Articles

   It was found that the MSCT semiotics of oral and oropharyngeal cancer corresponded to the magnetic resonance imaging (MRI) semiotics and included direct and indirect signs. Direct signs of the formation of malignant were volumetric proliferation of pathological tissue, thinning of the fat layer or complete obliteration of fat spaces, infiltration of muscle tissue and bone destruction. Indirect signs were structural heterogeneity of the tissue (in the presence of necrosis) and changes in density indicators after the introduction of a contrast agent during MSCT.

   A young child of 5.5 years of age presented with complaints of growth retardation .On examination, weight recorded was 11kg ;height was 91 cm .Micropenis was noted with poorly formed scrotum and testicular volume of ~1cc each.on Clonidine stimulation test ,GH values were found to be significantly low.LH,FSH and PRL values were also lower .gross motor skills ,language and social development was noted to be appropriate for age.working diagnosis of GH deficiency was made and imaging was done.

   In United States, head and neck cancer accounts for 3 percent of malignancies [1]. Head and neck cancer mainly remains localized to the primary site and regional lymph nodes. Cardiac metastasis is an uncommon site of metastasis for head and neck cancer. The reported incidence is 1% [2]. We present an interesting case of cardiac metastasis secondary to tongue cancer in a patient who presented with STEMI. It is prudent to consider cardiac metastasis in a patient with head and neck cancer presenting with non-specific cardiac symptoms.

   The Eastern Association of Surgery of Trauma trial of 275,555 patients demonstrated SBMI frequency of 1% in overall blunt trauma admissions, and within 3% of patients worked up for blunt abdominal trauma, with significant associated mortality of 19% and morbidity of 28.9% [1]. The underlying mechanism for SBMI is the result of either rapid deceleration, compression or crush injuries [2]. These mechanisms can create a mesenteric avulsion that occurs when a segment of the bowel, typically separates itself from the mesentery, leaving a devascularized segment that looks like a handle on a bucket [3].

    Primary myelofibrosis is one of the chronic myeloproliferative disorders characterized by abnormal proliferation of hematopoietic stem cells within the bone marrow that results in progressive fibrotic replacement of the bone marrow [1]. Bone marrow fibrosis eventually leads to extramedullary hematopoiesis which can affect bones and internal organs like the spleen and liver [1,2]. The most common presenting symptom in patients with myelofibrosis is severe fatigue, followed by abdominal pain, weight loss, and constitutional symptoms [3].

   Over the closing several decades, hydrogen sulfide (H2 S) as obtained hobby as a manufacturer new signaling molecule, with physiological and pathophysiological roles in human issues affecting vascular biology, immune capabilities, cellular survival, metabolism, longevity, development, and strain resistance. Apart from its considered competencies in oxidative stress and inflammation, new proof has emerged revealing that H2S consists of out physiological competencies thru focused on proteins, enzymes, and transcription factors via a post-translational modification known as per-sulfidation [1].

    Pediatric appendicitis is a common condition which affects 70,000 children in the US each year with a lifetime risk of nine percent for males and seven percent for females [1]. Although nonoperative management with antibiotics has become increasingly popular as a therapeutic tool to cure appendicitis, appendectomy remains the mainstay treatment option [2]. Laparoscopic appendectomy requires closure of the appendiceal stump in order to prevent leak of fecal matter from the cecum. Stump closure can be achieved via multiple techniques including stapling and suturing [3].

   Nurses’ experiences of maintaining the quality of the practice are important in the context of today’s safety and quality agenda. The intensive care unit (ICU) is complex and has one of the highest prevalence of medical errors. Patient injury is believed to be related to the rapidly changing patient status and complex diagnoses and treatments [1]. The organization of ICU patients varies greatly and is taken care of by many different providers who use different technologies. Therefore, adverse event reports are an important component of improving patient safety.

   Cervical lymphadenopathy is a common finding that prompts inpatient otolaryngology consults. Along with congenital causes, infections and neoplasms are primarily considered in the differential diagnosis of the neck mass. Recent travel, trauma to the head and neck, history of substance abuse, or exposure to animals suggest an infectious cause, and history of alcohol or tobacco abuse, or previous radiation treatment increases suspicion for malignancy [1].

