Biography:

Julin F Tang has completed his MD, MS & FCCM and is a HS Clinical Professor in Anesthesia & Perioperative Care University of California, San Francisco, School of Medicine. His areas of interests include cardiopulmonary physiology, echocardiography, transesophageal echocardiography, traumatic brain injury, critical care, respiratory care, fluid resuscitation, conscious sedation, neuromuscular problems, airway management, acidosis, alpha2 agonist, trishydroxyaminomethane (THAM), aerosolized prostacyclin, mechanical ventilation, trauma, geriatric anesthesia, ventilator associated pneumonia, artificial breathing patterns, capnography, bronchoalveolar lavage, methicillin-resistant Staphylococcus aureus, cardiac ultrasonography and lung scan.

Abstract:

Biography:

Agnes Molnar is a Specialist Anesthesiologist in Sydney, Australia. She has completed her Medical studies and gained specialist qualification in Anaesthesia and Intensive Therapy first in her native Hungary. Following her husband, she migrated to Australia and started a long journey to become an Anesthetist in her adopted country. She works as a Visiting Medical Officer in Western Sydney in both the public and the private system. She has extensive experience with Bariatric Patients.

Abstract:

Case of a morbidly obese 45 year old woman (BMI 50) undergoing a minor day case procedure with planned general anaesthesia and intubation who, after a standard induction including suxamethonium, presented a challenging airway and bronchospasm simultaneously. Haemodynamics initially were uncompromised with the main issues being sudden onset significant desaturation and bronchospasm which was managed after intubation with endotracheal salbutamol. Skilled assistance was sought from anaesthetic and intensive care colleagues. Rocuronium administration was then required after successful intubation had been confirmed and after saturations had improved, to facilitate further stabilization when the patient started to wake and cough on the endotracheal tube. After rocuronium was administered the ongoing bronchospasm and desaturation worsened again with subsequent haemodynamic instability. The patient’s body habitus made NIBP monitoring unreliable and difficult intravenous access further hindered attempts to fluid resuscitate, necessitating insertion of an arterial line and central venous catheter. Small boluses of adrenaline were administered for low blood pressure and in view of ongoing instability it was decided that surgery should be abandoned, and she was transferred to the intensive care unit intubated, where she was managed with a noradrenaline infusion. Mast Cell Tryptase was sent for suspected anaphylaxis after 28 hours when attempts at weaning from the ventilator proved difficult, despite having been haemodynamically stable and off vasopressors for more than 12 hours. Mast Cell Tryptase came back elevated and subsequent formal allergy testing confirmed a positive reaction to both suxamethonium and rocuronium. Despite quite a brief period of significant desaturation the patient unfortunately sustained hypoxic brain injury, although she has been able to return home and her cognitive function continues to improve. The case highlights the difficulties in managing emergency scenarios in situations where; More than one crisis occurs simultaneously (difficult airway management and anaphylaxis presenting initially with isolated bronchospasm); Morbidly obese patients present specific challenges regards to monitoring and iv access, delaying resuscitation efforts. Team leadership is not clearly defined in a scenario where several equally qualified experts are present.

Biography:

Mohamed Farouk Helal is an Associate Professor of ENT at Military Medical Academy, Egypt. Currently, he is ENT Consultant at Dallah Hospital, KSA. He has a special interest in Endoscopic Sinus Surgery. He was an Ex-Major General Dr. at Egyptian Armed Forces, was Winner of Long Service and received good example medal from Mr. President of Egypt 2007.

