1 INTRODUCTIONKawasaki Disease (KD) is a rare entity but one of the most common pediatric vasculitis. It predominantly affects the pediatric population, generally before the age of 5 years with coronary artery aneurysms being the most feared complication; however, due to the broader disease spectrum, patients can present with diverse clinical presentations [1]. Coronary aneurysms generally develop after two weeks of disease onset in about 25% of cases [2]. The standard treatment includes IV immunoglobulin and aspirin [3]. There are no specific laboratory markers and the diagnosis is mainly based on a set of clinical criteria, featuring prolonged fever, polymorphous rash, conjunctivitis, mucosal changes, lymphadenopathy, and extremity changes [4]. Systemic arterial aneurysm formation is a very rare entity, affecting 0.8% to 2% of the cases, approximately 3 months after disease onset [5].

Surviving the storm: Insights into the pericardial injuries and roller coaster of multisystem trauma in bomb blast victimsMuhammad Nadeem Ahmad1, Shahzeb Ali2, Muhammad Ahmed1, Naila Nadeem1, Mallick Muhammad Zohaibuddin1, Hatem Eltaly3, Muhammad Owais Rao1, Faheemullah Khan3, Uffan Zafar11 The Aga Khan University Hospital, Karachi, Pakistan.2 Quaid-e-Azam Medical college, Bahawalpur, Punjab, Pakistan.3 Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA .

1 IntroductionSubacute combined degeneration (SCD) is a neurodegenerative demyelinating disease that affects the posterior and lateral columns of the cervical and upper dorsal parts of the spinal cord and is caused primarily by vitamin B12 deficiency. In addition to SCD, vitamin B12 deficiency produces various other neurological and psychiatric symptoms as well as a wide spectrum of hematological abnormalities [1]. Chronic vitamin B12 deficiency has been identified in the majority of patients with hyperhomocysteinaemia (HHcy), which promotes venous thrombosis and atherosclerosis via various mechanisms [2]. One such case report of a young patient demonstrated severe HHcy secondary to vitamin B12 deficiency as a cause of pulmonary embolism and myocardial infarction [3]. Although the association of deep venous thrombosis with HHcy has been well established [4, 5], its presentation with SCD is not reported in literature to our best of knowledge. The current report describes a 68 years old female who presented with SCD of the spinal cord coexisting with deep venous thrombosis (DVT).

1 INTRODUCTIONPancreatitis is associated with a range of local and systemic complications (1,2). However, fistula formation is noted in only a very small proportion of patients with acute pancreatitis (3). These fistulas are generally a result of disruption of the pancreatic duct, which may be due to several etiologies such as trauma, surgical trauma, pancreatic resection, or those causing pancreatitis (4). Pancreatic duct disruption results in fluid leakage, which causes erosion and formation of pathways, the locations of which depend on the anatomic location of the duct disruption (4). Management of pancreatic fistulas includes medical and nutritional optimization, surgical interventions, endoscopic treatments, and catheter drainage (3, 5-7).Pseudocysts associated with acute pancreatitis are loculated fluid collections that are rich in amylase and usually develop within 2 weeks of onset of pancreatitis (8). They may be intra- or extra-pancreatic, are inflammatory, and lack a true epithelial lining. Just like pancreatic fistulae, pancreatic pseudocysts generally develop secondary to disruption of the pancreatic duct, and resolve spontaneously unless they develop complications (8). The management of pancreatic pseudocysts includes but is not limited to, percutaneous, endoscopic, and surgical drainage among others (9-11).Among these complications, pancreatic pseudocyst stands as a rare but significant entity. A pancreatic pseudocyst represents an abnormal fluid collection originating from the pancreas and can arise as a consequence of acute or chronic pancreatitis and remains relatively uncommon in clinical practice.The clinical presentation of pancreatic pseudocyst may include abdominal pain, fever, and biochemical abnormalities indicative of pancreatic injury.In this report, we present a case of pancreatic pseudocyst formation secondary to pancreatitis in a 42-year-old male, highlighting the clinical presentation, diagnostic evaluation, therapeutic interventions, and outcomes. Through this case, we aim to underscore the importance of early recognition and appropriate management of pancreatic pseudocysts to prevent complications and optimize patient outcomes.