   Diffuse intrinsic pontine glioma (DIPG) is the most aggressive primary brain tumor in children with a median age at diagnosis of 6 to 7 years [1-5]. Findings on MRI include an intrinsic, centrally located tumor involving >50% to 66% of the pons with hypointensity on T1 images and hyperintensity on T2 images with indistinct tumor margins and engulfment of the basilar artery, and absence of cystic or exophytic components [6-9]. Children diagnosed with DIPG have a less than 10% 2-year survival rate [10].

   Treating elderly and frail patients with diffuse large B-cell lymphoma (DLBCL) is a unique therapeutic challenge since standard chemotherapy is not applicable. In patients who are considered fit enough to receive cytotoxic chemotherapy, current treatment standards are modifications of the R-CHOP (rituximab, cyclophosphamid, doxorubicin, vincristin and prednisone) protocol and rituximab plus bendamustine. Patients unable to tolerate any cytotoxic chemotherapy due to severely reduced performance status and/or comorbidities are usually treated with best supportive care (BSC).

   During the last decades, a large number of people have been affected by the 3 epidemics caused by the coronavirus family (SARS-2003, MERS-2012 and COVID-2019) in the world. Nevertheless, there is significant genetic dissimilarity between the pathogens of the three previous epidemics, especially MERS with COVID-19. In the previous epidemics, the initial disease foci were the Middle East, Saudi Arabia (MERS), and China, and animal-to-human and then human-to-human pathogen transmissions have been reported in other countries [1,2].

   Primary mediastinal germ cell tumors (PMGCT) are potentially aggressive neoplasms that are rarely associated with hematological malignancies (HM) in young men.1 Among HM, an association between PMGCT and myelodysplastic syndrome (MDS) is extremely uncommon. The association between PMGCT and HM involves complex oncogenesis that has yet to be established, and these uncertainties are reflected in the unresponsiveness to the current therapeutic interventions, hence, leading to an unfavorable prognosis.

   Exosomes are biological nanovesicles (40–150 nm), are secreted by plant cells and transmits signals among the cells and organisms [1]. Plant Exosome like nanovesicles (PELNVs) are similar to the mammalian Exosome like Nano vesicles (ELNVs) [2]. PELNVs are experimentally harmless and eco-friendly vigorous and viable nano-carriers for modern medicine [3]. Plantderived exosome-like nanoparticles (PELNVs) are effective to treat the diseases. PELNVs are low cytotoxic and show good biocompatibility compare with synthesized nanoparticles which are linked with complications like immunogenicity, cytotoxicity [4].

   Paraneoplastic limbic encephalitis (PLE) is a rare neurologic that can be a manifestation of lung cancer. These manifestations are frequently seen in patients diagnosed with small cell lung cancer (SCLC), as in our case. This is a case report of a 66-years-old woman, with SCLC that has been diagnosed due to paraneoplastic encephalitis staining positive for anti-Hu antibodies. Sometimes differential diagnosis involves endocrinopathies and other neurological conditions, so many specialists must co-operate in each patient.

   Hemodialysis (HD) is currently the most widely used renal replacement therapy for end-stage chronic renal disease [1]. Native arteriovenous fistula (AVF) is the preferred access because of lower infectious and thrombotic risk [2, 3], higher survival, shorter hospitalization time, lower mortality and associated morbidity. The risk of AVF infection, namely by methicillin-resistant staphylococcus aureus (MRSA), should not be underestimated.

   Headache, especially migraine, and epilepsy are both common neurologic disorders, which cause transient, paroxysmal and recurrent attacks of altered brain function, and share some similar clinical features, genetic predisposition and therapeutic approaches [1]. Patients suffering from migraine are often referred for routine electroencephalogram (EEG), especially when atypical symptoms exist, in order for a possible epileptic disorder to be excluded [2].

   A 37-year-old male presented to Accident and Emergency following a high-voltage electric shock whilst trying to repair sheet metal products. The patient was anchored on stainless steel rollers, whilst holding two steel bars bilaterally, trying to manoeuvre. A high voltage shock from a broken junction box of domestic electrical supply was sustained by the patient. A fellow co-worker managed to drag the patient using a non-conductive instrument.