Abstract:

We present a case report of a 55 years old male patient who has been diagnosed as having Inverted papilloma of the frontal sinus which was incompletely removed elsewhere in 2014. The patient main complaint was nasal obstruction which improved after removing that part of the IP presenting in the nose. The patient's symptom of nasal obstruction recurred few months after his first surgery but he ignored it till few months ago when he started to have frontal headache and right sided proptosis moreover he complains of bilateral blocked ears which were diagnosed as bilateral otitis media with effusion. Radiologic workup (CT and MRI) showed erosion of the posterior table of the frontal sinus and the roof of the right orbit with infiltration of the Dura by the mass already left over from the previous surgery and diagnosed as IP. The nasopharynx showed a huge mass abutting the fossa of Rosenmullar and the eustachian tube bilaterally with suspicious retropharyngeal lymph nodes. This mass was found to be both radiological and surgically distinct from the frontal sinus mass. Histopathology revealed an inverted papilloma with malignant transformation involving the Dura of the floor of the anterior cranial fossa and a synchronous second nasopharyngeal carcinoma. The patient was referred to oncology department for combined chemo and radiotherapy.

Biography:

Samih Abed Odhaib has completed his Medical Education from Nahrain Medical School in 2001. He is a Fellow of Iraqi Board of Medical Specialization (Internal Medicine) FIBMS, Member of American College of Physician (ACP), Member of American Association of Clinical Endocrinologist (AACE). He is a Post-doctorate in Adult Endocrinology and is associated with Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) since September 2018. He was the Head of the Study Group that manage the case of Right Paraduodenal Hernia and the Manuscript Author.

Abstract:

Introduction: We present four cases that show a misleading increase in the thyroid function test towards a false diagnosis of Grave's disease after biotin administration of 20-30 mg for different periods, although all patients are free of signs and symptoms of hyperthyroidism, and all the results returned to normal after biotin withdrawal within 24-48 hours.

Case 1: A 23-year-old female was diagnosed as Grave's disease after a routine checking after she ingested prescribed 20 mg biotin per day for three months for excessive hair fall.

Case 2: A 19-year-old female with hair and nail problems associated with iron deficiency anemia. She had self-prescribed biotin dose of 20 mg a day for a month. She asked an endocrinologist opinion about a recent increase in her thyroid function tests, yet no signs of hyperthyroidism were found.

Case 3: A 45-year-old man with subtotal thyroidectomy for a retrosternal multinodular goiter with compressive symptoms, his usual levothyroxine dose had been decreased from 100 to 50 microgram per day, after which he felt unwell and gained four kilograms with signs and symptoms of hypothyroidism. His investigations were consistent with hyperthyroidism while his signs were of hypothyroidism which was illogical. He administered 30 mg medically prescribed biotin for a recent mild psoriasis nail changes.

Case 4: The author himself volunteered to take 30 mg of biotin daily for one week. His initial investigations were normal but changed within this period to be Grave's disease-like, with no signs or symptoms to be felt.

Biography:

Mohamed Farouk Helal is an Associate Professor of ENT at Military Medical Academy, Egypt. Currently, he is ENT Consultant at Dallah Hospital, KSA. He has a special interest in Endoscopic Sinus Surgery. He was an Ex-Major General Dr. at Egyptian Armed Forces, was Winner of Long Service and received good example medal from Mr. President of Egypt 2007.

Abstract:

We present a case report of a 55 years old male patient who has been diagnosed as having Inverted papilloma of the frontal sinus which was incompletely removed elsewhere in 2014. The patient main complaint was nasal obstruction which improved after removing that part of the IP presenting in the nose. The patient's symptom of nasal obstruction recurred few months after his first surgery but he ignored it till few months ago when he started to have frontal headache and right sided proptosis moreover he complains of bilateral blocked ears which were diagnosed as bilateral otitis media with effusion. Radiologic workup (CT and MRI) showed erosion of the posterior table of the frontal sinus and the roof of the right orbit with infiltration of the Dura by the mass already left over from the previous surgery and diagnosed as IP. The nasopharynx showed a huge mass abutting the fossa of Rosenmullar and the eustachian tube bilaterally with suspicious retropharyngeal lymph nodes. This mass was found to be both radiological and surgically distinct from the frontal sinus mass. Histopathology revealed an inverted papilloma with malignant transformation involving the Dura of the floor of the anterior cranial fossa and a synchronous second nasopharyngeal carcinoma. The patient was referred to oncology department for combined chemo and radiotherapy.