Colchicine is a cheap easily available and accessible drug that has been tried in different diseases which are not limited to gout, familial Mediterranean fever (FMF), Behcet’s disease, and constipation, and has recently been tried for the treatment of COVID-19 and heart diseases. There are many emerging reports of toxicity related to colchicine use. Patients with FMF are using this drug lifelong. We are sounding the alarm for monitoring patients with FMF to guard against chronic colchicine toxicity.
Bile duct injury (BDI) is a severe and sometimes life-threatening complication of cholecystectomy. Several series have described a 0.5% to 0.6% incidence of BDI during laparoscopic cholecystectomy. We received an emergency call from the operating theater by the surgery team to assess an iatrogenic BDI in a 58-year-old man with cirrhosis who presented for laparoscopic cholecystectomy. After many trials by endoscopic retrograde cholangiopancreatography (ERCP) the guide wire passed to the peritoneal cavity and failed to pass proximally. Laparoscopy resumed, and the surgeon tried to pass the flexible guide wire proximally unsuccessfully. Then, a decision to hold the sphincterotome by laparoscopy and passing it proximally in harmony with ERCP was taken, which was successful. A regular ERCP with 10F plastic stent insertion was carried out, and the perforation was secured by the inserted stent without any further surgical intervention. Laparoscopy-assisted ERCP may give new insights into the immediate repair of iatrogenic bile duct injuries.
In the late December 2019 an outbreak of a novel coronavirus termed as SARS-CoV-2 has emerged in Wuhan city, China then spread worldwide to cause serious life threatening pandemic that seriously affect the economics and daily life. The classical picture of COVID-19 is described as fever, cough and dyspnea. However, different atypical presentations have been described in the literature. We confronted by a patient 49 years old without respiratory manifestation who sought medical advice for swabbing for COVID-19, with refusal from the local governmental center for swabbing, two days later, the patient become dyspneic, desaturated with positive COVID-19 swab. We recommend that care givers should not wait the full typical respiratory manifestations of COVID-19.We also realize that there is a big shortage in swabbing and examination tools especially in the developing countries like ours, however, caregivers in swabbing center should have a high index of suspicion with patients who have persistent symptoms.
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