   The cisterna chyli and thoracic duct are important structures of the lymphatic system that serve to transport lymph and chyle into systemic circulation [1]. Inadvertent injury to either structure is most commonly iatrogenic, particularly as a complication of thoracic or abdominal surgeries [2]. Postoperative chyle leaks are rare complications, occurring less than 1% [3]. They can vary in presentation, depending on the location of injury along the lymphatic tract.

   It is common practice in the white-skinned world to wear sunglasses when exposed to the sun, on the one hand, and to apply sunscreen cream to the skin, on the other. In Australia, for example, this is a standard. The minutes of maximum sun exposure are regularly communicated on the radio. However, it is found that this has not reduced the number of melanomas. One could suspect that the theory of reducing the incidence of melanoma in this way might not be correct.

   The number of pacemaker implantations continues to increase, with a variety of techniques described and devices available. RV apex is often the site of choice for ventricular pacing [1]. Short- and long-term complications are not uncommon, and careful attention must be paid to avoid potential risks and to identify and treat all types of adverse events [2-6]. In particular, the use of an LV-lead instead of RV-lead in patients with appropriate risk factors has been studied and discussed for several years [2-3, 7].

   Epithelioid trophoblastic tumour commonly occurs within the reproductive age group and is usually discerned following a gestational event such as a full-term delivery, molar pregnancy or spontaneous abortion. Tumefaction is exceptionally delineated within postmenopausal women [2, 3]. Epithelioid trophoblastic tumour appears to be associated with a preceding gestational trophoblastic neoplasm, preceding normal pregnancy or preceding spontaneous abortion [2, 3]. Epithelioid trophoblastic tumour follows antecedent pregnancy by several months or years Generally, the neoplasm may follow a previous gestational event beyond > 6 years [2, 3].

   Head and neck squamous cell carcinomas (HNSCC) comprise a group of biologically similar cancers that originate in different structures, starting in the lip, oral cavity (mouth), nasal cavity (inside the nose), paranasal sinuses, pharynx and larynx. HNSCC is the sixth most common malignancy worldwide, it is predicted that the number of HNSCC patients will rise by 30% in 2030 [1]. HNSCC can lead to aesthetic alterations of the face and neck with disturbance of vital functions such as breathing, swallowing, phonation and hearing. Although significant progress has been made in surgical techniques, radiotherapy and chemotherapy, the prognosis is still poor [2].

   A 65-year-old man with a history of left renal cell carcinoma 25 years ago underwent left nephrectomy and was regularly followed up. Last year, positron emission tomography showed mediastinal lymph node enlargement. Bronchoscopic biopsy revealed cancer recurrence and metastasis. We administered ipilimumab (1 mg/kg) and nivolumab (4 mg/kg) combination therapy. A week later, he developed diarrhea and abdominal pain. Colonoscopy revealed a reddish edematous mucosa with erosions and ulcers from the terminal ileum to the ileocecal valve (Figure 1A, B).

   A 91-year-old woman with primary complaints of abdominal pain and vomiting visited our hospital. Abdominal computed tomography revealed an ileocecal tumor with ileal dilation (Figure 1a). Colonoscopy (PCF‐Q260AZI; Olympus, Tokyo, Japan) revealed a circumferential cecal tumor invading the ileocecal valve (Figure 1b). A biopsy revealed adenocarcinoma, which was diagnosed as ileocecal cancer, resulting in obstruction. Surgery was deemed difficult due to her dementia and bedridden status. We placed a palliative colonic self-expandable metal stent (SEMS), with informed consent from her family.

   Low grade endometrial stromal sarcoma (LG-ESS) is a rare malignant neoplasm of the uterus. Incidence is one to two from a million of women [1]. Endometrial stromal tumours have been classified by WHO as benign stromal nodule and endometrial stromal sarcoma (ESS). It is further classified based on mitotic count and cell morphology into low grade ESS and high-grade ESS [2]. It commonly presents as abnormal uterine bleeding and pelvic pain. However, it can present as uterine mass and metastases to the adnexa, lymph nodes and lungs.

