Diabetes ketoacidosis is one of the most serious and acute complications of diabetes. At the time of presentation and during treatment of diabetic ketoacidosis (DKA), several metabolic and electrolyte derangements can ultimately result in respiratory compromise. Most commonly, hypokalaemia, hypomagnesemia and hypophosphatemia can eventually lead to respiratory muscles failure. Furthermore, tachypnoea, hyperpnea and more severely, Kussmaul breathing pattern can develop. Also, hydrostatic and non-hydrostatic pulmonary oedema can occur secondary to volume shifts into the extracellular space and secondary to increased permeability of the pulmonary capillaries. The presence of respiratory failure in patients with DKA is associated with higher morbidity and mortality. Being familiar with the causes of respiratory compromise in DKA, and how to treat them, may represent better outcomes for patients with DKA.

HELLP syndrome is a complication of pregnancy characterized by haemolysis, elevated liver enzymes, and a low platelet count. It usually begins during the last three months of pregnancy or shortly after childbirth. HELLP syndrome is a life-threatening condition that can potentially complicate pregnancy. It is named for 3 features of the condition: Haemolysis, Elevated Liver enzyme levels, and Low Platelet levels. It typically occurs in the last 3 months of pregnancy (the third trimester) but can also start soon after delivery. A wide range of non-specific symptoms may be present in women with HELLP syndrome. Symptoms may include fatigue; malaise; fluid retention and excess weight gain; headache; nausea and vomiting; pain in the upper right or middle of the abdomen; blurry vision; and rarely, nosebleed or seizures. The cause of HELLP syndrome is not known, but certain risk factors have been associated with the condition. It is most common in women with preeclampsia or eclampsia. If not diagnosed and treated quickly, HELLP syndrome can lead to serious complications for the mother and baby. The main treatment is to deliver the baby as soon as possible, even if premature, if there is distress of the mother or the baby. Treatment may also include medications needed for the mother or baby, and blood transfusion for severe bleeding problems.

The deep peroneal nerve lies in the anterior muscular compartment of the lower leg and can be compromised by compartment syndrome affecting this area. It provides cutaneous sensation to the first web space. The superficial peroneal nerve provides more lateral cutaneous innervation.Origin: It originates from the common peroneal nerve, at the lateral aspect of the fibula, deep to peroneus longus. Root values of common peroneal nerve: L4, L5, S1, and S2.Course and relation: It pierces the anterior intermuscular septum to enter the anterior compartment of the lower leg. Following which, it passes anteriorly down to the ankle joint, midway between the two malleoli. It terminates in the dorsum of the foot.Throughout the course it innervates:- Tibialis anterior- Extensor hallucis longus- Extensor digitorum longus- Peroneus tertius- Extensor digitorum brevisAt its termination, it innervates the skin in the web space between the first and second toes.Actions performed by the muscles supplied by the nerve:- Dorsiflexion of ankle joint- Extension of all toes- Inversion of the foot

The Kaplan-Meier estimator, also known as the product limit estimator, is a non-parametric statistic used to estimate the survival function from lifetime data. In medical research, it is often used to measure the fraction of patients living for a certain amount of time after treatment.

The initial symptoms of spasmodic abdominal pain, rectal bleeding and vomiting might point towards intussusception, but the peak incidence is in children aged 6-9 months. Considering that this child has additional symptoms of haematuria, proteinuria and a purpuric rash, it is more likely that the child has Henoch-Schonlein purpura (HSP). HSP is an identifiable cause of intussusception. It is an IgA-mediated, autoimmune hypersensitivity vasculitis that targets the small vessels of the skin, GI tract, kidneys, and joints. It is most commonly seen in children aged 3 – 6years and is twice as common in boys than girls. Preceding viral URTI with low-grade pyrexia is common. The most common organism associated with HSP is, however, Group A streptococcal infection. A purpuric rash is seen on the back of the legs and buttocks and can less frequently, affect the arms. Arthralgia is common (usually knees/ankles) in these patients. Abdominal pain and bloody diarrhoea may occur. And half of the children with HSP have renal involvement. Rarely, it can lead to end-stage renal failure. Treatment includes adequate hydration, occasionally steroids, and other immunosuppressants. The disease can recur in 1 in 3 children.

