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The novel coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality worldwide. The most common symptoms include fever, cough, and shortness of breath (predominantly involving pulmonary function). However, there are lesser-known presentations that affect other systems too. Vascular complications have been reported in the literature focusing on venous thrombosis, which appears to be more common than arterial thrombosis. Among arterial thrombosis, mainly lower limb involvement is reported so far. Here, we report an unusual presentation in COVID-19, which presented with acute abdomen due to superior mesenteric artery thrombosis without respiratory symptoms. We report this case as a varied form of coronavirus complication presentation and highlight the need for eternal vigilance and a reactive approach for early diagnosis.

Objective: This descriptive case series conducted to evaluate the outcome of CSF rhinorrhea repair with the Endonasal Endoscopic approach in terms of success of the repair.Materials and Methods: The study was conducted at Neurosurgery department, Unit II, Punjab institute of neurosciences, Lahore. This study involved 40 patients aged between 3-80 years of both genders diagnosed of CSF rhinorrhea with presented with in 1 week after trauma and spontaneous and postoperative cases.Results: The age of the patients ranged from 5 years to 53 years with a mean of 22.75 ± 15.59 years. Total 30 (75%) male and 10 (25%) female patients are included in the study. The underlying etiology was found to be post-traumatic (67.5%) 27 cases, followed by post-operative in 7 (17.5%) and spontaneous in 6 (15.0%) cases. Successful repair was observed in 36 (90.0%). No significant difference was found in the frequency of successful repair among various age groups; 5-20, 21-36 and 37-53 years (95.7%, 83.3% and 81.8%; p = 0.381), gender groups; male verses female (86.2% and 100.0%; p = 0.194) and etiological groups; post-traumatic vs. post-operative vs. spontaneous (92.6% vs. 71.4% vs. 100.0%; p = 0.169).Conclusions: The frequency of successful repair was found to be 90% in patients of CSF rhinorrhea treated through Endonasal endoscopic approach. No statistically significant difference was found in successful repair frequency across patient’s gender, age and underlying cause of CSF rhinorrhea.

There are certain situations in redo cardiac surgery in adults where it may not be possible to use alternate arterial cannulation sites like the common femoral artery and axillary artery. We report a case where we established safe cardiopulmonary bypass with common carotid artery cannulation in an adult patient. The patient underwent aortic valve replacement for severe aortic regurgitation 8 months after repair of type A aortic dissection plus aortic valve resuspension. Case ReportA 55 year old gentleman underwent emergency ascending aortic replacement and aortic valve repair (valve resuspension) for a type A aortic dissection. He made an excellent recovery following this procedure and postoperative transthoracic echocardiogram (TTE) showed mild aortic valve regurgitation. A TTE repeated 4 weeks later showed presence of moderate aortic valve regurgitation. Follow-up investigations at six months showed that the ascending aorta repair was intact and the dissection flap extending to the left common iliac artery with minimal flow in the false lumen. At this stage there was no change in the degree of aortic regurgitation. However, cardiac catheterisation was performed at 8 months which revealed severe aortic regurgitation, systolic pulmonary artery pressure of 51 mmHg and impaired left ventricular function. Gradual failure of the aortic valve repair to resuspend the valve was speculated to be the likely cause of significant aortic regurgitation. Aortic valve replacement was contemplated.Various routes for cannulation for cardiopulmonary bypass (CPB) were discussed due to previous sternotomy and the X-ray finding of close proximity of the repaired ascending aorta to the sternum. During the first operation, an attempt was made to expose the right axillary artery but the artery was not accessible. CPB was established via the right common femoral artery (CFA). The left CFA was not a viable alternative in view of the dissection flap extending down to the left common iliac artery. It was therefore elected to institute CPB through the right common carotid artery (CCA). The right CCA and the left sapheno-femoral junction were exposed. A longitudinal incision was made along the medial border of the sternocleidomastoid muscle at the level of the thyroid cartilage. The internal jugular vein (IJV) and common carotid artery (CCA) were exposed. Two slings were passed behind the CCA to aid the control of the artery for the subsequent steps of the procedure. Skin incision and preparations for the sternotomy were made. Heparin was administered to maintain an activated clotting time (ACT) greater than 400 seconds. Once this was achieved a curved clamp was applied to the exposed carotid artery and a longitudinal 2 cm incision was made. A dacron graft was then sewn onto this incision in such a fashion so as to direct the inflow of the blood

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Background: - Trigeminal neuralgia is a disease typically characterized by involuntary attacks of lancinating pain in the distribution of the trigeminal nerve that are activated by non-noxious stimuli. Numerous anticonvulsants, either alone or in combination, remain the first choice in the medical treatment of trigeminal neuralgia.3If the disease becomes non responsive, there are numerous surgical options like micro vascular decompression or minimally invasive percutaneous lesioning of the trigeminal nerve, such as glycerol rhizolysis, Radiofrequency Rhizotomy, and balloon compression. Objective: - To determine efficacy of percutaneous Radiofrequency Rhizotomy for trigeminal neuralgia in terms of early pain relief in a tertiary care hospital. Methods: -  62 patients with refractory trigeminal neuralgia or lancinating, recurrent episodes of pain in the distribution of Ophthalmic (V1) and Mandibular (V3) branches of trigeminal nerve, not responsive to 6 months of conservative treatment were included. Study was completed in one year i.e. from March 2015 to Feb 2016. Result: - In our study population, 62 included patients were had mean age 56.08 ± 7.39 years. 44 patients (71%) were male. Our treatment was effective in 58 patients (93.5%) while there was recurrence among 4 (6.5%) only. Conclusion: - It is concluded that the efficacy of percutaneous Radiofrequency Rhizotomy for trigeminal neuralgia in terms of complete relief of pain with intact sensations in treated branch region is excellent (93.5%).