   Over the years, technology has impacted many spheres of life with the major aim of creating a positive transformational effect. The 20th century was met with an expansion in the use of information and communication technologies, which strongly influenced healthcare delivery not just in developed countries, but also in developing countries. Technology in healthcare has attempted to address the issues of equity, quality, access, cost-effectiveness and other problems associated.

   Central neuraxial blocks (CNBs) relevant to the practice of obstetric anesthesia and analgesia are spinal, epidural and combined spinal-epidural injections. These techniques are routinely used for cesarean deliveries and labor pain relief. Traditionally, CNBs are performed using surface anatomical landmarks. In the first instance the highest point of each iliac crest is identifies. The imaginary line connecting these points allegedly passes through the L4 vertebral body in non-pregnant women, and L3 vertebral body in pregnant women [1].

   Immune checkpoint inhibitors (ICPi) have begun to be widely used in the treatment of cancers in the last two decades. They have been approved in the treatment of melanoma, renal cell carcinomas, lung cancer and other solid tumors [1, 2]. They block checkpoint proteins including Cytotoxic T Lymphocyte Antigen-4(CTLA-4) and Programmed Death-1 (PD-1) present on the surface of immune cells, cells of other organ systems as well as cancer cells in addition to their ligands such as the PD-Ligand 1.

   The term thrombosis refers to the formation, from constituents of blood, of an abnormal mass within the vascular system of a living animal. When this process occurs within the deep veins, it is referred to as deep vein thrombosis (DVT). Deep vein thrombosis (DVT) commonly affects the lower limb, with clot formation beginning in a deep calf vein and propagating proximally [1, 2]. Deep vein thrombosis occurs most often in the legs, but can form in the veins of the arms, and in the mesenteric and cerebral veins [3].

   Anxiety is a long-term human reaction to an unknown indefinite threat and this is because the stimulus that causes it is not clear. Etymologically, the root of the term “Anxiety” is found in the ancient Greek verb anxiety, which can be rendered as push, strangle or strangle. When a person is possessed by anxiety, he experiences tension, a feeling of indefinite fear, waiting for an impending danger or a difficulty without a justified reason.

   The development and shaping of gender identity is a complex process that evolves in interaction with individual, biological, family, social, cognitive and psychological factors [1]. People with behaviors, expressions and gender identities that differ from the social and cultural expectations and rules that result from their biological sex at birth are often referred to as transgender.

   An 18 month old Caucasian female presented with rapid onset weight gain (2kg in two weeks), stridor and overnight apnoea, and irritability. On examination she weighed 14kg (+ 2.45SD, 99th centile) with a height of 76.4cm (-1.48SD, 5th centile) with a BMI of 23.99(+4.68, >99thth centile). She was markedly hypertensive (100/50mmHG) (95th centile). She was cushingoid in appearance (central obesity, rounded face and dorsocervical fat pad) as seen in (Figure 1).

   Cervical cancer (CC) is one of the leading causes of cancer death in women in sub-Saharan Africa (SSA) [1]. CC is caused by persistence of high-risk human papillomavirus (HPV) infection, which may lead to pre-cancer and then progress to cancer [2]. All of this process takes 10 to 20 years, making CC a preventable disease [3]. World Health Organization (WHO) estimates that 68’000 cases of CC are diagnosed annually in SSA, supporting the urgent need for implementation of preventive strategies to eliminate the CC burden [4].

   Hemorrhoidal disease is one of the most prevalent medical disorders, its incidence ranging between 4 and 35% [1] in patients between 40-60 years of both sexes, being rare under 20 years [2]. Hemorrhoids are composed of a submucosal connective tissue associated with smooth muscle (Treizt muscle) and an arteriovenous network, forming pads located at the left, anterolateral and right posterolateral level in the anal canal, and there may be accessory plexuses between them.

   Weaning isdescribed as the transitional period starting from 4 monthsonwards till the end of second or even third year in certaincultures so that the infant’s diet progressively changes from milk alone to semi-solids and finally to the adult family food [1].WHO recommends the introduction of complementary foods (traditional or commercial weaning foods) around the sixth month of life, instead of between the fourthand sixth month, as previously recommended [2].

