ISSN 2771-019X

Journal of Clinical and
Medical Images
Case Reports
(JCMICR)

Impact Factor: 1.2* Submit Your Manuscript

Journal of Clinical and Medical Images
Case Reports (JCMICR)

ISSN 2771-019X

Journal of Clinical and
Medical Images
Case Reports

Impact Factor: 1.2* Submit Your Manuscript

Journal of Clinical and Medical Images
Case Reports

ABOUT US

Journal of Clinical and Medical Images, Case Reports (JCMICR)

In all areas of medicine, case reports and clinical photographs are essential as human volunteers who are meant to contribute to medical knowledge involve the research.
The Journal of Clinical and Medical Images, Case Reports (JCMICR) is a fantastic resource for keeping up with the latest clinical advancements and for publishing case reports and clinical images related to a variety of medical illnesses. This peer-reviewed publication provides a comprehensive overview of the diagnosis, treatment, and therapeutic solutions for a variety of disorders.
Journal of Clinical and Medical Images, Case Reports (ISSN 2771-019X) pertaining to many fields of clinical and medical sciences are welcomed. The journal's open access policy allows anybody in the medical community to read and share published case reports and clinical images without having to pay a subscription fee. The case reports and clinical photographs published in the journal are of the greatest quality, and they are peer-reviewed. Also has a significant impact on health outcomes.
This multidisciplinary open access journal provides the chance to researches to disseminate the work in the form of case reports, Clinical Images, short communications, commentaries, Perspectives, Editorials, Rapid Communications, Letters to Editor, Video Articles etc.

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Volume-3 Issue-5

Clinical significance of serum miR-21, CA153 and CEA in breast cancer


Cancer is one of the illnesses where the stage at which the disease is diagnosed plays a crucial role patients survival and quality of life [1]. A diagnostic indicator that can detect cancer in early stages is of great significance, especially for breast cancer (BC), as it is the most common cancer in woman [2]. One field of interested is that of tumor markers, due to their noninvasive, rapid and simple nature [3]. Despite their low sensitivity and specificity, the carcinoembryogenic antigen (CEA) and cancer antigen 153 (CA153) are the commonest markers used.
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Cardiac tampoande following percutaneous coronary intervention of unknown etiology


Cardiac tamponade is a life-threatening condition characterized by the accumulation of fluid, blood, pus, clots, or even gas within the pericardium which compromise of cardiac function. It can occur due to various causes such as inflammation, trauma, heart rupture, aortic dissection. Recently it has become increasingly common as a complication of complex cardiac interventions usually caused by epicardial artery rupture. In this case, we present a patient who developed delayed cardiac tamponade following percutaneous coronary intervention, with no apparent cause identified despite extensive investigation using imaging methods. After antiplatelet therapy de-escalation pericardial bleeding in ceased and patient had survived with full recovery.
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Ibrutinib-induced cystoid Macular oedema


Ibrutinib is a small-molecule drug approved for the treatment of mantle cell lymphoma, chronic lymphocytic leukemia, and Waldenstrom macroglobulinemia. Although it has been connected to ocular side effects, few clinical cases explain cystoid macular oedema associated with long-term Ibrutinib treatment. A case of Cystoid Macular Oedema (CMO) caused by ibrutinib in a patient with chronic lymphocytic leukemia is presented. In our case study, an 85-year-old man’s vision deteriorated over 6-7 months. His right eye’s presenting vision was 0.76 and his left eye was 0.2. There was bilateral macular oedema on inspection. His ibrutinib treatment lasted 12 months. The temporal correlation between ibrutinib treatment modifications and the ocular inflammation in our patient points to a causal relationship. Ibrutinib is thought to cause drug-induced cystoid macular oedema.
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Cone dystrophy


We report a case of a 33-year-old woman, who complains of a progressive loss of visual acuity for 6 years. Visual acuity was 4/10 which cannot be improved in both of eyes. The examination of the anterior segment of both of eyes was normal. Fundus examination reveals the existence of a rounded yellowish macular lesion with major macular atrophy in both of eyes (Panel A and B), the peripheral retina was normal. Auto fluorescence picture describe a bull’s-eye maculopathy limited by a hyperautofluorescent ring (Panel C). Macular OCT shows loss of the outer segments of the foveal photoreceptors (Panel D). The electroretinography confirmed the diagnosis of cone dystrophy by demonstrating an absence of response under photopic conditions, while the scotopic response is preserved.
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Analysis of erg 11 expression in clinical isolates of dermatophytes in patients with resistant tinea infection


Dermatophytes, a group of keratinophilic filamentous fungi thriving on the keratin substrate, are the etiological agents responsible for causing superficial fungal infection in human and animals with an estimated global prevalence of approximately 20 percent as per the World Health Organization (WHO) report. Predominant in the tropical and subtropical countries; especially in the developing countries like India, the hot and humid climate is favorable to the acquisition and maintenance of the disease [1].
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Research progress in the relationship between intestinal flora and cerebral stroke


Cerebral stroke, also known as “stroke” and “cerebrovascular accident”, is an acute cerebrovascular disease, including ischemic and hemorrhagic stroke. Cerebral stroke is the first cause of death and adult disability among Chinese residents [1], characterized by high incidence, high mortality, high disability and high recurrence [2]. Recent studies have found that intestinal flora may affect the occurrence and development of cerebral stroke through various channels such as nervous, neuroendocrine, and immune systems [3]. The immune and inflammatory responses of cerebral stroke patients continue to participate in the whole process of brain tissue injury and repair. As the largest immune system, the digestive tract plays an important role in regulating the immune function of the body [4].
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Removal of a rod from the penile urethra: A case report


Foreign body placement in the urethra has always been alluring to urologists, and is an uncommon urological emergency. Wide varieties of foreign bodies have been encountered and reported in the literature including electrical wires, batteries, beans, sharp tiny objects and other tools, mostly in male adult population although there are reported cases in the pediatric population as well. Many causes have been linked to such presentations which range from sexual gratification, psychiatric mental illness, masturbation curiosity etc.
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Hand of benediction: An indicator of median neuropathy


A common hand motion known as the Hand of Benediction is connected to blessings and spiritual significance. In addi- tion to its symbolic significance, this hand position is regarded by medical professionals as a crucial indicator of median neuropathy. The image in the article explores the relationship between the Hand of Benediction and dysfunction of the median nerve, emphasising its clinical importance and implications for diagnosis.
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Comparison of clinical, functional, histologic and proteinuric parameters in the functional outcomes remission and ESRD in 170 patients with Glomerulonephritis (GN) and Nephrotic Syndrome (NS) and 190 patients with GN and Persistent Non-Nephrotic Proteinuria (PP)


The etiopathogenesis of glomerulonephritis is not completely known and several different factors have been suggested as responsible of development of various types of glomerulonephritis (GN). Glomerulonephritis is a renal disease in which immune-mediated glomerular damage is the initiating factor. The hallmark of glomerulonephritis is increased permeability of the glomerular barrier. Proliferative glomerulonephritis is characterized by proliferation of the mesangial cells with influx of inflammatory cells. Membranous glomerulonephritis is characterized by accumulation of matrix and thickening of the glomerular basement membrane (GBM) and capillary wall.
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Sudden onset unilateral proptosis in a 10-year-old female: Unique case of orbital vein varix management and treatment using bleomycin


This report adhered to the ethical principles outlined in the Declaration of Helsinki as amended in 2013. Orbital varices are venous malformations of the orbit caused by vascular dysgenesis. It is a rare condition, accounting for 0-1.3% of all histopathologically proven orbital masses [1]. They are usually diagnosed between the ages of 10-30 years. Most cases occur unilaterally. They most commonly involve the superior ophthalmic vein. Symptoms include intermittent proptosis associated with Valsalva maneuver.
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From chest pain to dual diagnosis: navigating the nuances of Takotsubo cardiomyopathy and acute pericarditi


Takotsubo cardiomyopathy, also commonly known as stressinduced cardiomyopathy or 'broken heart syndrome,' was first described by Japanese physicians in the 1990s and has since garnered global recognition [1]. It is characterized by transient regional systolic dysfunction, typically affecting the apex of the left ventricle, and often mimics the clinical presentation of acute coronary syndrome. However, a key distinguishing fea ture of this condition is the absence of obstructive coronary artery disease on angiography [2].
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Delayed onset Takotsubo cardiomyopathy following post mitral valve placement


Takotsubo cardiomyopathy (TCM), also known as acute stressinduced cardiomyopathy or broken heart syndrome, is a temporary heart condition characterized by transient dysfunction and ballooning of the left ventricle (LV) of the heart. The condition is often attributed to events that cause major physical or emotional stress. Surgery may also impose substantial physiological and psychological stress on patients [1]. Diagnosis of TCM is typically based on the Mayo Clinic criteria and the criteria established by Kawai et al [2].
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A case report of a symptomatic pericardial cyst: Comprehensive review of diagnosis and management


Pericardial cysts are the most common primary benign masses found in the mediastinum and are typically discovered incidentally during chest imaging [1]. The estimated incidence of pericardial cysts in the population is approximately 0.001%, accounting for 33% of all mediastinal cysts. Interestingly, 75% of patients with pericardial cysts do not experience any symptoms [2]. However, in the remaining cases, symptoms primarily arise due to the mass effect exerted by the cyst.
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Anaplasic large cell lymphoma ALK+: Anatomo-pathological characterization of three pediatric cases


The anaplastic large cell lymphoma (ALCL) is a set of malignancies inside of the non-Hodgkin lymphomas, mostly with histopathologic and immunohistochemical features like cells of T origin. One of their first descriptions was made in 1985 by Stein et al, who presented a series of cases consisting of lymphomas composed of large and pleomorphic cells capable to express Ki-1 (CD30), considering it an entity derived from activated lymphocytes, probably cytotoxic T cells [1].
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Removal of a Bent intramedullary nail in lower extremity: Review of removal techniques


Intramedullary nailing has become the gold standard for stabilizing fractures in the lower extremity, promoting early mobilization and faster healing. However, a small subset of patients may experience complications, such as a bent intramedullary nail [1]. The removal of a bent intramedullary nail (IMN) is a rare but challenging issue in orthopedics. While various re- moval techniques have been described in the current literature, there is a lack of comprehensive reviews or established algorithms to guide surgeons in managing such cases effectively [2].
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Femoral neck fractures in adults: Epidemiological aspects and evaluation of the results of surgical treatment in the Orthopedics-Traumatology Department of the Ignace Deen University Hospital


Femoral neck fractures (FNF) or true cervical fractures are defined by their intracapsular location and their anatomical limits, namely the cervico-trochanteric crest and the cervicocephalic chondro -osseous junction. They most often occur during low-energy domestic trauma in elderly women with osteoporosis [1, 2]. In young adults, true cervical fractures occur after high-energy trauma and often in the context of polytrauma and multiple fractures [3]. The treatment of choice for most femoral neck fractures is operational to allow early mobilization of the patient, reduce the risk of complications and improve functional results [4].
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Particularities in cutaneous filariasis


The larva in the third stage of development is inoculated into a vertebrate organism during the insect’s feeding through a sting, after which it crosses the dermis and enters to the lymphatic vessels. In humans the life cycle of the parasite lasts between five to 12 months and in the vector between 10 and 12 days. Over a period of 9 month the larva transform into an adult worm with dimensions between 20 and 100 milimeters. In general the parasite can survive for about 5 years [1]
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Zoo animal health and conservation; A case study of traumatic VentriculoPeritonitis in African ostriches (Struthio Camelus)


