Articles

   Gallbladder cancer is a rare and aggressive form of gastroin- testinal malignancy, accounting for 1.2% of new cancer diag- noses worldwide in 2018 and 1.7% of cancer deaths [1]. It is estimated that 12,130 new cases of cancer involving the gall- bladder and large bile ducts will be diagnosed in the United States in 2022, with 4 in 10 of these cases being gallbladder cancer [2]. The most common histologic subtype of gallblad- der carcinoma is adenocarcinoma, comprising 90% of all cases.

   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. Nev- ertheless, 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].

   Infective endocarditis is caused by the adherence of infectious agents to the endocardial surface, resulting in inflammation and damage, especially to the heart valves. Acute infective endocarditis is usually characterized by the presence of a virulent pathogen, such as Staphylococcus aureus, with involve- ment of a normal heart valve, commonly resulting in a typical clinical presentation and early complications, with signs and symptoms usually reported in less than two weeks of onset. Subacute infective endocarditis is frequently characterized by the presence of a less virulent pathogen, such as Streptococcus viridans or Staphylococcus epidermidis, with the involvement of an abnormal heart valve and symptoms reported af- ter two weeks from the onset [1].

   The Myocardial infarction is defined as a presence of the myocardial injury with an elevated of the heart biomarkers [1]. The detection of an elevated troponin more than 99th percentile upper rate limit (URL) is defined as myocardial injury [2]. Myocardial infarction has five types, the type II° will be discussed in our case. The Myocardial Infarction type II is due to insufficient blood flow to the ischemic myocardium to meet the increased myocardial oxygen demand of the stressor [3,4]. In our case we introduce a myocardial infarction type II° by congenital TTP.

    PDP is the primary form of hypertrophic osteoarthropathy (HOA) which should be distinguished from the secondary form of HOA, which is much more frequent and mostly associated with severe pulmonary disease, bronchogenic carcinoma, lung empyema, bronchiectasis, congenital heart dis- ease, and thyroid or GI malignancy [1]. It was first described by Friedreich [2] in 1868, who called it ‘Hyperostosis of the entire skeleton’. In 1907, Unna named the term ‘cutis verticis gyrate’ for thick, transversely folded skin of scalp and forehead [3].

   A 09-month-old infant referred by a geneticist to look for ra- diological signs of pycnodysostosis. From a first degree con- sanguineous marriage, who presented since birth repeated spontaneous fractures. The examination found Facial dys- morphia made of: Macrocephaly, persistent anterior fontanel, protruding frontal bumps, a prominent nose and Microgna- thia, curved aspect of the left lower limb. Skeletal radiographs showed, at the level of the skull: hypoplasia of the lower jaw bone, densification of the base of the skull. In the thorax: hy- poplastic aspect of the acromial extremities of the clavicles as well as the ribs several fractures of different ages of the anterior and posterior arches.

    Malaria is a life threatening disease caused by five species of protozoan parasite of the genus Plasmodium (P. falciparum, P. vivax, P. malariae, P. ovale and P. knowlesi) that is trans- mitted to humans through the bites of an infected 34 female anopheles mosquito [1,2,3]. Nearly all human deaths by ma- laria are caused by P. falciparum, mainly in sub-Saharan Af- rica. Globally, an estimated 3.3 billion people in 97 countries and territories are at risk of being infected with malaria and developing disease and 1.2 billion are at high risk [3,4].

   Behcet’s disease is a systemic vasculitis of unknown etiology affecting arteries and veins of different calibre. Vascular mani- festations are frequent and occur mainly in young male sub- jects. Depending on the series, arterial injury affects 4 to 17% of patients [1], and occurs early in the course of the disease. Aortic lesion is rare and serious and can be life-threatening in the event of rupture [2].

   This is a 28 year old female patient followed for polycystic ovarian syndrome under oral contraception, who has been presenting for a week with asthenia and cough motivating her consultation, and given the pandemic context a PCR was requested which came back positive for sars cov2 pneumopa- thy, the symptomatology worsened 6 days after the onset of symptoms with the sudden appearance of a hot and painful red swelling of the left lower limb which became tense and bluish 3 hours later, prompting her consultation in the covid care unit, On physical examination.

