGE, 20 protein bands (12 to 250 kDa) were observed in the raw extract while the cooked extract demonstrated fewer bands. Protein bands between 40 to 250 kDa were sensitive to heat denaturation and no longer observed in the cooked extract. In immunoblotting experiments, raw and cooked extracts demonstrated 11 and 4 IgE-binding proteins, respectively, with molecular weights of between 23 and 250 kDa. A heat-resistant 36 kDa protein, corresponding to crab tropomyosin was identified as the major allergen of both extracts. In addition, a 41 kDa heat-sensitive protein believed to be arginine kinase was shown to be a major allergen of the raw extract. Other minor allergens were also observed at various molecular weights.
Arginine Kinase

Stroke is frequently associated with long-term disability. Stroke leads to high risk of physical and neuropsychological consequences. Residual disabilities among post-stroke survivors can lead them to depression. This study aimed to determine the relationship between clinical characteristics and the levels of depression among post-stroke survivors at a teaching hospital in Kuala Lumpur. This cross-sectional study recruited 195 post-stroke survivors who attended follow-up Rehabilitation Clinic of a teaching hospital over a study period of 4 months. Information collected included socio-demographic, clinical characteristics (post stroke duration, stroke types and stroke severities) and level of depression. Beck’s Depression Inventory (BDI) was used to assess the level of depression. The mean age of participants was 61 years (SD=13.86, range: 22-87 years), with 118 male and 81 female survivors having a median duration of post-stroke of 12 months (range: 1–79 months). This study showed post stroke survivors 116 (59.5%) with depression. A Chi-square test for level of stroke severity was significantly associated with depression, χ2 (2, n=195) = 28.724, p<0.001, phi = 0.384. The results of the present study showed that survivors with mild stroke had less depression (44.0%) compared to moderate stroke (81.7%) and severe stroke (87.5%).
Stroke ; Depression

The popularity of ultrasound for acute diagnosis of fractures in the Emergency Department (ED) has increased over the recent years. This present study aimed to determine the sensitivity and specificity of ultrasound use for detection of fractures in a different environment, which is at the triage area of the ED. We compared the results of bedside ultrasound in detecting non-critical fractures to the current gold standard of X-rays in the triage area. The design was a single centered crosssectional study. From August 2014 till November 2014, a total of 46 patients were recruited, creating 75 image pairs. Following consent, a bedside ultrasound was performed and subsequently compared with X-ray reporting regarding the presence or absence of fractures. SPSS analysis was used to determine the sensitivity and specificity of ultrasound in diagnosing fracture as compared to X-rays. Ultrasound had a sensitivity of 72% (95% CI, 50.6% - 87.9%) and a specificity of 80% (95%CI: 66.3 – 90%) when compared to X-rays in fracture diagnosis. The kappa analyses showed moderate inter observer agreement (0.5) between ultrasound and X-rays in diagnosing fractures. This study suggests that the use of ultrasound as a triage tool yet has unacceptable sensitivity and needs further evaluation and consideration.
Ultrasonography

Previous genetic studies demonstrated that survival and proliferation of Plasmodium falciparum parasites is dependent on salvage of essential purines from the host. Plasmodium falciparum, the causative agent of the most lethal form of human malaria lacks the enzymes required for de novo synthesis of purines. Analysis of the hypothetical nucleoside/nucleobase transporter protein, the gene product of PfNT3 (PF14_0662) gene in P. falciparum parasites was carried out by localisation, in view of a novel chemotherapeutic target. Immunoblotting, immunofluorescent and immunoelectron microscopic localization of PfNT3 was demonstrated using polyclonal antiserum in in vitro cultured Plasmodium falciparum parasites, propagated in human red blood cells. PfNT3 protein, the translated product of PfNT3 gene was detected in intraerythrocytic ring, trophozoite, and schizont stages. PfNT3 was localized primarily to the PPM (Parasite Plasma Membrane). The endogenous PfNT3 putative nucleoside transporter with the predominant location to the parasite plasma membrane may serve not only as routes for targeting of purine analogs/cytotoxic agents into the intracellular parasite but may also serve as drug targets. Being genome encoded the vital transporter protein can be prevented from expression by silencing of the gene, validating it to be a novel drug target.
Plasmodium falciparum

Low Grade Papillary Nasopharyngeal Adenocarcinoma (LGPAC) is a very rare tumour of mucosal origin compared to a higher incidence of well differentiated keratinized/non-keratinized nasopharyngeal carcinoma. It is an epithelial tumour with glandular differentiation. Its papillary figure seen histologically, is also seen in metastatic papillary thyroid carcinoma. This has caused a significant challenge to the Pathologist to differentiate primary papillary nasopharyngeal adenocarcinoma and metastatic tumour. Thyroid Transcription Factor-1 (TTF-1) is also expressed in subsets of papillary nasopharyngeal adenocarcinoma, which is valuable as a diagnostic tool. LGPAC is a benign-like malignant neoplasm. An early diagnosis with a complete tumour removal via conventional excision or endoscopic approach has offered a good prognosis with low risk of recurrence.
Thyroid Neoplasms

Open tracheal injury is rare but can lead to disastrous consequences such as massive bleeding, airway obstruction or failure and aspiration of blood. We present a case of open tracheal injury of a man who tried to attempt suicide using a knife. In this case, the initial management was securing the airway by attempting orotracheal intubation. However, it was unsuccessful when the tube came out from the laceration wound. Intubation was then re-attempted through the distal cut-end of the trachea in the face of airway failure. A quick initial assessment and anticipation of a failed airway should always be the top priority in any emergency physician managing these cases. Direct intubation through the laceration wound might be the only option when all else fail and your patient is crashing.