Zoological gardens play a vital role in the conservation of endangered species and provide an opportunity for the public to connect with wildlife (Fukano et al., 2020; Spooner et al., 2023). The well-being of animals in these settings is paramount, and veterinary care is central to achieving conservation goals (Tallo-Parra et al., 2023). The concept of zoos has always been a subject of controversy, with various concerns raised by researchers (Maynard, 2018). Some argue that animals can seem to be controlled and confined for human benefit, rather than their own welfare (Normando et al., 2018).
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Carotid body tumor: A case report


Carotid body tumors, arising from the neural crest-derived paraganglia located at the carotid bifurcation, they’re rare representing less than 0,7% of head and neck neoplasms. Radiological techniques play a pivotal role in enhancing our understanding of the anatomical relationship between these tumors and adjacent structures, guiding treatment decisions, and improving patient outcomes. We present the case of a 60-year-old in whom CBT was diagnosed following hospitalization for a progressive cervical mass.
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Fetal MRI revealing a rare jejuno-ileal atresia: Apple peel intestinal atresia


Apple peel atresia is the rare form of atresia with an incidence of 0.7-0.8% in 10,000 live births accounting to 5-10 % of all intestinal atresias [1]. Premature newborns have a higher risk of developing atresia. It is formed up of a distal small bowel that spirals around its vascular supply strongly resembling an apple peel and a proximal jejunum that ends in a blind pouch. They hypothesized that jejunal and ileal atresia occur due to an intrauterine vascular assault due to placental vascular anomalies [1, 2]. We present a report of fetal MRI findings in JIA with corroborative postnatal radiologic and surgical examination.
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Synthesis and anticancer activities of Cu2+, Zn2+, Co2+ and Ni2+ complexes containing pyridine carboxylic acids


Due to their distinctive structures and excellent properties, metal complexes have been widely used in catalysis [1], biosensing [2], gas storage [3] and capture [4] and molecular recognition and separation [5], and they exhibit antifungal [6], antituberculous [7], analgesic [8] and anticancer [9] activities. Organic carboxylic acids are widely used as ligands in the design of metal-organic complexes because they can bridge multiple metal ions using various coordination modes, such as monodentate coordination and bidentate chelation [10].
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Euthanasia and physician-assisted suicide: Most controversial issue in medical ethics; An overview


The root of the term euthanasia is Greek. It is derivative of two words “eu” and “thanatos” meaning “good death” or “easy death”. Another term used for this phenomenon is mercy killing. In other words to cause pain free death for a person who is otherwise suffering from a hopelessly incurable and agonizing disease is called euthanasia [1]. There are different sets of rights and wrongs associated with different forms of euthanasia.
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A case report: A multidrug-resistant tuberculous meningitis case, household contact with an multidrug-resistant pulmonary tuberculosis patient


Any organ or system in the body might become affected by tuberculosis. Patients with disseminated TB may experience extrapulmonary involvement alone or in conjunction with a pulmonary focus [1]. One of the most severe forms of extrapulmonary tuberculosis is tuberculous meningitis (TBM), which accounts for 70-80% of instances of neuro tuberculosis. TBM is caused by Mycobacterium tuberculosis [2].
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Evaluation of treatment regimens of human brucellosis


Brucellosis, also known as “Mediterranean undulant fever”, remains the most common zonoosis worldwide [1]. It is caused by Gram-negative coccobacillus bacteria belonging to the genus Brucella which include 12 species [2]. Its myriad presentation and various symptoms explain the diagnostic delay and the evolution of the disease to the sub-acute cases of brucellosis with the occurrence of osteoarticular, cardiovascular and neurological complications [3].
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Hibernoma: An unveiling of a rare adipocytic tumor


Classic lipomas are among the most prevalent soft tissue tumors and histologically resemble white fat. The back, specifically the inter-scapular region, is the location of hibernoma that is most frequently observed. The neck, axillae, thigh, and intra-thoracic region are other frequent locations. Hibernoma is a lesion that shouldn't be excluded from the differential diagnosis because it can't be distinguished from malignant tumors clinically or radiographically.
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Secondary syphilis presenting as pulmonary nodules: A case report and review of the literature


Syphilis is a chronic infectious disease caused by Treponema pallidum (TP). It is mainly transmitted through sexual intercourse. Syphilis can also infect fetuses through mother-tofetus transmission. Syphilis can invade the genitals and skin in the early stage. It often invades the central nervous system or cardiovascular system in the late stage but rarely affects the lungs [1, 2]. The prevalence of the disease has increased all over the world in recent years [3]. In addition, HIV infection usually results in secondary syphilis due to immune deficiency, and clinical manifestations are usually nonspecific, which poses a challenge for clinical diagnosis [4]. Here, we report a case of pulmonary nodules in an HIV-positive patient diagnosed with secondary syphilis.
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Assessment of nasal obstruction before and after surgery of nasal polyposis by the DYNACHRON questionnaire


Sino nasal polyposis (SNP) is a chronic rhinosinusitis with bilateral and multifocal polyps in the nasosinusal cavities especially in the ethmoid [1]. It represents a prevalence estimated to be around 4% in general population. However, its pathophysiology remains poorly elucidated. Indeed, the hypertrophic transformation of the nasosinusal mucosa leads to nasal obstruction, anosmia and sometimes rhinorrhea. In fact, nasal obstruction is one of the main diagnostic criteria for chronic rhinosinusitis according to the definition of EPOS (European Position Paper on Rhinosinusitis and Nasal Polyps) in 2012 [2]; though it has a significant physical and psychosocial impact on quality of life.
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Measurement of calvarial thickness in multidetector computed tomography


In the last few decades, computed tomography (CT) scans have revolutionized the imaging and diagnosis of calvarium. Calvarial thickness in humans can be measured with a computerized tomography scan (CT scan). This could aid in determining racial and gender differences in calvarial thickness in a population. The information collected from the calvarial thickness study in the human population may be beneficial to researchers, anatomists, anthropologists, surgeons, and surgical screw manufacturers. Measurement of calvarial thickness is also important in various disease conditions including hemolytic anemia like thalassemia where there is expansion of diploic space and increased calvarial thickness.
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Bartholin’s gland cyst


A 39-year-old woman with no notable pathological history presented to our department with a genital formation that had been progressively evolving for 1 year and becoming uncomfortable. The clinical examination found a painless nodule of cystic consistency measuring approximately 2 cm, covered with normal skin located in the labia minora (Figure 1). We performed an excisional biopsy under local anesthesia, revealing cystic formation with a regular, simplified cubo-cylindrical epithelium, resting on a fibrous layer. The lumen contained a polymorphous inflammatory infiltrate with cellular debris. The diagnosis of Bartholin’s cyst was made.
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Systemic air embolism after percutaneous lung puncture: A case report


The incidence of systemic air embolism (SAE) during percutaneous lung puncture is between 0.02% and 0.21%, and the occurrence is rare but potentially fatal [1-3]. During percutaneous lung puncture with positive pressure ventilation, air passes into the pulmonary vein if alveolar or bronchial pressure is higher than venous pressure, thus forming SAE. Coronary and cerebral embolism lead to cardiac and neurologic ischemia [3, 4]. Several diagnostic tools can detect intracardiac and cerebral embolism, such as TEE, Doppler and CT [5, 6].
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Nocardia elegans mixed infection of pulmonary and cutaneous: A case report


Nocardia spp. is clinically important bacterial pathogens that cause suppurative infections ranging from localized lung or cutaneous involvement to disseminated disease. The number of sdhpmacases of pulmonary nocardiosis reported in the literature is increasing, and in some cases, a diagnosis is reached even postmortem [1,2]. The majority of the human Nocardia infections has been attributed to Nocardia asteroids and Nocardia brasiliensis, with Nocardia otitidiscavarium, Nocardia nova, Nocardia farcinica and Nocardia elegans known as uncommon pathogens [3,4,5].
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The criminally-legal responsibility of medical workers for professional crimes against the person and health


As follows from the content of the State Health Development Program of the Republic of Kazakhstan "Densaulyk" for 2020- 2025, approved by Decree of the President of the Republic of Kazakhstan dated October 12, 2021 No. transfer of modern medical technologies [1]. During the period of implementation of the State Health Development Program of the Republic of Kazakhstan "Salamatty Kazakhstan" for 2011-2015, the following was noted: an increase in the population in the republic to 17,417.7 thousand people (as of 01.01.2015) with an annual population growth rate of 1, 4%; increase in life expectancy to 71.62 years
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Atypical lipid keratopathy


A 26-year-old patient, presented with a bilateral corneal clouding that had been slowly progressive over the last 2 years. He was a sports trainer having consumed protein for bodybuilding. Visual acuity was 6/10 in the Right Eye (RE) and 1/20 in the Left Eye (LE). Slit lamp examination showed deep yellow corneal deposits with stromal neovascularization (Figure 1). No other ocular abnormalities were found. The anterior segment optical coherence tomography revealed a hyper-reflective area in the deep stroma.
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Invasive squamous cell carcinoma of the conjunctiva


Squamous cell carcinoma is the most common epithelial malignancy of the conjunctiva [1]. The tumor primarily affects middle-aged to elderly male patients [1]. Sun injury, viral infections, and immunocompromised states are known etiological factors. The limbal epithelial cells appear to be the progenitors of this disease [2]. It is generally a low-grade tumor. Invasive squamous cell carcinoma, however, is uncommon, and intraocular extension has rarely been reported [3].
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Vanishing lung - A massive tuberculosis destruction


A 22-year-old female patient sought emergency medical services because she was complaining of asthenia, cough and haemoptysis for one month. She had a past medical history of a pulmonary tuberculosis four years ago while she was living abroad. The treatment was administered only for three months but isolates, antibiotic sensitivity and exact therapeutic regimen were not known. Upon clinical examination, patient exhibited sings of respiratory distress, lung sounds were abolished in the right hemithorax and diminished in the left hemithorax. Recurrent episodes of hemoptysis were evident. The chest-x-ray upon admission revealed a complete absence of lung parenchyma in the right hemithorax and in the upper half of the left hemithorax.
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Clear cell sugar tumor – A rare lung tumour


A 82-year-old woman, never smoker, retired farmer with known medical history of hypertension, heart failure, chronic kidney disease, hyperuricemia, and dyslipidaemia was referred to a pulmonology consultation due to the identification of a nodule on a chest-x-ray and one-year history of fatigue. A chest CT scan confirmed a well-defined nodular lesion (22x20mm) in the external segmental of the middle lobe. A PET-CT scan showed increased metabolic activity (SUVMax of 3.5).
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Acute traumatic tentorial subdural hematoma: A diagnostic challenge


Subdural hematomas are mostly located on the frontal, temporal and parietal surfaces over convexity [1]. However, there are also subdural hematoma types, which are called by various names according to the location like peritentorial, and pure tentorial vs vs [2,3]. However, the main classification of subdural hematomas is based on the bleeding time as acute, subacute and chronic [4,5-9]. Acute tentorial subdural hematomas are rare among these types. Although it generally has a benign course, sometimes it may be complicated [6,7].
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Role of Superoxide Dis-Mutase in Sera of Iraqi Lung Cancer Patients


An unrestrained growth of cells in the lungs characterizes lung cancer, a harmful tumor. Without proper treatment, this cancerous growth has the potential to progressively spread into nearby tissues or even affect other parts of the body [1]. Primary lung cancer can be categorized into two main types [2]: Non-Small Cell Lung Cancer (NSCLC), which accounts for approximately 85 percent of all diagnosed cases, and Small Cell Lung Cancer (SCLC) are the two main types of lung cancer. Among NSCLC subtypes, adenocarcinomas are the most commonly observed.
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Successful treatment of cystoid macular edema in central retinal vein occlusion with retinitis pigmentosa: A case report and literature review