Pityriasis rosea is a common, acute exanthem of uncertain aetiology. Viral and bacterial causes have been sought, but convincing answers have not yet been found. Pityriasis rosea typically affects children and young adults. It is characterized by an initial herald patch, followed by the development of a diffuse papulosquamous rash. The herald patch often is misdiagnosed as eczema. Pityriasis rosea is difficult to identify until the appearance of characteristic smaller secondary lesions that follow Langer’s lines (cleavage lines). Several medications can cause a rash similar to pityriasis rosea, and several diseases, including secondary syphilis, are included in the differential diagnosis.

The risk of ischemic stroke in patients using combined oral contraceptives is increased in patients with additional stroke risk factors, including smoking, hypertension, and migraine with aura.

Congenital hypothyroidism (CH) is inadequate thyroid hormone production in new-born infants. It can occur because of an anatomic defect in the gland, an inborn error of thyroid metabolism, or iodine deficiency.CH is the most common neonatal endocrine disorder, and historically, thyroid dysgenesis was thought to account for approximately 80% of cases. However, studies have reported a change in the epidemiology, with a doubling in incidence to around 1 in 1500 live new-borns.‹Infants with congenital hypothyroidism are usually born at term or after term. Symptoms and signs include the following:Decreased activityLarge anterior fontanellePoor feeding and weight gainSmall stature or poor growthJaundiceDecreased stooling or constipationHypotoniaHoarse cryProlonged neonatal jaundice or unconjugated hyperbilirubinemia

From the options mentioned here, the closest diagnosis is haemophilia. This is a mixed picture, as a purpuric rash on the buttocks does not correlate with this diagnosis. However, the most appropriate diagnosis is haemophilia.

The skin lesion described is the typical presentation of a keloid scar.Keloid scars extend beyond the limits of the incision.Note:Surgical wounds are either incisional or excisional and either clean, clean-contaminated or dirty. The main stages of wound healing include:- Haemostasis:It occurs minutes to hours following injury. It is characterised by the vasospasm in adjacent vessels, platelet plug formation and generation of fibrin rich clot.- Inflammation: It occurs typically 1-5 days after the injury. Neutrophils migrate into the wound (this is often impaired in diabetes). Growth factors, including basic fibroblast growth factor and vascular endothelial growth factor, are released in this phase. Fibroblasts replicate within the adjacent matrix and migrate into wound, while macrophages and fibroblasts couple matrix regeneration and clot substitution.- Regeneration: It occurs typically between 7-56 days after the injury. The factors that stimulate this phase are platelet-derived growth factor and transforming growth factor. They stimulate fibroblasts and epithelial cells. Fibroblasts produce a collagen network. Furthermore, they cause angiogenesis and thus wound healing.- Remodelling: This is considered the longest phase of the healing process and may last up to one year (or longer). During this phase, fibroblasts become differentiated (myofibroblasts), and these facilitate wound contraction. Collagen fibres are remodelled, and microvessels regress, leaving a pale scar.Clinical correlation:Abnormal scar formation:- Hypertrophic scars:It is the condition where excessive amounts of collagen are produced within a scar. Nodules may be present histologically containing randomly arranged fibrils within and parallel fibres on the surface. The tissue itself is confined to the extent of the wound itself and is usually the result of a full-thickness dermal injury. They may go on to develop contractures.- Keloid scars: This is also a condition where excessive amounts of collagen occur within a scar. A keloid scar will typically pass beyond the boundaries of the original injury. They do not contain nodules and may occur following even trivial injury. They do not regress over time and may recur following removal.