   Surgical resection remains the standard-of-care for patients diagnosed with non-small cell lung cancer at initial stages [1]. Post-surgical complications, both cardiac and non-cardiac, oc- cur to a significant proportion of the patients, 9-37%, affecting short- and long-term prognosis [2]. They depend on age and comorbidities of the patient, and type of resection. Complica- tions are further classified as early, ie occurring in the 6-month period after the surgery, and late [3].

   Acute abdomen in adults is very common in clinical practice, which may be resulted from various reasons. Among them, in- testinal obstruction triggered by incarcerated hernia with 6~8 hours duration or beyond often leads to irrevisible intestinal necrosis, even life-threatening risk, requiring an urgent sur- gery. [1,2] For this reason, the optimum option is laparoscopic exploration rather than dangerous“waiting to see”or spend- ing plenty of time on addressing the true culprit, especially for those uncommon internal hernias.

   Giant left atrium (LA) is a very rare entity and rarely reported in the literature due to decreased frequency of rheumatic mi- tral valve (MV) disease in the last four decades. Earlier diagno- sis and treatment of rheumatic MV disease contributed to the considerable decline in the rheumatic heart disease incidence, especially in developed countries [1]. Giant LA is uncommonly seen in rheumatic mitral stenosis, but is usually related to se- vere mitral regurgitation or mixed mitral disease [2,3].

   Oesophagogastric varices (EGV) are a common complication of cirrhotic portal hypertension, for which endoscopic variceal therapy (EVT) is always used as the means of primary preven- tion and treatment. However, repeated EVT may lead to por- tal vein thrombosis (PVT). A meta-analysis [1] involving 833 patients from 13 studies showed that the overall incidence of PVT after EVT was 10.4% (95% CI, 4.9–17.7%), with a statisti- cally significant difference (I2 = 83.3%, P < 0.0001).

   Endocarditis is an inflammation of the endocardium and its structures (valves), most often of infectious origin, described by William Osler in 1885. Non-infectious causes of endocar- ditis (autoimmune, cancerous) are exceptional. Infective en- docarditis (IE) is not a uniform disease: its presentations are highly variable, depending on the initial clinical manifesta- tions, pre-existing heart disease if any, the microorganism, the presence or absence of complications, and the patient’s characteristics. Its diagnosis is often difficult.

   Solitary plasmacytoma of bone (osseous plasmacytoma) is a rare entity characterized by the proliferation of malignant plasma cells, These are localized to a bone segment without diffuse bone marrow invasion. The dorsolumbar location is the most frequent; sternal involvement is rarely described.

   Osgood-Schlatter disease (OSD) is a painful inflammation of the bone and cartilage of the tibial tuberosity. First described by Osgood and Shlatter in the early 1900s as a group of growth plate disorders occurring in children and adolescents who are growing rapidly and who regularly participate in sports. The main symptoms are: pain, which usually gets worse with activ- ity and gets better with rest, swelling and tenderness in the tibial tuberosity just below the kneecap.

   The water lily appearance corresponds to the presence of wavy or serpiginous structures within an excavated mass. It indicates the presence of a complicated hydatid cyst. Hy- datid cyst is a cosmopolitan anthropozoonosis, related to the development of a larval form of a parasite “echinococ- cus granulosis”. The pulmonary localization comes in second place after the hepatic one [1]. From an anatomical point of view, a hydatid cyst appears to be made up of a reactionary tissue membrane belonging to the host and two other mem- branes, constituents of the parasite; one is acellular (anhistic cuticle) whereas the second, the germinative proliga, gives rise to daughter vesicles.

   We report the cases of two patients, a 62-year-old woman fol- lowed for hypertension under treatment who presented an episode of TIA with paresthesia of the left hemisphere, and a 74 year old man with right hemiparesis and central facial palsy, both patients were referred to our training for supra- aortic angioscan. A CT scan with helical acquisition after injec- tion of contrast medium at the cervico-thoracic level with fine reconstructions revealing in both patients the presence of an unusual origin of the left common carotid artery in the TABC.

   Residency training across specialties is based on gaining clinical knowledge in the field, developing diagnostic acu- men, mastering appropriate use of therapeutic options, and increasing surgical experience. Traditionally, residency pro- grams are evaluated on their ability to ensure specific num- bers of patient encounters and minimum surgical volumes, a formal schedule of didactic sessions, and clinical exposures to related subspecialties. A resident’s competency is confirmed based on measurable outcomes.