   Lately, the left common iliac vein angioplasty associated withstenting deployment, either by isolated iliac vein compression or associated with deep venous thrombosis, or even caused by post-thrombotic syndrome became very common and very widespread, leading to long-term satisfactory results,with completely resolution of the symptoms [1]. Among the complications related to the endovascular treatment of the left common iliac vein obstruction, the contralateral deep venous thrombosis is poorer described in the overall literature, despite the incidence of 4-9%, consisting in a late complication of the procedure.

   Social media has been used as a tool for public health interventions [1, 2] like smoking cessation studies [3], promoting weight loss and physical activity among individuals with mental illness [4], and HIV prevention among men who have sex with men [5]. The increase in social media use in research interventions is likely to continue as 72% of the public used social media in 2019 compared to 5% in 2005 [6]. Studies using social media (i.e., Instagram, Pinterest, Tumblr, Flickr) for health promotion and education have trended upwards [7].

   Dysphagia Lusoria is a rare condition in which dysphagia results from external vascular compression of the esophagus. Named after lusus naturae, jest of nature, dysphagia lusoria was first documented in 1794 [1]. It is most commonly due to an aberrant retroesophageal right subclavian artery that affects around 0.5-2% of the population. Here, we describe a case of longstanding dysphagia lusoria that resulted in severe malnutrition and failure to thrive.

   A 72-year-old woman was on dialysis for 44 years. Chest radiography revealed hazy opacity in the upper lung field (Figure 1A). Chest computed tomography (CT) showed patchy ground-glass opacities and fusion with overt calcification (Figure 1B). She had mild hypoxemia and impaired diffusing capacity. 99mTc-HMDP scintigraphy showed a prominent uptake in the lung fields corresponding to the patchy opacities (Figure 1C), indicating the accumulation of calcium in the lung parenchyma.

   A well-known, energetic, 93 year-old patient comes to the geriatric clinic for her regular follow up. Noted on her gen- eral physical were back dimples. Casually she mentions that they have been there since her younger days. Decades have passed, the eyesight has blurred, skin has wrinkled, hair has thinned, bones are brittle, but the dimples have not changed.

   Gallbladder herniation is an uncommon event. Most case reports describe a para-stomal, incisional or lesser sac location of the herniated gallbladder1-3. Since the first case of gallbladder herniation (lesser sac) was reported by McGrea4 in 1951, the surgical literature has seen multiple other sporadic instances of this rare phenomenon. With the increasingly liberal use of cross-sectional imaging, incidental identification of an uncomplicated gallbladder herniation has become increasingly common.

   Cellular angiofibroma (CAF) is a rare benign mesenchymal tumor that affects both genders in the genitourinary region [1]. Nucci et al. first described this entity in the vulva in fe- male in 1997 [2]. Cellular angiofibroma is generally a slow- growing and form asymptomatic mass that primarily arises in the vulvar-vaginal region in female and the inguinal region in males [3]. Although rare, cases have been reported in the pelvic and extra pelvic regions [4].

   Primary extranodal NHL is a type of non-lymphoma Hodgkin’s (NHL) that develops in tissue other than the lymph nodes, Waldeyer’s ring, thymus and spleen [1, 2]. Diffuse large B cell lymphoma (DLBCL) is the most frequent kind of NHL, particularly among the elderly [3], and has a subtype with extranodal presentation [4]. Extranodal DLBCL with primary skeletal muscle involvement is extremely unusual, especially in the thigh and calf areas [5].

   The presented image was a 6 x 6 cm encapsulated hematoma deep to the gastrocnemius muscle with the surgeon’s finger as a reference for size (Figure 1 A/B). The surgery team had a high index of suspicion that an encapsulated hematoma was present in a coagulopathic patient who had previously underwent four-compartment fasciotomy, but despite excellent exposure from the fasciotomy incisions, the team was unable to locate the hematoma.

   Biopolymers are made up of repeating monomers of one or more than one type, produced by living organisms. Chitin is among the most abundant biopolymers in nature. It is second most widespread polymer after cellulose existing in the form of ordered polysaccharide micro-fibrils. Chitin has structural homology to cellulose with a hydroxyl group on C2 position replaced with acetyl amide functional group (- NHCOCH3) [1].