Inherited Retinal Dystrophy (IRD) is a diverse range of diseases characterized by the degeneration of retinal cells due to genetic factors. Among these, Retinitis Pigmentosa (RP) is the most prevalent and is a leading cause of visual impairment in most countries [1]. RP is a clinically and genetically heterogeneous group of retinal degenerations primarily affecting the peripheral photoreceptors. The estimated prevalence is approximately 1 in 3000 individuals [2]. It is characterized by a progressive loss of vision, initially presenting as night blindness, followed by the gradual decline of peripheral visual fields. It is often accompanied by central vision deterioration [3].
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Otitis media can also complicate neurosurgically


Physical examination: afebrile, conscious and oriented. Left otoscopy: minimal whitish-yellowish discharge, crust with tympanic retraction is observed. Right otoscopy without alterations. The rest of the physical examination was unremarkable. Given the clinical findings and the patient's comorbidities, we started antibiotic treatment with amoxicillin-clavulanic acid and she was called to assess again in 48 hours, after which she presented with feverish spikes of up to 40ºC and abundant otorrhea. To conscious exploration, disoriented in time and space. Otoscopy disabled by pain.
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Unusual case of Lemierre’s Syndrome in a 5-year-old


Streptococcus pyogenes is a rare pathogen of meningitis. However invasive infections as bacteraemia, pneumonia, skin and soft tissue, and toxic shock due to S pyogenes are common. Very few cases of Sinus vein thrombosis as a complication of S pyogenes have been reported [1]. Children suffer from associated complications much more than adults. This case report point out an uncommon presentation of meningitis due to S pyogenes [2].
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Risk factors for anti-infliximab antibody formation among patients with inflammatory bowel disease


Biologic therapy has evolved in recent years as the mainstay of treatment in Inflammatory Bowel Disease (IBD). Despite the cause of this condition being yet unknown, it is considered a result of an inappropriate inflammatory response, in which Tissue Necrosis Factor (TNF) is a central mediator. Thus, antiTNF drugs like Infliximab (IFX) improved moderate-to-severe IBD [1]. Despite this success, they have limitations, including a high rate of primary and secondary failure. Approximately 30% of patients do not respond. There are several explanations for this loss of response; however, Anti-Drug Antibody (ADA) development is the most common cause of this loss [2].
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Pellagra: A forgotten sporadic clinical entity in primary health care


A 45- year- old male from an urban community, laborer, heavy alcohol consumer, exclusively on rice diet presented to outpatient department in primary health care centre with chronic diarrhea for three months. He was treated multiple times with antibiotics with no improvement. There was no family history of similar illness. He had normal vital signs and mental state. On general examination, he had typical sharply marginated symmetrical scaly hyperpigmented plaques in sun exposed areas of his forearms and hands and necklace pattern of erythematous scaly plaque around the neck popularly known as Casal’s necklace as described in figure 1.
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Photoelastic stress in mandibular overdenture retained by three implants


Insufficient stability and retention are the main complaints of the conventional complete dentures users. This prosthetic rehabilitation is associated with several problems, such as lack of stability, support and retention. However, when mandibular complete denture is supported by implants an improvement could be seen in the patients' psychological and social well-being. This treatment also requires different types of attachment systems that connect the complete denture to the implant [1].
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Isokinetic torque curves abnormalities of the knee extensors during patellofemoral syndrome


Patellofemoral pain syndrome (PFPS) is one of the most prevalent causes of anterior knee pain encountered by physicians. Its etiology remains without a clear consensus; however, it is probably multifactorial. One of the main factors seems to be muscular imbalance. Isokinetic assessment is regularly used in this regard to accurately measure muscle function at different modes and speeds and is therefore the investigation of choice in mechanical knee disorders such as PFPS.
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Volume-3 Issue-4

A huge solitary duodenal hamartoma; A rare endoscopic finding


Generally, duodenal polyps are uncommon, they are usually found with Familial adenomatosis polyposis or Peutz-Jegher’s syndrome, but maybe rarely seen as a solitary polyp presenting with gastrointestinal symptoms [1]. Duodenal polyps are usually asymptomatic and symptoms are usually related to size and location and range from dyspepsia, and abdominal pain, to more seriously overt gastrointestinal bleeding, intussusception, and gastric outlet obstruction [2]. CT and MRI are useful for diagnosis, moreover, Endoscopic ultrasonography (EUS) and EGD provide very useful information regarding tumor characteristics [3].
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Method of treatment of trigeminal neuralgia in the elderly


The main link where the pathological focus of demyelination is formed (in oncological diseases of the nervous system) remains outside the sphere of influence of the existing therapeutic techniques. The need to improve therapeutic methods is also due to the fact that—in addition to primary NTN patients—there are patients with comorbid osteoporosis of the skull bones (OCD) that requires treatment, patients in whom a relapse of pain occurs after successful MIA, cases where the expansion of the channel of the branches of the trigeminal nerve is required, but in which safe expansion cannot be achieved without causing nerve damage due to technical reasons, and cases with medical contraindications to general anesthesia.
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Eruptive Sebaceous Hyperplasia: A rare adverse effect of systemic corticosteroid use in two immunosuppressed patients


Sebaceous hyperplasia is a benign, not uncommon cutaneous disorder. The disorder is caused by overabundance and proliferation of sebocytes in the sebaceous glands [1]. The proliferation induces enlargement of the sebaceous gland up to several times its regular size, but still keeping the normal anatomical structures. Sebacceous glands have a central duct that may become dilated in sebaceous hyperplasia due to secretion of an oily substance, sebum, which presents flesh- or yellowish coloured [2]. Sebaceous glands are localized everywhere on the skin except for palms and soles of the feet.
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Stanford a aortic dissection with involvement of supraaortic vessels associated with bicuspid aortic valve, ascending aortic aneurysm and coarctation of the proximal descending aorta: A case report


Aortic dissection is characterized by a tear in the intima and media layer of the aorta, producing a dissection flap that separates the true lumen from the extraluminal channel called the false lumen, with the possibility of anterograde and/or retrograde extension of the lesion and limiting the distal flow. Determining the exact prevalence of aortic dissection is s challenging due to its high mortality rate, particularly before reaching the hospital. However, in studies involving the general population, it is estimated than there are between 2.6 and 3.5 cases of aortic dissection per 100.000 people per year.
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Kartagener Syndrome: Three rare cases report and systematic review


Kartagener syndrome (KS) belongs to the group of primary ciliary dyskinesia (PCD), which are a spectrum of genetic disorders. It is an autosomal recessive condition. PCD is characterized by chronic upper and lower respiratory tract disease, infertility/ectopic pregnancy, and situs anomalies, that occur in 50% of PCD patients (Kartagener syndrome), and these may be associated with congenital heart abnormalities [1]. The clinical hallmark of KS is the presence of the triad of bronchiectasis, chronic sinusitis, and situs inversus [2,3,4].
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Insulinoma in a thin, Lean Indian male


Insulinoma is a rare type of functional neuroendocrine tumor (NET) characterized by a small insulin-secreting tumor that leads to excessive insulin secretion and subsequent hypoglycemia. Its incidence is exceptionally low, with an annual frequency ranging from 1 to 4 cases per million per year [1,2]. Here, we present the case of a 30-year-old male who presented with recurring episodes of palpitations, sweating, dizziness, and vision difficulties, primarily occurring during periods of fasting and alleviated by consuming food. These symptoms are typical manifestations of hypoglycemia induced by the excessive release of insulin from the insulinoma.
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Monrad Krohn’s Dissociation between emotional and volitional facial paralysis with paradoxical hypermimia: A case report


This 40-year-old previously healthy man presented with sudden onset of cervical pain, vertigo, oscillopsia, and facial paralysis after swim practice. On examination, he had a right Horner's syndrome, skew deviation with right eye hypertropia, left beating pure torsional nystagmus, and left supranuclear volitional facial paralysis. During the interview, when his wife made a joke, he showed an excessive contraction of the left side of his face during spontaneous smiling (a dissociation between the volitional paralysis and the emotional facial contraction - Video 1).
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Preventing coronary occlusion in an elderly severe aortic stenosis patient with critically low coronary heights – A case report


Among all valvular heart diseases, degenerative calcific aortic stenosis (AS) and mitral valve disease affect 9 and 24 million people, respectively [1]. Asia has the highest prevalence of rheumatic aortic stenosis (AS), with the prevalence of 4.54, 1.86, and 1.3 per 1000 people in India, China, and Bangladesh, respectively. Because of the rising prevalence of AS along with the effects of population ageing, the clinical attention on VHD and particularly on AS has increased considerably. While there are more VHD cases among women than among men globally, it has been observed that large trials included more men [2].
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Bouveret’s syndrome in a young, stable patient: Clinical case report and summary of evidence


Gallstone ileus occurs in only 0.3-0.5% of patient cholelithiasis with the most common site of obstruction at distal ileum, but in 1-3% of patients, it occurs at duodenal bulb or pylorus Bouveret´s syndrome after the publication by French physician Leon August Bouveret in 1896 [1]. Better diagnostic and surgical techniques have reduced mortality, but still ranges 12% [2]. Surgical procedure election is controversial.
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Occult HBV infection among chronic hemodialysis patients and its role in viral transmission


Hepatitis is an infection-related liver inflammation that has a high rate of morbidity and mortality. High levels of infection can spread from through blood transfusions, sexual activity, and vertical routes. patients with end-stage renal disease are more likely to have HBV and HCV infections. These bloodborne which are a source of higher morbidity and mortality may be more infectious in HD patients than in the general population [1].
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Groin foreign body in intravenous drug users: Case series


Patients with a retained foreign body are a common scenario in healthcare setting. The implantation can be accidental, selfinflicted or a part of a self- embedding procedure. Foreign body retained for a prolonged duration may complicate to cellulitis, deep tissue infections, sinus, restriction of joint movements, necrotizing fasciitis, osteomyelitis or formation of a tumorlike mass [1]. Foreign bodies may be ingested, inserted into body cavities or may enter the body by penetrating injury or iatrogenically. Among penetrating injuries, intravenous drug use is considered to be a world-wide problem responsible for numerous minor to life-threatening and fatal complications. Intravenous drug abusers use peripheral veins as the route for injecting drugs.
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Disorders of the hemostasis system in the stage of burn shock in patients with burn injuries


Burns are complex traumatic injuries, and much of the focus of research and clinical treatment has been on the acute trauma, appropriate surgical intervention and survival with reduced scarring [1]. Any injury triggers the process of blood clotting, but thermal injuries, represented by shock, lead to abrupt changes in all coagulation systems. [2-4]. Any damage to the vascular wall, "blood damage", on the one hand, leads to different levels of plasma loss, on the other - can be considered physiological, and then pathological changes in the hemostasis system can lead to spontaneous death of the organism [5,6].
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Homolateral and synchronic clear cell and papillary type of renal cell carcinoma – Diagnostic hints and review of literature


Renal cell carcinoma (RCC) is the most common solid mass in the kidney constituting 2-3% of all adult cancers [1]. The most common subtype of RCC is clear cell (80%), besides papillary(10%) and chromophobe type RCC(5%) [2]. Common benign renal neoplasms include renal oncocytoma, angiomyolipoma (AML) and renal adenomas. Data on ipsilateral synchronous clear renal cell carcinoma (CCRCC) and papillary renal cell carcinoma (PRCC) is insufficient.
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Early vertebral artery thrombosis presenting as subclavian steal by virtue of windkessel and venturi effect