   The connection between the mind and body has been stud- ied for many decades, and without a doubt, there is a strong link between these two entities. The largest and most vis- ible organ of the body, which is immediately accessible to the public eye, is the skin. In a culture that emphasizes the importance of beauty, any insult to one’s physical appear- ance can lead to substantial psychological disturbances, or even exacerbate them. Notably, the relationship between the mind and body is reciprocal.

   Small bowel volvulus is a real surgical emergency. Early diag- nosis and prompt operation are essential to prevent gangrene in the small intestine, which is associated with high morbidity and mortality. This is a life-threatening complication of intes- tinal malrotations, which is defined by abnormal twisting of a loop of small bowel around the axis of its own mesentery dur- ing embryologic development [1].

   Spinal and epidural injections for anesthesia and analgesia has been a popular choice and one of the most cost effective means of providing anesthesia and analgesia during caesar- ean section . They are generally regarded as safe and the fre- quency of severe, permanent neurological complications re- lated to them, based on prospective and retrospective studies, seems to be extremely low (roughly less than 0.01%).

   The hemiconvulsion-hemiplegia-epilepsy syndrome (HHE) is a partial epilepsy [1], first described by GASTAUT et al. in 1957 [2]. This syndrome, which has become rare, occurs in children under 4 years of age [1, 2]. Its exact etiopathogenesis remains poorly defined. Therefore, the authors consider that a viral infection can cause vascular disorders which, in turn, lead to ischemic lesions explaining the installation of hemiplegia, convulsive seizures, and cytotoxic edema. Others explain these lesions by the recurrence of convulsive seizures or status epilepticus [3].

   60-year-old diabetic patient, followed for Hodgkin’s lymphoma who presented to the emergency room for diffuse abdominal pain in a febrile context. The biological examination showed hyperleucocytosis with a high CRP (320mg/l). An ultrasound was performed showing a voluminous lateralized right pelvic collection confirmed by an abdominal CT scan. The patient benefited from a percutaneous drainage objectifying a purulent liquid. The cytobacteriological examination came back in favor of E.coli.

   Cerebral fat embolism (CFE) is a rare phenomenon in pae- diatric settings and is usually seen post-trauma in pa- tients with pre-existing intracardiac shunting. We pres- ent a rare case of CFE in the absence of cardiac anomaly.

   Listeria monocytogenes is a ubiquitous, gram-positive, faculta- tive anaerobic, rod-shaped bacterium with virulence factors that enable its bacterial resistance to heat, drying, freezing, and extreme environments. These factors contribute to its ability to cause invasive listeriosis, which can encompass bactere- mia, neurolisteriosis, meningitis, and maternal-neonatal listeriosis [5]. L. monocytogenes is one of eight food-borne patho- gens monitored by the CDC. Amongst the eight, listeriosis has the lowest overall incidence of 0.3 per 100,000 population but is the third most deadly, specifically due to invasive Listeria monocytogenes gastroenteritis with an average fatality rate of 20% [1].

   In 1905, Felix Gaisbock, MD (from Innsbruck University, Tyrol, Austria) first described a syndrome observed by him in hyper- tensive male patients having high hematocrit levels [1]. Work- ing in the Austrian highlands for many years, he focused his scientific interests on the cardiovascular pathophysiology of living under such conditions and on sports medicine. Gaisböck syndrome is associated with high cardiovascular risk and, not rarely, with obesity, lipid profile abnormalities, as well as with high renin and uric acid blood levels; it is more common in men, especially in smokers [2].

   A 40-year-old Hispanic female was referred to our center com- plaining of 6-mo episodes of dyspnea associated with chest pain and abdominal pain located in the right hypochondrium refractory to medical treatment. She denied any previous his- tory of trauma or surgery. There were no positive findings on the physical examination. Computed tomography (CT) re- vealed a well-circumscribed homogenous soft tissue mass, de- scribed as an apparent protrusion of the liver into the thorax of 6 cm, suggesting a diaphragmatic hernia (Figure 1).

   Inadvertent injection of autologous blood in both subdural and intrathecal spaces following EBP is extremely rare. Case reports describe SSH or SAH after attempted EBPs. This illus- tration depicts combined subdural and subarachnoid collec- tion after EBP for post dural puncture headache (PDPH)(from a lumbar spinal drain), 6 days after 40 ml of autologous blood was injected in the “epidural space” at the same spinal level as the preceding spinal drain.

