Arnold Chiari malformation type I is a developmental pathology characterized by herniation of the cerebellar tonsils towards to the spinal canal through the foramen magnum. The herniation of the cerebellar tonsils can also compress or stretch anatomical structures in the brainstem, leading to various symptoms. This condition is rarely seen, due to common and non-specific complaints, it may be confused with other diseases, and patients may get misdiagnosis. In this article, a patient who applied to hospital with the complaint of hypoesthesia and diagnosed as Arnold Chiari malformation type 1 is reported.

Introduction: Hypopituitarism is a clinical syndrome characterized by deficiency of pituitary hormone production. Snake bite is an uncommon cause of hypopituitarism. Envenoming by poisonous animals is an occupational hazard often faced by farmers and farm laborers in tropics. Viperine snake bites cause local cellulitis, tissue necrosis, bleeding manifestations, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), shock, cardiac arrhythmia, neurotoxicity, coma, and death. Worldwide estimates vary from 1.2 to 5.5 million snakebites, 421,000 to 2.5 million envenomings, and 20,000 to 125,000 deaths

Case Report: We report case of a 37-year-old female who was bitten by a Saw scaled viper snake and developed chronic hypopituitarism diagnosed after 11 months. Patient improved with treatment of essential hormones

Conclusion: Hypopituitarism after a snake bite is often insidious in onset and a rare complication. Diagnosis is often delayed due to unawareness causing significant morbidity. Physicians should have a low threshold to suspect hypopituitarism in snake bites

We report a 47-year-old Caucasian man, a construction worker, with multiple asymptomatic hyperkeratotic lesions on the palms and soles. The lesions developed after puberty and slowly increased in size and number thereafter. His father, sister, and son had similar lesions on the palms and soles. Examination revealed numerous yellowish brown hyperkeratotic papules varying in size from 1 to 3 mm irregularly distributed on his palms, fingers, and soles. Central depressions were observed in some of the larger lesions. Some of the papules were coalesced to form larger hyperkeratotic plaques on the weight-bearing areas of his soles. A diagnosis of punctate palmoplantar keratoderma type 1 was made based on a positive family history, typical lesions (punctate hyperkeratotic papules), typical locations (palms and soles), and typical course (lesions increased in size and number with time)

Isoniazid is one of the commonest drugs used for treatment and prophylaxis of tuberculosis especially in developing countries. The commonest adverse effects of isoniazid are mild increased liver transaminases (10-20%), peripheral neuropathy (dose-related incidence, 10-20% incidence with 10 mg/kg/d), loss of appetite, nausea, vomiting, abdominal pain and weakness. Adverse effects also include fever with rash but only fever without any other adverse effects or rash is uncommonly reported. We report a patient with pulmonary tuberculosis developing isoniazid induced pyrexia without rash with first dose of treatment. It can occur within 8 hours of starting the first dose. Patients may have drug allergies even though they might not report. High index of clinical suspicion is required for diagnosis as serology and other investigations have limited value

Medical knowledge is the result of individual and collective experience produced over time. It has been that way since the medicine was recognized as a science and since this is provided in a collegial way [1].

Since the knowledge of the human anatomy, physiology of its different systems, the behavior of different diseases to the application of new diagnostic technologies and innovative therapeutic techniques based on molecular medicine, this has been the result of the gathering of individual experiences based on observation and experimentation [1,2]