A 56 y/o M presented with persistent dizziness and associated nausea, non-bloody emesis and diarrhea since the night before admission. He had generalised fatigue, right sided weakness and room spinning sensation unrelated to head position/ movement. He experienced similar episodes the week prior partially relieved with rest. He denied hearing loss, recent upper respiratory tract infection, headache, fever, chills, or food poisoning.
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Transient ischemic mitral regurgitation caused by non-obstructive coronary lesion


81-year-old Tai female with a history of hypertension, nonocclusive coronary artery disease, atrial fibrillation and hyperthyroidism initially presented with urosepsis and pneumonia. She required intubation and was admitted to MICU. Once she recovered from the above infections with antibiotics and guideline directed therapy, she was transferred to the floors. However, she acutely decompensated and went into cardiogenic shock requiring reintubation. On physical exam, she appeared cachectic. She had bilateral crackles and coarse breath sounds in 2/3 lung fields and irregularly irregular heart sounds with Grade II/VI systolic murmur at the apex but no extremity edema.
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Tuberculosis medication adherence in a secondary care center in SouthEastern Nigeria


Tuberculosis (TB) is an infectious disease caused mainly by Mycobacterium tuberculosis, and occasionally by Mycobacterium bovis or Mycobacterium africanum.1 The lungs are usually affected (pulmonary TB), but other sites could also be affected (extra pulmonary tuberculosis) [1]. It is acquired by inhalation of infected droplets coughed out by infected persons and by consumption of unpasteurized milk from infected cow. Tuberculosis thrives where poverty, overcrowding and chronic debilitating illness abound [2]. The true sign of active TB are chronic cough with blood-containing sputum, fever, night sweats, and weight loss [3].
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Menstrual irregularity and chronic pelvic pain revealing Krukenberg tumours: The contribution of imaging


Krukenberg is a rare signet ring cell metastatic tumour of a digestive adenocarcinoma mostly originating from the stomach. It is bilateral in more than 80% of the cases and it represents 1-2% of all ovarian tumours (1). Unlike primary ovarian cancer, Krukenberg tumours are more likely to occur in younger women, which can be explained by the high blood supply leading to hematogenous spread. The clinical presentation varies and is not specific. Imaging examinations including ultrasound, CT, and MRI are very contributive in both the diagnosis and prognosis.
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Her2 Gene Amplification by Fish Technique in Ovarian Cancer Patients


The Human Epidermal Growth Factor Receptor (HER) family member - HER2 is a transmembrane tyrosine kinase receptor that triggers a cascade of cellular responses leading to cell proliferation, survival, and metastasis [1,2]. HER2 expression is often observed to be dysregulated in various malignancies such as those of breast, ovarian, lung, prostate, colorectal and gastric cancer [3-8]. Overexpression of HER2, commonly by gene amplification is observed in 15-30% of breast cancers, wherein an anti-Her2/neu-therapy administering Trastuzumab is directed against the extracellular domain of the Her2/ neu protein and reveals a significant anti-tumour activity [9,10]. It is an established therapeutic target in breast and gastric carcinomas [11,12].
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Acute cerebrovascular disease Saccular Aneurysm, Hunt-Hess 3, fisher grade 2: Application to Myra Levine’s four conservation principles


In setting the prevalence of stroke internationally, review of related literatures and articles are conducted. According to [1], “the worldwide prevalence of cerebral aneurysms is estimated to be approximately 3.2%, with a mean age of 50, and an overall 1:1 gender ratio. This ratio changes significantly after age 50, with an increasing female predominance approaching 2:1, thought to be due to decreased circulating estrogen causing a reduction in collagen content of the vascular tissue. The rate of rupture causing SAH is about 10 per 100,000. This is higher in certain populations such as the Finnish and Japanese. However, this is not due to a higher prevalence of aneurysms in these populations.
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Obesity in Adolescent Boys: Physical Inactivity, Unhealthy Diets, Screen Time and Irregular Sleep


Obesity is a rapidly growing threat and it’s as common as under nutrition, infectious diseases etc. Obesity is known to affect people of all ages and genders [1]. Childhood overweight and obesity has an adverse effect on physical and psychological health [2]. It is also a major risk factor for many chronic conditions (Type2 diabetes, cardiovascular disease, hypertension, cancer, sleep apnoea etc [3]. Environmental factors, lifestyle choices, genetics and cultural environment playan important role in the prevalence of obesity worldwide [4]. Consumption of high energy foods are linked to obesity.
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Discharge education and sepsis re-admission: An integrative review


Hospital readmission has long been a threat to our country’s healthcare system. Acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, and pneumonia were the primary disease conditions which were closely tracked by the CMS for readmission [1]. Sepsis has recently become the number one disease condition resulting in readmissions following an initial inpatient hospital discharge [1]. Out of 49 million people who are hospitalized with sepsis worldwide, 38 million survive (World Health Organization) [2].
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Bilateral ovarian mature teratoma in a middle-aged female: A rare entity


Mature cystic teratomas of ovary are most common benign ovarian neoplasm of reproductive age group [1]. It accounts for 10-20% of all ovarian neoplasms [2]. Most of them are asymptomatic or may present with complaints of abdominal pain when they enlarge. Mature cystic teratomas most commonly present as unilateral cyst, bilateral presentation of mature cystic teratoma is rare and accounts for only 10-15% [3]. Malignant transformation of mature cystic teratomas seen in 0.1-0.2% of cases.
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Schistosoma Mansoni infection and hepatocellular carcinoma: A co-morbidity study


Schistosomiasis is a chronic disease caused by the genus Schistosoma of the trematode parasites. It is endemic in 78 countries, infecting more than 207 million people worldwide and provoking above 200,000 deaths yearly [1]. Human infection occurs after exposure to contaminated water with schistosome cercariae which penetrate the skin and become schistosomula. They penetrate the wall of a nearby vein and are carried out in the blood circulation, eventually reaching the portal venous system, where they mature and lay eggs. These eggs are either trapped in the tissues and provoke a granulomatous reaction or are passed in the feces, then hatch in water to miracidia which invade the snail and are developed into cercariae to start a new cycle causing schistosomiasis which affects several organs, including the genitourinary, digestive, and nervous systems causing a spectrum of serious diseases [2].
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Brownish limb tumor as a presentation of primary hyperparathyroidism


43-year-old male, with tumor in the anterior region of the right lower limb (figure 1) and biopsy compatible with brown tumor. He presented total serum calcium 12.3 mg/dl and 13 mg/dl (NR: 8.3-10.3), parathormone (PTH) 1057 pg/ml (NR 15-65). With the diagnosis of primary hyperparathyroidism, a 99mTc-MIBI parathyroid scintigraphy with SPECT was requested, which showed hyperfunctioning parathyroid tissue in the projection of the left inferior parathyroid gland. Hand radiographs showed a lytic lesion in punch in the distal phalanx of the first finger of the left hand (figure 2); in the clavicle radiograph: lytic lesion of 10 mm x 8 mm in the right clavicle, no alterations were evidenced in the skull radiograph.
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Solitary pityriasis versicolor: an uncommon presentation as a large single patch: Report of three cases and review of unusual clinical forms


Pityriasis versicolor (PV) is a very common disease in daily practice and it is almost always easily diagnosed by any dermatologist, without the need for further laboratory analysis. However, in the last 10 years we have seen 3 cases of PV with an infrequent presentation, characterized by a single and large lesion located in the neck in all of them, which could hinder the diagnosis. No description of this form was found neither in large series of PV, nor in extensive reviews.
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Cerebellar Abscess- A rare case


The incidence of brain abscesses has been estimated at 0.3 to 1.3 per 100,000 people per year but can be considerably higher in certain risk groups, for example, immunocompromised patients [2]. The most common underlying etiology includes 30%-50% contiguous spread, 10% direct invasion due to trauma or surgery, 10% immunodeficiency, and 30% bacteremia [3,4]. Cerebellar brain abscesses account for 9%–28% of all brain abscesses, and 85%–99% of cases result from the contiguous spread of infection from an ipsilateral otogenic or sinus site [5]. Bacterial spread to the cerebellar region is either retrograde, spread through emissary veins draining the middle ear or sinuses or via direct spread from the site of osteomyelitis or osteitis [5].
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Illustration of skin diseases in the Unani clinical research OPDs


Unani System of Medicine is one of the ancient systems of Medicine, in a historical course, the embranchment of sciences have flourished from the very Greek medical knowledge. Now, India is the largest land in which the Unani system of Medicine is still growing with glorious practices of advanced research and provision of health facilities for curing various complex, untreatable diseases.
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Percutaneous Internal Ring Suturing (Pirs): A minimally invasive procedure in pediatric inguinal hernia repair


A congenital inguinal hernia in the pediatric population is one of the most common conditions requiring surgical treatment, with the reported incidence ranging between 1% and 5% [1, 2, and 3]. It manifests clinically more commonly in younger children, especially premature infants, and the incidence rate is up to 10 times higher in boys. Percutaneous internal ring suturing (PIRS) is a single-port laparoscopic technique used to repair a pediatric indirect inguinal hernia [4]. This technique is still new in the fraternity, and only a few centers practice it. We applied this technique to our patients and found that the duration of surgery was shortened, with smaller surgical incisions, lesser complications and early discharge.
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Evaluation of results of anterior cervical discectomy and fusion by standalone peek cage for the treatment of double level cervical spondylotic myelopathy


Cervical spondylotic myelopathy (CSM) is a disorder of the spinal cord due to compression of the cord by degenerative disease depicted at radiological examinations [1]. Myelopathic or upper motor neuron lesion findings (e.g, hyper-reflexia and gait disturbance) are the typical manifestations of this disorder [2]. Patients may also present with radiculopathy due to degenerative process including bulging or tear of annulus, herniation of disc material into the canal causing pressure effect over the spinal cord and nerve roots [3]. Myelopathic hand signs, Grip release sign, Hoffman’s sign, Romberg test along with gait disturbances (broad based and hesitant) are common in advanced conditions.
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The use of clinical, laboratory, and radiologic data in the assessment of pediatric extrapulmonary tuberculosis cases in Kisumu County, Kenya


Mycobacterium tuberculosis belonging to Genus Mycobacterium is the predominant species causing Tuberculosis (TB), which primarily affects the lungs. It mainly spread through aerosols when the infected cough, sneeze or spit is inhale by an individual. According to the World Health Organization (WHO) 2017 report, the mortality rate has reduced by 37% but still remains top killer due to its antibiotic resistance pattern and co-infection with HIV [1]. Ten million people get sick from TB annually, with 1.5 million people succumbing to TB each year, making it the world’s top infectious killer. World Health Organization (WHO) 2021 reported that children aged below 15 years constituted approximately 12% of 10.4 million new tuberculosis cases in 2020.
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Ramsay hunt syndrome in an immunocompromised patient


A 37-year-old male presented to the emergency department with headache, confusion, right-sided facial droop, and painful rash. One month prior, he underwent staged resection of an intraventricular neurocytoma and was placed on a postoperative dexamethasone taper. Examination revealed weakness in the right cranial nerve VII distribution (Figure 1A), clustered vesicles with erythema in the right ear canal and conchal bowl (Figure 1B), and scattered vesicles on the preauricular cheek. The right anterior third of his tongue had clusters of pustulovesicles (Figure 1C). The patient was diagnosed with Ramsay Hunt Syndrome (herpes zoster oticus) and urgently started on IV acyclovir
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Gastro-gastric intussusception in the setting of unclear lead point: Radiological imaging


