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Atrial septal defect (ASD) is a congenital heart disease often encountered in the adult population, as it is frequently asymptomatic in childhood. In untreated patients with ASD, some may go on to develop complications such as atrial arrythmias, pulmonary hypertension and Eisenmenger syndrome. Pulmonary hypertension is seen in 6 – 35% of this group of untreated patients in adulthood as a result of left-to-right shunting. Symptoms of pulmonary hypertension include progressive dyspnoea, ascites and syncope. Here, we would like to illustrate a case of ASD presenting with recurrent syncopal attack.

Background Cardiac tamponade is a medical emergency. This study was carried out to determine the etiologies of cardiac tamponade and review the management and outcomes. Methods We retrospectively analysed case records of patients who underwent pericardiocentesis for cardiac tamponade during the two consecutive years (1 January 2018 to 31 December 2019) at Hospital Sultanah Nora Ismail, Batu Pahat, in Johor, Malaysia. Results There were ten patients (eight males, two females; age range 20 to 70 years old, mean age 36 years old) who underwent pericardiocentesis for cardiac tamponade during the said period. Malignancy (40%), tuberculosis (30%), idiopathic (20%), and bacterial (10%) were among the common causes of the pericardial effusion in this center. The commonest symptoms were breathlessness (90%), chest pain (60%), cough (50%), and unexplained fever (20%). Pulsus paradoxus was the most specific sign (100%) for the presence of echocardiographic feature of cardiac tamponade. Two of the patients with tuberculous pericarditis had retroviral disease; one patient had bacterial pericarditis due to salmonella typhi. Conclusion This study has confirmed that there are many etiologies and presentation of cardiac tamponade; clinicians should be alert as urgent pericardiocentesis is lifesaving.

Skin conditions are a common reason for consulting primary health care. The public frequently expects their primary health care providers to be able to recognise and treat common skin conditions with confidence. Primary care providers must be able to identify ‘red flag’ skin conditions that require dermatology referral. However, diagnosis is often delayed due to the non-specific clinical presentation, low incidence, slow evolution and long-term history of such lesions. We report the case of a patient with extramammary Paget’s disease that presented to her primary care provider and subsequently underwent a wide local excision.

Primary cardiac tumor are extremely rare. Incidence is approximately 0.017-0.019% of all primarytumor. An early diagnosis of cardiac tumor may improve the outcome. Bangladesh J Medicine July 2020; 31(2) : 111-113

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is a rare disease. It is a maternally inherited multisystem disorder caused by mutations of the mitochondrial DNA. MELAS usually occur during childhood period after a normal early development. Commonly, the patients will have a relapsing and remitting course of illness with stroke like episodes and seizures. It will subsequently lead to progressive neurological dysfunction and memory problems. We would like to present two siblings who presented to us with different age of onset and presentation of their illness. Bangladesh J Medicine July 2019; 30(2) : 96-99

Sarcoidosis is a multisystemic, chronic granulomatous disease of unknown aetiology that often affects the lungs. Diagnosis and treatment of sarcoidosis can be strenuous. Patients may be asymptomatic or experience cough, dyspnoea, fatigue, unintentional weight loss or night sweats. Computed tomography is valuable in the diagnosis of sarcoidosis. The typical histopathological lesion of sarcoidosis is granuloma without caseous necrosis in the involved organs. As tuberculosis is endemic in our region, clinicians should not forget this great mimicker. The cornerstone of treatment of sarcoidosis is corticosteroids but newer agents such as steroid-sparing agents and biological agents are available. We report a case of pulmonary sarcoidosis presenting with chronic cough.

Kocuria kristinae is a gram-positive cocci bacteria of the family Micrococcaceae . Kocuria species are bacteria commonly found in the environment and human skin flora. They are usually regarded as non-pathogenic bacteria, thus rarely associated with human infections. We report a case of K. kristinae related continuous ambulatory peritoneal dialysis (CAPD) peritonitis. The clinical presentation resembles that of usual CAPD peritonitis and diagnosis was made via routine laboratory and microbiological investigation. However, mortality occurred in our case due to severe sepsis with multi-organ failure.