Choledochal cysts present differently in adults and children; whereas children present with the classic triad, adults present with common biliary or infective complications. Although the methods of detection and surgical treatment are similar for the two groups, the type IVa cyst typically seen in the adult group creates a marked deviation with respect to long-term complications such as ascending cholangitis, anastomotic strictures, stone formation, and development of cholangiocarcinoma. These are areas of grave concern that can be addressed to a large extent by providing an access loop during the initial surgery especially for type IVa cysts. The glaring differences in terms of presentation, histologic picture, and outcome urges us to consider choledochal cysts in children as a separate entity.

Background:Due to lack of correct blood grouping practices, the rare Bombay Oh phenotype may be missed, subjecting patients to the risk of severe hemolytic transfusion reaction. In the absence of blood donor registry, transfusion management of patients needing immediate surgery is a challenge. This study presents detection of rare Bombay Oh phenotype patients and their management by acute peri-operative acute normovolemic hemodilution (ANH) in a hospital from central India.Materials and Methods:Blood grouping of patients and blood donors with a standard tube method was carried out and samples identified as rare Bombay phenotype were confirmed by saliva inhibition test. Surgical management of cases needing transfusion was done by ANH, as per the British Committee for Standards in Hematology guidelines.Results:The incidence of Bombay phenotype was 0.002% or 1 in 51,924 in the study. Amongst three cases (patients) identified as Bombay phenotype, one was Bombay Oh, Rh negative. Two cases were missed in the first instance and one case actually did not require transfusion. In the absence of a blood donor registry for Bombay phenotype, the cases needing transfusion were successfully managed with ANH in the operation theatre.Conclusion:A simple test like blood grouping should be done with serious intention with incorporation of both forward and reverse grouping, so that no patient receives wrong blood leading to fatal hemolysis due to transfusion. ANH is a cost-effective transfusion option for suitable patients. Appropriate clinical decision making, use of strategies to decrease peri-operative blood losses and cost-effective country based planning could be more widely applied to improve clinical transfusion practice.

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Objective: The goal of the study was to report clinical characteristics, contributing variables and outcome of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM). Study Design: Observational/descriptive study Place and Duration: Multan Medical and Dental College and Bakhtawar Amin Medical and Dental College. Duration Jan 2021 to July 2021. Methods: Total 90 patients of both genders had symptoms of mucormycosis during pandemic corona virus disease were presented in this study. Patients were aged between 22-80 years. Patients detailed demographics age, sex, body mass index and duration of disease were calculated after taking informed written consent. Patients were admitted in COVID-19 emergency ward and underwent for RT-PCR and MRI. Comorbidities, symptoms and cause of mucormycosis were assessed. At the end of study mortality rate, hospital stay and ICU admission were calculated. The SPSS 20.0 version was used to examine the entire set of data. Results: Majority of the patients 65 (72.2%) were males and the rest were females 25 (27.8%). Mean age of the patients were 51.42±12.64 years with mean BMI 28.44±8.72 kg/m2. 55 (61.1%) cases had COVID-19 and 35 (38.9%) were recovered from corona virus in this study. Mean duration of mucormycosis was 18.08±7.11 days. Most common symptoms of disease were eye pain/swollen of eyes, nasal stiffness, headache and blurring of vision. Rhino-orbital mucormycosis found in 63 (70%) cases. Majority of the cases were from urban areas 60 (66.7%) and 38 (42.2%) were literate. Diabetes mellitus was the most common comorbidity found in 70 (77.8%). Frequent consumption of the steroids during pandemic disease was the most common cause found in 59 (65.6%) cases. Mortality rate was 32 (35.6%) at the end of study. Conclusion: In this study we found that the complication of COVID-19 in high-risk patients can be mucormycosis. Poor diabetes mellitus is a significant CAM predisposing factor and frequent usage of excess steroids were the most common cause. Systematic surveillance for diabetes mellitus control and to educate the doctors are indicated for early detection of CAM. Keywords: COVID-19, Mucormycosis, Diabetes Mellitus, Steroids, Mortality