Intussusception is defined as telescoping or invagination of the proximal part of the gastrointestinal tract (intussusceptum) into an adjacent section (intussuscipiens) which results in obliteration of the lumen [1-2]. It is considered as a form of bowel obstruction as it accounts for only 1-5% of cases of bowel obstruction [3]. Intussusception in children can occur at any site in the GI tract, and it often presents similar clinical and radiographic features at all sites. These characteristic features are the key to diagnose intussusception even at unusual sites [4]. While Intussusception is a common diagnosis among children, it is in fact a rare condition in adults with the incidence of approximately 2-3 per 1,000,000 per year [5-6].
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Bithalamic signal anomaly


Deep veinous thrombosis is manifested by headache, vomiting, neurological deficit or confusional state. In more severe forms and due to the function of the affected venous territory, it manifests itself by consciousness disorders. The diagnosis is based on imaging. In cases in which a CT scan has been performed as a first-line procedure, it shows both direct and indirect signs [1].
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Dermoscopy of nodular hydradenoma


A 41-year-old woman reports for 5 years a bluish papule on the leg progressively increasing in size and asymptomatic for which she applied by self-medication topical antibiotics without improvement.Clinical examination found a bluish papule subcutaneous with irregular contours on the anterior face of the lower left leg. Dermoscopy revealed an homogeneous pinkish zone without structure (asterisk) and amorphous zone whitish (blue arrow) and bluish (blue triangle), and a lagoonlike appearance in places (red arrow). Histopathologic study was compatible with nodular hydradenoma.
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Hybrid intraoperative sutured stenting for anastomotic leak after total gastrectomy


Total gastrectomy with Roux en Y reconstruction is the mainstay in the treatment of gastric cancer, with survival rates up to 98% for early stage gastric cancer [1-3]. Esophagojejunal anastomotic leak (EJAL) is a potentially fatal postoperative complication with an incidence reported up to 15% and mortality up to 60% [2,4-9]. EJAL may be attributed to patient- related or surgical technique- related factors. Management of the anastomotic defect and optimal supportive care of the patient can be challenging and requires a multimodal approach. Evaluating the size of the defect and monitoring the output of the drains are essential steps towards designing the treatment options [9-11].
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Living with yoga in everyday life


Yoga practice in today’s life: Yoga practice is not restricted now to a few qualified individuals, as it was happened to be in ancient times. Owing to the efforts of the Masters aimed at the welfare of the humanity, the knowledge of yoga practice has reached to every corner of the world. People today are taking interest in yoga, be it for their health, physical flexibility, overall well-being or to experience their spiritual [1,2]. The number of yoga enthusiasts has risen significantly all over the world in recent years especially after the time of covid-19.
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An Unusual Presentation of Sarcoidosis Mimicking Metastatic Peritoneal Carcinomatosis: A Case Report and Review of the Literature


Sarcoidosis is a multi-organ system autoimmune disorder characterized by the presence of non-caseating granuloma formation within one or more organ systems [1]. The majority of cases present with lung involvement, however 30-50% of cases have extra-pulmonary involvement at the time of clinical presentation [2]. These extra-pulmonary manifestations typically involve the skin, lymph nodes and eyes. Rarely sarcoid can manifest in the abdomen; however, this is typically noted in the liver and spleen [3]. Peritoneal sarcoidosis is a rare manifestation of the disease with less than 50 reported cases and it can rarely mimic ovarian or primary peritoneal carcinoma with elevated CA125 levels. There are 5 reported cases reported in the literature.
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Spontaneous rupture of a benign renal cyst: A rare and misleading cause of Wünderlich syndrome


Spontaneous, atraumatic, subcapsular and perirenal renal bleeding was first described by Bonet in 1700. Wünderlich defined it as “spontaneous apoplexy of the renal capsule” in 1856 and in 1910, Coenen referred to this condition as Wünderlich syndrome (WS) [1]. Subsequently, Lenk’s characterized it with a triad of acute flank pain (83%), hematuria (19%), and hypovolemic shock (11%) [2]. WS is a rare condition with a total of 165 cases has been reported by 2002 [3]. Its various etiologies include; (a) tumors viz. renal cell carcinoma, angiomyolipomata, metastases, sarcoma, fibroma, adenoma, oncocytoma and transitional cell carcinoma (61%), (b) vasculopathy viz. polyarteritis nodosa and renal artery aneurysms, renal vein thrombosis, renal arteriovenous malformations, fistulas and portal hypertension (17%), (c) infections viz.
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ChatGPT versus Bard: An analysis and update


ChatGPT and Bard are both large language models, also known as conversational AI or chatbot trained to be informative and comprehensive. They are trained on a massive amount of text data and are able to communicate and generate human-like text in response to a wide range of prompts and questions. For example, they can provide summaries of factual topics or create stories. ChatGPT is a large language model chatbot developed by OpenAI. It is trained on a dataset of 300 billion words and is able to communicate and generate human-like text in response to a wide range of prompts and questions.
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Bronchopulmonary sequestration: A rare congenital anomaly presented in an adult female patient


Bronchopulmonary sequestration represents a spectrum of abnormalities [1]. Pulmonary sequestration refers to the situation whereby a portion of lung tissue receives its blood supply from an anomalous systemic artery [2]. Two types of pulmonary sequestration are recognized [3-10], depending on whether or not the malformation possesses its own pleural covering. Intralobar sequestration is an abnormal region within the normal pulmonary parenchyma without its own pleural covering. Extralobar sequestration corresponds to a true accessory lung, with its own pleural envelope. Intralobar sequestration accounts for 0.15% to 1.7% of all congenital lung abnormalities [11].
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De novo formation of a giant dural arteriovenous fistula after cerebral venous sinus thrombosis


A 45-year-old male patient with past medical history of obesity and diabetes presented with complaints of pulsatile, frontal headache evolving in the past two days. His vital signs were normal and he had no meningeal signs or neurologic deficits. Magnetic resonance angiography (MRA) revealed cerebral venous sinus thrombosis (CVST) with intraluminal thrombus in galen's vein, and right rectum and transverse sinuses (Figure1). The patient was administered oral anticoagulation for six months and a brain MRA was repeated with recanalization of the previously documented venous thrombosis.
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Systemic Burkholderia cepacia complex in a patient with ACLF associated to extreme polarization of the intestinal microbiota toward the phylum Proteobacteria: A case report and review of literature


The Burkholderia cepacia complex (Bcc) is a group of aerobic Gram-negative rod-shaped bacteria, some of which are opportunistic pathogens [1]. Bcc infection has been rarely reported in patients other than cystic fibrosis. In liver cirrhosis, there are reports of SBP (spontaneous bacterial peritonitis) caused by Bcc [2]. However, to date, no study has reported the systemic presence of these bacilli in the context of decompensated alcohol-associated cirrhosis with acute-on-chronic liver failure (ACLF), in the absence of SBP. Likewise we report a gut microbiota with extremely polarized and frank loss of bacterial diversity associated with a poor prognosis.
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A case report of homocysteinuria with endophthalmitis and diabetes


Homocysteine is an intermediary amino acid formed by the conversion of methionine to cysteine. Homocysteinuria is a rare autosomal recessive metabolic disorder caused by a deficiency of enzymes involved in the metabolism of methionine. Homocysteine can be metabolized through two pathways: transsulfuration and remethylation. In the transsulfuration pathway, homocysteine is converted to cysteine with the help of the enzyme cystathionine-beta-synthase. This enzyme requires pyridoxal phosphate, the active form of vitamin B6, as a cofactor. In the remethylation pathway, homocysteine is converted back to methionine. This reaction can be catalyzed by either methionine synthase or betaine-homocysteine methyltransferase.
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Outcome of anatomical arthroscopic trans-portal anterior cruciate ligament reconstruction among sudanese patients


Anterior Cruciate Ligament (ACL) is the major internal stabilizing ligament of the knee and its injury generates major instability. Anterior cruciate ligament is the most commonly injured ligament in the body, making ACL reconstruction is one of the commonly performed procedures in orthopedic surgery. In Sudan no exact data or registry available for knee ligament injuries but in America about 250,000 ACL torn patients presented to hospital each year and about 100,000 ACL reconstruction performed per year [1]. ACL tear seriously affects the life of the patient by incapacitating in his daily life activities and affecting directly his quality of life. Patients with a rupture of ACL may report pain, difficulty with athletic performance and/or giving-way symptoms in daily activities [2].
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Uveitis in with Juvenile Idiopathic Arthritis (JIA): Study of 12 cases


Uveitis is a serious complication of Juvenile Idiopathic Arthritis (JIA) that can lead to significant visual impairment or even blindness. It is the most common cause of uveitis in children and differs from uveitis associated with spondyloarthropathies by the paucity of its functional signs, resulting in diagnostic and therapeutic delays and affecting visual prognosis. The aim of our study was to identify the epidemiological, diagnostic and prognostic features of patients with uveitis associated with Juvenile Idiopathic Arthritis (JIA), as well as to discuss the complications and best therapeutic alternatives and prognostic data on these cases, shedding light on the challenges of managing this complex condition.
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Epithelioid hemangioendothelioma of the brachial artery: A rare benign vascular tumor


Epithelioid hemangioendotheliomas are uncommon vascular tumors presenting with different biological behavior and clinical features. It is a pathology that should be diagnosed early because it is seen at earlier ages and can cause distant organ metastases. Due to its rarity, it is often not included in the differential diagnosis of soft tissue masses [1]. In this case, we aimed to present a malignant epithelioid hemangioendothelioma presenting with palpable swelling.
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Exploring the prevalence and causes of normal Tc-99m thyroid uptake in thyrotoxic patients: A retrospective study at a regional hospital of nuclear medicine in Oman


Thyroid disorders are prevalent globally and affect people of all ages. Thyrotoxicosis, also known as hyperthyroidism, is a common endocrine disorder characterized by increased secretion of thyroid hormones resulting in elevated basal metabolic rate, weight loss, tachycardia, and sweating [1]. It is usually diagnosed by clinical examination, laboratory tests, and imaging studies, including Technetium-99m (Tc-99m) pertechnetate thyroid scan [2]. Tc-99m pertechnetate is a radioactive tracer that is taken up by the thyroid gland and visualized using nuclear medicine imaging [3].
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An illustration of clinical warts before and after treatment with the unani kit medicines in general OPD: A case study


Masāmīr/Tha’ālī are Arabic words used in the Unani System of medicine for a diseased condition called warts. Indeed, it is a hard, grainy skin growth fastened in between the dermis and underneath muscles, its colour is whitish, it is oval or rounded in shape, and it is placed inversely in the skin as a nail; that’s the reason it is called Masāmīr [1]. Its commonest site is the fingers of the hands and soles, because this person gets trouble walking and touching [1]. Type of mass hard growth on the body, when its margin is rounded to be called Masāmīr (nail), but meandering and irregular imagination is called Qarn (corn/horn). Its material is thick, phlegmatic, and sticky [2].
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Severe SARS-Cov-2 infection with extrapulmonary manifestation in a 3-month-old child


Here we present a description of severe COVID-19 infection with extrapulmonary manifestation in infant at a time when the prevalent SARS-CoV-2 strain was the so-called Omicron variant. A male infant, born at 38 weeks' gestation, was admitted to the emergency department on January 31, 2022 due to congenital pneumonia. A chest X-ray showed interstitial pneumonia, however, RT PCR of the patient’s nasopharyngeal swab sample was negative for SARS-CoV-2, as well as for other respiratory viruses. The most common causes of congenital pneumonia, including TORCH-infections, chlamydia, and other pathogens that colonize the mother’s birth canal, were ruled out.
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Biomarkers of some commercial lotion and shampoo based-pesticides toxicity in male mice


