2 Galv an Casas C, Catal a A, Carretero Hern andez G et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases.

A case of Goldenhar-Gorlin syndrome in a seven-month-old male infant presented with the features of epibulbar dermoid, microtia and hemifacial microsomia associated with thumb defect. The dermoid was bilateral and microtia was unilateral. Preauricular appendages and pits were double and single respectively on both the sides. Hemifacial microsomia was unilateral and was associated with cleft lip, macrostomia, dental misalignment, large tongue and high arched palate. The association of hypoplastic thumb with Goldenhar-Gorlin syndrome has not been documented in the past.

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Background: Tuberculosis kills more than any infection in India. TB is a serious public health problem in India. Tuberculosis causes immense morbidity. The mortality rate of this disease is also very high. Tuberculosis causes a great distress to the patients. To control this infection is a challenge to the health care facility of India. A lot of steps are being taken at various levels to end this disease. Still a huge number of patients are dying everyday from these deadly diseases. Out of so many recognised risk factors, malnutrition is considered to be as one of the most important among them. The immunity of a malnourished patient is suppressed. When the patient’s immunity is ineffective, the conversion of latent tuberculosis to diseases happens. Malnutrition invites tuberculosis and tuberculosis again causes morbidity, so there is a complex relation between this two. Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world.Methods: In this cross sectional hospital based study involving 400 newly diagnosed Tuberculosis cases were taken. Their nutritional status was measured by BMI.Results: It was found that 66% of the study population is having malnutrition (BMI <18.5kg/m2). Malnutrition was more in females (71%). Mean BMI is 17.9Kg/m2. Mean height of the population is 1.53 meters.Conclusions: Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world. This study has demonstrated that half of newly diagnosed adult TB patients were malnourished at the time of starting treatment, with more than a quarter having moderate to severe malnutrition.

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COVID 19 pandemic is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The first case was identified in December 2019, in Wuhan, China. It is an infectious disease and has led to the ongoing global pandemic. This pandemic has also started in Assam, with its first case reported on 31 March, 2020. A prospective study was conducted on 2000 laboratory confirmed coronavirus cases. Proper history were taken and clinical examinations were performed. They were also advised to do the necessary blood investigations, electrocardiogram and chest X- rays. Olfactory functions were assessed using substances like scented soap, mint toothpaste, vicks vaporub, etc. Gustatory functions were also assessed. In our study, we found that 83% (1650) patients presented with otorhinolaryngological or ENT (Ear, nose, throat) manifestations and 17% (350) did not have any otorhinolaryngological manifestations. The most common ENT symptoms with which the patients presented were sore throat (80%) and headache (76%). The other ENT symptoms were hyposmia (44%), dysgeusia (32%) and nasal congestion (28%). The most common non-ENT symptoms were fever (92%) and cough (85%). The other non-ENT symptoms with which the patient presented were malaise, generalized bodyache and abdominal symptoms (like diarrhea). This prospective study gives a view of the incidence of otorhinolaryngological manifestations in COVID 19 patients. But, no significant co-relation was seen between presence of ENT symptoms and the severity of the disease. However, further studies are required to know the pathogenesis of causing ENT symptoms properly and also for definitive treatment of these symptoms.

Traumatic abdominal wall hernia (TAWH) is a rare clinical entity in terms of aetiology. It occurs following a blunt abdominal injury with energy high enough to cause disruption of the musculoaponeurotic layer but not the elastic skin layer. It is often associated with underlying intra-abdominal injuries, which can be diagnosed either clinically or radiologically. We report a case of TAWH in a young man with associated large bowel transection, which remained undiagnosed in the preoperative period owing to its masked features. He was managed surgically, with no recurrence to date. Considering the high volume of blunt abdominal trauma cases that present to the accident and emergency department, only few cases of TAWH have been reported in the literature. Confusion still exists regarding the timing and mode of management of this condition. KEYWORDSAbdominal wall -Traffic accidents -Abdominal hernia -Aetiology -Motorcycles Traumatic abdominal wall hernia (TAWH) is an unusual type of hernia that occurs following a non-penetrating abdominal trauma resulting in breach of the musculoaponeurotic layers of the abdomen with an intact overlying skin. Although blunt abdominal trauma is very common, the incidence of TAWH is low. The diagnosis of TAWH is rarely straightforward owing to the various clinical presentations and management therefore varies substantially. 1 We report a unique case of TAWH following a road traffic accident with associated hollow viscous injury. Case historyA 30-year-old man presented to the accident and emergency department having sustained a high velocity blunt trauma injury over his left flank from a hollow metal pipe two hours earlier while driving a motorcycle. The patient was haemodynamically unstable. He had a tender, irreducible swelling of approximately 15cm x 10cm over the left flank with evidence of an overlying bruise and abrasions (Fig 1). There was no expansile cough impulse over the swelling and the swelling was soft in consistency. General abdominal examination was insignificant and there was no peritonitis. Focused assessment with sonography for trauma showed no intra-abdominal fluid collection. However, ultrasonography indicated a possible parietal breach at the site of the lump. Multidetector computed tomography (CT) of the abdomen revealed a full-thickness defect over the left lumbar region with small bowel herniation (Fig 2).The patient was posted for an exploratory laparotomy by a midline approach. A 20cm loop of jejunum was found to be herniating through a gap of 7cm over the left lumbar region. A complete transection of the descending colon was also noted (Fig 3). Both the proximal and distal ends of the transected colon were also seen to be herniating through the defect. There was collection of stool and blood clots in the ONLINE CASE REPORT Ann R Coll Surg Engl 2016; 98: e133-e135