Head lice (Pediculus humanus capitis) are considered as the most prevalent parasitic infestation of humans in the developed and developing countries, where the parasitic insects live on the scalp and neck hairs of humans and feed on human blood, causing social distress, discomfort, anxiety, and embarrassment [1,2]. The most likely targets for invasion by head lice are kindergarten and school-aged children between 3 and 11 years and occur commonly each year in all socioeconomic statuses [3-5]. In the United States, each year about 6-12 million kids lose their lost school days due to the infestation of head lice and treatment costs of more than US 500 million/ year [6].
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Hypoglycemia imitating cardiac ischemic symptoms: A case report and review of literature


Diabetes mellitus (DM) is known as one of the largest global health challenge in current century. Diabetic patients have a higher mortality risk due to cardiovascular diseases, and ischemic heart disease (IHD) is considered the leading cause of death among this population [1]. Serum insulin and glucose levels can affect the sympathetic nervous system and norepinephrine release [2]. Autonomic nervous system stimulation triggers hemodynamic changes, including tachycardia, increased peripheral systolic blood pressure, myocardial contractility, stroke volume, cardiac output, and decreased peripheral arterial resistance and central blood pressure.
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Embolization Using the Novel Menox Liquid Embolic System for Arteriovenous Fistulas: A Case Report


The formation of blood clots in the brain’s venous sinuses leads to a condition known as cerebral venous sinus thrombosis (CVST). CVST, also known as cerebral venous thrombosis (CVT), results in the breaking of the blood cells causing blood leakage into the brain tissues, thereby resulting in hemorrhage [1]. Symptoms of CVT are nonspecific, which makes the diagnosis difficult [2,3]. The symptoms include focal neurological disturbances/loss, headaches, nausea, vomiting, altered consciousness, dizziness developing over days to weeks, cranial nerve palsies, papilledema, and seizures resulting in coma in some patients [4-6]. Deep venous thrombosis in patients leads to increased intracranial pressure, with an estimated mortality due to CVT of 5%-30%. However, early diagnosis and treatment can lead to favorable recovery, with about 80% of patients leading a normal life [7].
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Paget’s disease with angioid streaks of the retina: Case report


Angioid streaks are often associated with a systemic condition, most frequently pseudoxanthoma elasticum, Paget’s disease and sickle-cell anemia. They are described as visible, linear, irregular, cracklike dehiscences of Bruch membrane, which may be unilateral or most commonly bilateral. Several diagnostic methods are useful to diagnose, evaluate, and monitor angioid streaks, and various treatment modalities have been used, with promising results.
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Prescription audit in an outpatient department of a Tertiary Care Teaching Hospital


An ‘audit’ is defined as ‘the review and the evaluation of the health care procedures and documentation for the purpose of comparing the quality of care which is provided, with the accepted standards’. Studying the prescribing audit is that part of the audit which seeks to monitor, evaluate and if necessary, suggest modifications in the prescribing practices of medical practitioners. Prescription Audit offers the most comprehensive overview of performance, detailing parameters as per the check list of prescription audit. Prescription writing is an important means of therapeutic intervention by the doctor and reflects his approach towards safe prescribing.
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Uncommon clinical features of juvenile primary hypothyroidism


An 18-year-old boy, the result of a non-consanguineous marriage, was brought to the endocrinology clinic by his parents due to concerns about his short stature, which had been noticeable for the past 8 years. The patient did not have a history of headaches, visual difficulties, hearing impairments, joint pain, chronic cough, altered bowel habits, bone pain, or fractures. There were no reported cases of short stature, psychiatric disorders, or behavioural abnormalities in the family.
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A uniportal video-assisted thoracic surgery approach for lung cancer with silicosis and highly inflammatory lymph nodes


While uniportal video-assisted thoracic surgery (U-VATS) is a viable minimally invasive surgical approach [1], it may restrict the control of surgical instruments. Surgery for lung cancer with silicosis and inflammatory lymph nodes is always difficult, and U-VATS is not considered to be a good indication for such cases. In general, inflammatory lymph nodes cannot be dissected easily, so the vessels and bronchi are cut at the periphery while avoiding these lymph nodes via approaches such as open thoracotomy or multiport VATS.
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Toxocariasis, as a cause of multiple pulmonary and liver nodules in an immunocompetent adult


Human toxocariasisis a cosmopolite parasitic infection due to an helminth Toxocara canis (T.canis) and Toxocara catis (T.catis) transmitted by dogs and cats, respectively. It represents one of the main causes of hypereosinophilia but it is misdiagnosed. It can affect all sites. It’s often an asymptomatic and benign infection and can be recovered without treatment. But some forms are serious and can be life-threatening. Visceral larva migrans constitutes a rare and doubtful form. Clinical signs and radiologic features are not specific, which can mislead the positive diagnosis.
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Leprosy misdiagnosis in Tanzania: An alarming situation, should we concerned?


The disease is endemic in many developing countries, including Tanzania. Leprosy can cause severe disabilities, and its diagnosis and treatment require specialized skills and resources. Leprosy is considered as one of the oldest human endemic diseases.is at least 4,000 years old. It was reported in 1873, when Doctor Armauer Hansen discovered Mycobacterium leprae as the causative agent of leprosy in Bergen, Norway therefore confirming the infectiousness of leprosy [1]. Leprosy is a chronic infectious disease caused by Mycobacterium leprae and one of the world’s most neglected diseases [2].
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Pityriasis Amiantacea – A Diagnostic Challenge


Pityriasis Amiantacea (PA) (synonyms: Tinea amiantacea, asbestos scalp,) is an uncommon papulo-squamous condition of the scalp which presents with thick yellowish, silvery, asbestos-like scales attached to the hair shafts. This condition was first described as asbestos-like tinea by Baron Jean-Louis Alibert of France in 1832 [1]. Etio - pathogenesis of this condition remains unclear and it represents a reaction pattern of the scalp to various inflammatory diseases.
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Erythema nodosum: A rare inflammatory disorder: A case report


Erythema nodosum (EN) is a type of panniculitis, which is an inflammation of the subcutaneous fat. It is characterized by tender, erythematous nodules on the lower legs, although it can occur on other parts of the body as well. EN is a relatively uncommon condition that is most commonly seen in young adults, and it is more prevalent in females than males [1]. The exact etiology of EN is not well understood, but it is believed to be associated with a hypersensitivity reaction to various triggers, such as infections, medications, autoimmune disorders, and malignancies. Infections are the most common cause of EN, with streptococcal infections being the most commonly identified pathogen. Other infectious causes include tuberculosis, Epstein-Barr virus, and hepatitis B and C.
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Small Intestinal GIST: A rare cause of spontaneous and abundant hemoperitoneum


Spontaneous hemoperitoneum is a rare cause of acute abdominal pain. When it happens, it may be fatal. The etiology includes generally hepatic, splenic, gynecologic, vascular causes, and bleeding disorders [1]. Gastrointestinal stromal tumors (GIST) are uncommon tumors with a diverse malignancy potential, habitually detected in the stomach and the small intestine [2]. This entity is exceptionally responsible for a spontaneous hemoperitoneum [3].
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Worm or wool? That is the question?


With an increase in migration and travel, physicians should have an index of suspicion for parasitic infection. Parasitic worms that can affect the lung include trematodes, protozoa and nematodes [1]. Diagnostic investigations such as serology are prone to cross-reactions [2]. Blood eosinophilia may be absent in immunocompromised patients with Strongyloides hyperinfection syndrome [3]. In addition, Ascaris eggs are only passed in the stool following pulmonary symptom resolution, and many non-infectious causes of pulmonary eosinophilia have been described [1].
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Volume-3 Issue-3

Salmonella Hepatitis & Colitis: A case report


Typhoid fever is a systemic infection transmitted by water or food contaminated with the bacteria Salmonella enterica serotype Typhi and/or Paratyphi A, B, C [1]. According to the World Health Organization (WHO), up to 20 million infections are estimated in the world per year; in Mexico, 70,000 infections are reported per year according to the General Directorate of Epidemiology [2]. Approximately 90% of patients with infection receive ambulatory medical care and present resolution of the typical presentation, characterized by fever, abdominal pain, diarrhea or constipation, and macular rash, with the appropriate use of antibiotics.
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Effects of Passive Dehydration on Muscular Strength


The effects that dehydration (hypohydration) has on increasing heat strain and cardiovascular strain and aerobic exercise performance are well documented. Less understood are the effects of dehydration on skeletal muscle performance metabolism. While two studies reported that hypohydration reduced muscle endurance another study found no difference in fatiguability during handgrip exercise. Likewise, anaerobic exercise performance has been reported to be decreased or not altered by hypohydration [1].
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Localized hypopigmentation under the Dermoscope: A diagnostic conundrum


Patients with hypopigmented skin conditions may face cosmetic and psychological difficulties due to the significant difference in appearance between the affected skin and the surrounding normal skin. As a result, they may feel the need to seek evaluation and treatment [1]. On occasion, we have encountered patients with acquired well- demarcated, scattered hypopigmented papules which can suggest multiples diagnosis such as warts, guttate hypomelanosis or an hypopigmented variant of seborrheic keratosis.Seborrheic keratoses are a common type of acquired skin lesion in adults.
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Monitoring the battlefield: Antimicrobial resistance, antibiofilm patterns and virulence factors of Acinetobacter baumannii isolates from hospital system


Supervision of multidrug-resistant Acinetobacter spp. infections is a great task for physicians and clinical microbiologists. Its aptitude to subsist in a hospital setting and its ability to last for extended periods of time on surfaces makes it a frequent cause for health care associated infections and it has led to several outbreaks [1,2]. The organism usually causes a varied spectrum of infections that include pneumonia, bacteremia, meningitis, urinary tract infection, and wound infection. In 1911 in Delft, Nether-lands, a Dutch microbiologist isolated Acinetobacter in Beijerinck [1], but was not definitively recognized until 1971 [2]. Acinetobacter species were originally treatable with antibiotic monotherapy, but high rates of resistance were noted only four years later in 1975 [1].
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Hepatitis B profile among adults: An alarming situation, should we concern?


Hepatitis B is one of the most common infectious diseases globally and a potentially life-threatening liver infection caused by the hepatitis B virus (HBV) [1]. It was originally known as ‘’ serum hepatitis’’ it can cause both acute illness and chronic illness whereas acute illness cause liver inflammation, vomiting, and jaundice illness lasts for a few weeks and then gradually improves in most affected people. Chronic may eventually cause cirrhosis and liver cancer over a period of several years, chronic illness is so fatal compared to acute illness and sometimes put people at high risk of serious complications and prone to death [2].
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A rare case of cardiac metastasis from primary anaplastic thyroid carcinoma


A 56-year-old man, followed for anaplastic thyroid carcinoma, revealed by a large cervical mass and confirmed on anatomopathological examination of a thyroid biopsy, since April 2022. Without notion of dysthyroid (normal TSH at 2.86 mIU/l). The patient received 3 sessions of chemotherapy based on anthracycline. And as part of the monitoring of cardiac function under CHT, the patient consulted in cardiology. Cardiological examination and electrocardiogram were normal. Echocardiography objectified an echogenic mass, fixed to the anterolateral wall of the left ventricle, with a wide base of implantation, and pedicled, measuring 36*25mm (Figure 1), not revascularized by color Doppler, with good biventricular function, LVEF was 58%, with no other abnormalities. The evolution was marked by death four days later
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Diffuse Large B-cell Lymphoma of the Broca Area presented as a Rare Cause of Progressive Cognitive Impairment in a Middle-Aged Woman uncovered with DTI, Fiber tracking and Spectroscopy: A Case Report


Lymphomas are a group of hematologic malignancies that can involve various organs, including the brain. Primary central nervous system lymphoma (PCNSL) is a rare subtype of nonHodgkin lymphoma that originates in the brain or spinal cord. PCNSL accounts for less than 5% of all primary brain tumors, and its diagnosis can be challenging due to its nonspecific symptoms and radiological findings. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of PCNSL and has a poor prognosis [1].
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Emphysematous pyelonephritis: Case series


EPN is a rare and severe necrotizing infection of the kidney and its surroundings which is characterized by intraparenchymal gas [1]. Most of the cases are reported in diabetics, about 90% reported according to different series; obstructive uropathy is the other contributing factor in other cases. Patients are usually critically ill, with a high mortality rate ranging from 18% to 90% according to various case series. Escherichia coli is the most common causative pathogen isolated on urine or pus culture in nearly 70% of the reported cases [2]. In addition, Klebsiella, Clostridium, Candida, Aspergillus, Cryptococcus, and Amoeba also has been reported from the culture.
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Ipoma arborescens: an uncommon diagnosis for swelling knee


A 30-year-old woman with no prior medical history reported left knee pain and swelling evolving for 4 years. The swelling had progressively worsened over the past 4 months, becoming resistant to analgesics and nonsteroidal anti-inflammatory drugs. Physical examination showed only a positive patellar shock on the left without local inflammatory signs. Biological data were within normal range particularly, phosphocalcic and uricemia tests. The conventional knee radiograph was normal. Joint fluid was sterile on puncture, with a predominance of neutrophil cells.
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Rapidly progressive renal dysfunction in systemic sclerosis: Scleroderma renal crisis or…?


Systemic sclerosis (SS) is an autoimmune disease of unknown etiology and characterized by fibrosis and thickening of skin and systemic involvement including gastrointestinal tract, lungs, kidneys and heart [1,2]. It is more commonly seen in females. SS has an overall female to male ratio of 3:1 or greater. [3] Diffuse systemic sclerosis and limited cutaneous systemic sclerosis are the two subsets of SS based on the extent of skin and systemic involvement. Oesophageal dysmotility, pulmonary fibrosis, arterial hypertension and hypertensive heart failure are some of the systemic manifestations of SS [3].
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Surgical Management of Craniocervical Junction Tuberculosis: report of two cases


The incidence of tuberculosis (TB) in spine is <1% [1]. Isolated involvement of the craniovertebral junction (CVJ) comprising the atlas, axis, and basiocciput is even rarer. Tuberculosis in this area is a rare clinical entity and involves 0.3% to 1% of spondylodiscitis [2,3].There is scarce information on CVJ tuberculosis even in developing countries. While this infection mainly involves the atlas and the axis, it can also involve the lower end of the clivus and occipital condyles. The CVJ is the most mobile segment of the cervical spine and extensive osteocartilaginous destruction can lead to atlantoaxial instability.
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Autism in Females: Understanding the Overlooked Diagnoses, Unique Challenges, and Recommendations


Autism Spectrum Condition (ASC) (previously Autism Spectrum Disorder (ASD)) is a neurodevelopmental disorder that affects individuals across different ages, genders, and ethnicities [1]. Despite being commonly associated with males, research suggests that females are also affected by the condition, but their symptoms often go unnoticed or misdiagnosed due to the heterogeneity of the condition and gender bias in the medical profession [2]. In fact, evidence suggests that the condition is underdiagnosed in females [3].
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MRI-Based Personalized Medicine for Schizophrenia: Predicting Antipsychotic Treatment Response using Machine Learning


This study is based on the growing interest in personalized medicine for the treatment of schizophrenia (SCZ), a complex psychiatric disorder that affects approximately 1% of the global population [1]. Despite the availability of several antipsychotic medications, response rates vary widely, and treatment is often characterized by a trial-and-error approach [2]. This approach can lead to suboptimal outcomes, including prolonged illness, relapse, and poor quality of life [3].
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Unmasking the truth: Progressive multifocal leukoencephalopathy – immune reconstitution inflammatory syndrome (PML-IRIS) in a 36-year old male with HIV, A case report


Progressive multifocal leukoencephalopathy (PML) is a rare, serious and often fatal demyelinating disease caused by the JC (John Cunningham) virus characterized by subacute progressive neurologic deficits. Motor, speech and cognitive impairments are the most frequent initial presentations [1]. It most commonly occurs in the setting of immunosuppression, and the most commonly underlying illness is HIV/AIDS, accounting for more than 80% of cases.
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Dermoscopy of lipoid necrobiosis


Lipoid necrobiosis is a rare granulomatous dermatosis, it usually occurs in diabetic subjects. Clinically, it presents as papules, nodules or erythematous plaques with a yellowish atrophic center, sometimes telangiectatic, and is located preferably at the pre-shin level. the confirmation of the diagnosis is based on the histology spectra which will find a granulomatous infiltrate arranged in palisades occupying the whole height of the dermis with an infiltrate composed of lymphocytes, histiocytes, plasma cells and epithelioid cells, as well as epithelioid cells and giant cells.
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A brief comment about terminology and diagnostic standards in temporomandibular disorders


Otorhinolaryngological disorders are amongst the common reason for seeking medical advice in health care setup. Otorhinolaryngological disorders constitutes to one of the major causes of morbidity in any hilly area. Poor socio-economic condition of general population and lack of proper medical facilities further aggravate Otorhinolaryngological problems [1]. The burden of disease on health care system and its impact on general wellbeing is very high and the analysis of 2000 for Global Burden of Disease (GBD) study stated that cause of morbidity (excluding injuries) is most commonly due to infectious diseases and common tropical diseases 60%, 27% due to life-style disorders and 13% due to potentially preventable per-natal conditions. It has been stated that non-communicable diseases are leading cause of death globally [5].
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Otorhinolaryngology Morbidity Pattern among Patients Attending Outpatient Clinic of Suez General Hospital, Egypt


Otorhinolaryngological disorders are amongst the common reason for seeking medical advice in health care setup. Otorhinolaryngological disorders constitutes to one of the major causes of morbidity in any hilly area. Poor socio-economic condition of general population and lack of proper medical facilities further aggravate Otorhinolaryngological problems [1]. The burden of disease on health care system and its impact on general wellbeing is very high and the analysis of 2000 for Global Burden of Disease (GBD) study stated that cause of morbidity (excluding injuries) is most commonly due to infectious diseases and common tropical diseases 60%, 27% due to life-style disorders and 13% due to potentially preventable per-natal conditions. It has been stated that non-communicable diseases are leading cause of death globally [5].
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Lumbo-Aortic lymphadenectomy for residual retroperitoneal masses in testicular germ cell tumors


It is about a 24-year-old male, with no past medical history, diagnosed in April 2021 with left testicular germ cell tumor. He had a left orchiectomy. Postoperative thoraco-abdominopelvic CT scan showed inter-aorto-caval and pre-caval lymph nodes with a diameter of 31mm and 23mm respectively. He received three cycles of BEP (Bleomycin, etoposide and platinum). The post-chemotherapy CT scan showed tumor progression : appearance of mediastinal adenomegaly with a magma of retroperitoneal necrotic adenomegaly compressing the inferior vena cava and renal veins.
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A Rare Case of Arnold-Chiari Malformation Evident after a Streptococcal Throat Infection in a Young Female


Arnold-Chiari malformation (ACM) is the pathological herniation of the cerebellar tonsils through the foramen magnum into the cervical canal [1]. ACM I, being the most common type, consists of a downward tonsillar descent of at least 5 mm or more [2]. ACM II is characterized by caudal herniation of the brainstem, comprising the inferior vermis, pons, and medulla, in addition to elongation of the fourth ventricle and cerebellar tonsillar displacement [3]. ACM I is usually asymptomatic until adulthood [4] and is an incidental finding [5].
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The infective endocarditis: inflammatory markers for earlier diagnosis and corticosteroids for better renal prognosis: Case report and review of literature


Infective endocarditis (IE) is defined as an infection of the heart endocardial surfaces, usually involving one or more cardiac valves, and, to a lesser degree, the mural endocardium or a septal defect. In the Moroccan context, the incidence is not well known due to the absence of national epidemiological data. Despite major efforts to prevent IE, more than a quarter of these infections are related to healthcare measures. Treatment is based on prolonged intravenous antibiotic therapy and requires surgical intervention in more than half of the cases.
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Newborn with epispadias


A newborn was examined. The patient was born to 29-yearold women at 38 weeks and 5 days via normal spontaneous vaginal delivery. Prenatal care was uncomplicated. Fetal anatomy ultrasound and labs were within normal limits. Vital signs were stable and physical exam revealed atypical genitalia (Figure 1 and 2). Urinary incontinence with palpation of the abdomen was noted. Given the findings of absence of the dorsal aspect of the urethra and overlying skin we made the diagnosis of epispadias. Diagnosis is based on clinical and physical exam findings during routine newborn examination.
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Ballooning without Compaction- Left Ventricular aneurysms in Noncompaction Cardiomyopathy


Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy that involves prominent trabeculations and deep intertrabecular recesses in the left ventricle [1]. While the etiology of LVNC is not fully understood, it is believed to be due to a failure of the myocardium to compact the epicardium, resulting in the inhibition of the intertrabecular recesses from being compacted into capillaries [1]. Without the aforementioned capillaries, problems can arise in the microcirculation, leading to congenital left ventricular aneurysms [2].
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Abnormal origin of the left coronary artery


A 31-year-old female with a medical history of unexplained syncope presented with atypical chest pain. The patient has a healthy lifestyle and no risk factors. The EKG showed a sinusal rhythm with a flattened T wave in the anterior region, she then underwent a cardiovascular computed tomography and was found to have an abnormal origin of the left coronary artery from the right coronary sinus, with an inter-arterial course (figure 1). Coronary artery's anomalous origin and course are rare but can result in myocardial infarction, heart failure, arrhythmias, and sudden death [1].
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Angiosarcoma of the scalp : A zosteriform presentation


Cutaneous Angiosarcoma is an aggressive malignant tumor of the vascular endothelium that accounts for approximately 1,6 % of cutaneous soft tissue sarcomas [1]. It mostly occurs in elderly white men, and can appear anywhere on the skin with a predilection for head and neck in 60% of cases and can be unifocal or multifocal at presentation [2]. Timely diagnosis is often delayed, because of the very variable clinical presentation of this tumor and its slow onset and thus a dark prognosis with a 5-year overall survival less than 26% [1]. We report the case of a patient with Angiosarcoma of the scalp mimicking an herpes zoster ophthalmicus.
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Biobioequivalence of Immediate Release-Glibenclamide 5mg Tablets: A Comparative Study in Healthy Volunteers


The physical, chemical and biological qualities of medicines are considered as major aspects. This is due to the drug pharmacological action in treating the target disease would be largely affected by the quality of medicines and pharmaceuticals [1-3]. In Sudan as like other Sub-Saharan countries in Africa, the regulation of the medicines and maintaining their quality standard is governed mainly by the Federal Department of Pharmacy.
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A rare tumor of atypical scrotal location


Apocrine hidrocystoma is a rare benign adnexal tumor considered a cystic proliferation of the apocrine glands, rather than simple retentive cysts of the apocrine sweat glands [3]. It occurs most often in adults on the neck and head and especially on the external canthus of the eye [1,2]. They vary in size from 3 to 15 millimeters and are most often pigmented, blue, blue-black, grayish, translucent or violet in color. Apocrine hidrocystomas located in other sites such as the shoulders, fingers, abdomen and genital region have been rarely described.Differential diagnoses of apocrine hidrocystomas of scrotal location include eccrine hidrocystomas, blue nevus, melanoma, median raphe cyst, milium grain, epidermoid or pilar cyst, and hemolymphangioma [1,2].
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Flattned nose revealing syphilitic aortitis


Syphilis, before the era of antibiotics, reigned among the leading causes of cardiovascular disease [1]. In its tertiary phase, it can be responsible for several vascular manifestations of varying severity. It occurs on 30% of patients not treated during the primary phase, symptomatic on 10 to 15% of cases [2]. We illustrate through this observation a case syphilitic aortitis revealed by flattened appearance of the nose.
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Radiologic issue in central venous catheter insertion in children: A rare case report


Central venous catheterization was used first in 1929 and the subclavian vein was introduced as an access to the central veins in 1952. On the other hand, silicon catheters were used in 70s to access the central veins [1,2]. Walser et al described indications, implantation technique, follow-Up, and complications the portal catheter in 2012 [1] Radiologic placement of long-term central venous peripheral access system portsin 150 patients [2]. There are limited contraindications for portal catheter insertion, including severe coagulopathy, sepsis, and not tolerating subcutaneous devices in case of burn, trauma, and other connective tissue disorders in the chest wall [1-2].
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Maxillary’s cystic lymphangioma: A rare location


Lymphangiomas are developmental malformations that arise from the proliferation of the sequestered lymphatic tissues during embryogenesis. It is a benign congenital lymphatic malformation [1]. It is usually diagnosed in children under 2 years old [2]. In adults, cystic lymphangioma (CL) is a fairly rare disease [3]. Its etiology remains unclear, but it is supposed to be congenital or to result from the lymph fluid pathway obstruction and its retention in the developing lymphatic vessels. Head and neck is the main region affected probably due to the rich lymphatic network in this area.
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Spontaneous maxillary mucocele: Diagnosis and management


Maxillary sinus mucocele is a rare and benign lesion that accounts for approximately 10% of all paranasal sinus mucoceles [1]. Although it is a slow growing tumor, it can cause bone erosion and remodeling [2] resulting in facial asymmetry, pain and other symptoms depending on its extension. We report in this study a case of spontaneous maxillary mucocele causing facial and hard palate deformity
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The AMSAN Variant of GBS, A Rare Complication of COVID-19: A Case Report and Literature Review


SARS-CoV-2, a beta coronavirus, produces fever, cough, and difficulty breathing as the presenting symptoms were very much similar to SARS and MERS [1]. Mao et al. study was the first who reported Neurological manifestations of COVID-19. About one-third of COVID-19 sufferers manifest neurological complications, including nausea, vomiting, headache, dizziness, anosmia, ageusia, altered level of consciousness, and acute cerebrovascular disease. Anosmia and ageusia are the commonest neurological symptoms.
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Osteoma of external auditory canal: A case report


A 36-year-old female patient presented with a gradual decrease in hearing in the right ear since 1 year and dull aching pain since 2 months. It was associated with itching, chronic irritation and cerumen impaction in the ear. It was associated with itching, chronic irritation and cerumen impaction in the ear. No history of tinnitus or vertigo. On examination, a hard, non-tender mass covered with skin completely occluding the external auditory canal was seen. (Figure 1A) Probing around the mass showed posterosuperior and anteroinferior attachment.
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Life Story of a Mycotic Pulmonary Artery Aneurysm


A 29-year-old woman with a history of IV heroin use presented to the emergency department with hemoptysis. Prior to admission, she had a large tricuspid valve vegetation with embolism to the left lower lobe (Figure 1A). At that time, she had an embolic event to the right lower lobe pulmonary artery (Figure 1B) and underwent tricuspid valvuloplasty. Intraoperative microbiology confirmed Candida albicans. On this admission, she was intubated, and CT-angiography suggested mycotic pseudoaneurysm (Figure 1C) of the right lower lobe pulmonary artery, resulting in endovascular coiling by interventional radiology (Figure 1D).
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High degree degloving injury of the lower limb: A case report and literature review


Degloving injuries occur when shearing forces act parallel to the tissues, resulting in displacement of superficial layers and separation of the skin and subcutaneous tissue from deep structures, such as muscular fascia and muscles [1]. These types of injuries are considered severe, with high morbidity and mortality rates [2], due to the increased risk of infections, thermal dysregulation, and fluid loss [3]. The severity of a degloving injury depends on factors such as the mechanism of injury, patient comorbidities, anatomical region, and type of injury (open or closed) [4]. Such injuries must be treated as a life-threatening emergency.
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Intra-pelvic migration of the femoral head in two cases of septic arthritis in Uganda


In many regions of the developing world, pediatric osteomyelitis and septic arthritis are still a major clinical and economic burden, with the incidence of these conditions being much higher in comparison with the developed world [1,2,3]. Early detection and prompt initiation of management are integral to avoid potential serious and permanent complications [4]. Several factors, both cultural and economic, lead to misdiagnosis and/or under-treatment of these children in low-resource settings and, as a consequence, patients present with severe complications.
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Chronic cough: An unlikely complication of pharyngolaryngeal herpes zoster


After the primary infection by varicella zoster virus (VZV), known as chickenpox, the virus remains latent at the dorsal roots or cranial nerve ganglia. The reactivation of the virus can result to herpes zoster and any autonomic ganglion or cranial nerve can be involved. It is rare for herpes zoster to be located in the pharynx or larynx, especially without vagal and/or glossopharyngeal palsy being present. Although postherpetic neuralgia (PHN) is a common complication of herpes zoster, chronic cough after the infection is extremely rare.
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More than an anal abscess: An atypical pancreatic pseudocyst clinical presentation


A 50-year-old man presented to the emergency department due to painful perianal swelling. Previous medical history included Sjögren's Syndrome, heart failure with reduced ejection fraction, dilated cardiomyopathy, and alcoholism. He was previously admitted to our hospital six weeks before with mild alcohol-induced pancreatitis. Gallstones were excluded. On physical examination, he presented a right anal abscess (AA) with fluctuation.
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Cervical transpedicular irrigation and drainage in a patient with cervical spondylodiscitis after hypopharyngeal cancer treatment: A case report


Cervical spondylodiscitis (SD) is a rare condition, but it has the highest morbidity and mortality among infections of the spine [1]. Its incidence is increasing due to high numbers of aging, immunocompromised patients, and intravenous drug users [2,3]. Cervical SD can be managed conservatively with specific antibiotics, but in cases of epidural abscess, septicemia, kyphosis, and neurologic compromise, surgical intervention is necessary [4]. There is some evidence that cervical SD requires surgical intervention more frequently than SD in other spinal regions[5].
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Retroperitoneal Bronchogenic Cyst with Intracystic Hemorrhage Masquerading as an Adrenal Tumor: A Rare Presentation


Bronchogenic cysts are congenital abnormalities of the tracheobronchial bud originating from the primitive foregut, commonly found in the thorax. Occurrence of such cysts in the retroperitoneum is rare [1], with the common site of occurrence being the corpus of pancreas or left adrenal gland [2]. Bronchogenic cysts are commonly asymptomatic, detected incidentally on imaging unless they are infected or enlarged enough to compress nearby organs. Although imaging modalities can help detect these cysts, only histopathological examination can provide a definitive diagnosis of retroperitoneal bronchogenic cyst.
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Psoriasis in children: Study of 463 patients


Psoriasis is a common skin disease in children and adults; it is an immune-mediated inflammatory skin disease, clinically characterized by erythematous papules and plaques covered with silvery scale. It is associated especially in children with physical and psychological burden [1]. Both genetic and environmental factors interact to precipitate the development of psoriasis [2]. Estimates of the total prevalence of psoriasis in various parts of the world range from 0.1 to 3% [3].
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Pneumothorax in pulmonary histiocytosis X syndrome


A previously healthy 21-year-old man was admitted to the emergency department due to severe respiratory distress. A chest X-ray was requested, it showed a tension pneumothorax of the left hemithorax, which required surgery for treatment. As a personal history, this patient was a smoker of 5 cigarettes a day for 3 years. In the contralateral hemithorax, a diffuse nodular interstitial pattern was found, leading to the decision to request an additional chest Computed Tomography (CT). An extensive analytical study was carried out with negative results for sputum culture, negative Mantoux, complete blood count (CBC), biochemistry and urine without alterations.
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Thimble ladder


Thimble bladder is a small, contracted, thick urinary bladder after chronic infection, inflammation, and fibrosis following genitourinary tuberculosis. The bladder is involved when tubercle bacilli are excreted in urine from the Kidneys. Small capacity urinary bladder presents with frequency, incontinence, and deranged creatinine.
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Anatomical classification of catterpillar hump of RHA and its surgical importance (nagpur classification)


Good optics and infrared imaging and safe energy sources added recently in armamentarium of surgeons has increased safety of laparoscopic cholecystectomy and CBD exploration. In spite of advancement and improvement in techniques, certain anatomical variations spring surprises, and may lead to surgical complications -biliary and vascular. Laparoscopic cholecystectomy makes it mandatory to have a thorough knowledge of normal anatomy and variations in this region to reduce the likelihood of uncontrolled intraoperative bleeding, iatrogenic extrahepatic biliary injury and conversion to open cholecystectomy [1].
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Utilization of ActiGraft, an Autologous Whole Blood Clot, for Treatment of Complex Wounds Linked to Comorbidities


Chronic, non-healing wounds are defined as wounds that have not progressed through the normal healing process and are open for over a month, affecting over 2% of the worldwide population [1,2], with prevalence increasing with age [3,4]. Data from 2014 calculated that Medicare expenditure for all wounds ranges from $28.1 to $96.8 billion, including costs for infection management [5]. The EU financial burden was estimated at €4-6 billion in 2009 [6].
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Nuclear morphometry and stereological analysis of gastrocnemius and pectoralis major muscle tissue from MDX mice supplemented or not with creatine for 16 weeks


Duchenne muscular dystrophy is a recessive genetic disease that manifests itself in the individual's sex chromosome, compromising the DMD gene, responsible for encoding dystrophin, an important structural protein located in the subsarcolemmal area of striated muscle cells [1]. Genetic defects in the DMD gene can occur through deletions, duplications, or point mutations, and currently, there is no cure for this disease, with the use of corticosteroids being the most effective treatment [2].
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Editorial Board

Haruto Nishida

Haruto Nishida

Editor in Chief

Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan

Haruto Nishida

Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan

Jianlu Zhang

Department of General Surgery, Beijing Shijitan Hospital/ Peking University Ninth School of Clinical Medicine, China

Guoping Jiang

School of Public Health, Nanchang University, Nanchang, China

Ehizogie Edigin

Loma Linda University Health, Loma Linda, California, USA

Riccardo Monterubbianesi

Department of Clinical Sciences and Stomatology, Polytechnic University of Marche Via Toronto 10/a, 60126, Ancona, Italy

Abdullah Hussein Abdullah Al-Amoodi

Universiti Pendidikan Sultan, Tanjung Malim, Malaysia

Irma Korinteli, Department of Pediatrics

Tbilisi State Medical University, Tbilisi, Georgia

Mohamed Araby

Interim Translational Research Institute (iTRI), Hamad Medical Corporation (HMC), Doha, Qatar

Agron Dogjani

Medical University of Tirana, the University Trauma Hospital, Tirana, Albania

Guilherme Dienstmann

Ociedade Educacional de Santa Catarina (UNISOCIESC), Joinville, SC, Brazil

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