   Malignant peritoneal mesothelioma (MPM) is a malignancy of the peritoneum, the lining which covers the internal organs of the abdomen. It is a rare cancer, with a worldwide incidence of approximately one case per four to five million people with a higher incidence in developed and industrialised nations [1].

   We report a case of erythema annulare centrifugum-like pso- riasis occurring in a 44-year-old female. The patient presented with annular erythematous plaques with trailing collarette scales affecting the elbows and antecubital fossae, which are consistent with a clinical diagnosis of erythema annulare cen- trifugum (EAC). Given the presence of classical clinical features of EAC, this case was notable due to biopsy findings, which revealed classic histologic changes of psoriasis.

   Tomato (Lycopersicun esculentum L.) is the family Solanaceae. After carrots, lettuce, and onions, tomatoes are the world 4th most popular fresh vegetable. The production of tomato is growing dramatically in the world as like its consumption. According to the data provided by [1] world has produced 182,301,395 tons tomatoes in 2017. To achieve this produc- tion, almost 5 million hectares were used. However, China, In- dia and the USA are the top most countries dominating in the production of tomatoes.

   Hemoglobinopathies are genetic hemoglobin problems gen- erated by mutations in the genes that codify the polypeptide chain of hemoglobin. These structural hemoglobin defects provide functionally compromised molecules, which induce poor oxygen supply and vulnerability to elimination by the victim’s reticuloendothelial system, with lethal or life-threat- ening severe anemia and hypoxia as a result [1].

   The repair of emergent thoraco-abdominal aneurysms (TAAA) remains challenging. Open surgery carries high rates of mor- bi-mortality [1]. Off-the-shelf branched endovascular devices can be a solution for the repair of TAAA in emergent cases. The Octopus technique [2]. (OT) entails bifurcated grafts in the thoracic segment in TAAA to access visceral arteries with multiples parallel covered stents. This appears to be an op- tion with acceptable target vessels patency varying between 89-100% [3].

   Tobacco smoke is the leading avoidable cause of mortality worldwide, causing over 5 million deaths annually [1]. A com- plex mixture of more than 4,000 substances, tobacco smoke induces a chronic condition, increases the risk of death from many types of cancer and causes alterations of multiple or- gans. These compounds include gaseous and liquid media such as carbon monoxide (CO), nitrogen monoxide, hydro- carbon, and nicotine, which is responsible of smoking addic- tion [2].

   Well and poorly differentiated neuroendocrine neoplasms (NENs) may be associated with an ectopic production of Ad- renocorticotropic Hormone (ACTH) [1] that leads to a para- neoplastic Cushing Syndrome (CS). This heterogeneous clini- cal pattern is the result of a hypercortisolism [2] due to an uncontrolled and continuous hyperstimulation of the adrenal cortex, which escapes the negative feedback of the Hypothal- amus-Hypophysis axis [3].

   Cervical cancer is the most common female malignant tu- mour globally which seriously threatens female’s health. Per- sistent infection of high-risk human papillomavirus (HPV) has been clarified to be the necessary cause of cervical cancer [1]. Cervical cancer is the commonest cancer cause of death among women in developing countries. Mortality due to cer- vical cancer is also an indicator of health inequities, as 86% of all deaths due to cervical cancer are in developing, low- and middle-income countries [2].

   The falciform ligament is a peritoneal fold that contains the ligamentum teres, obliterated umbilical vein, and extraperi- toneal fat [1]. Pathology of the falciform ligament is rare but can include focal infarction and necrosis. Torsion of the fatty appendages of the falciform ligament results in ischemia [1,2]. Clinically, focal infarction of the falciform ligament can present with acute abdominal pain which may mimic other hepatobili- ary, gastroduodenal, and pancreatic diseases [3].

   Pseudoaneurysm is a false aneurysm that occur at the site of arterial injury that involves one or more layers of the arterial wall but no all three layers of the wall [1]. The renal artery pseudoaneurysm is a rare clinical entity due to iatrogenic pro- cedures like percutaneous procedures, renal biopsy, nephrec- tomy or to penetrating or blunt traumas [2,3]. The clinical can be different according to patient blood pressure, blood flow and also to the effectiveness of the hemostasis.

   Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition characterized by osteophytic growth along the anterior longitudinal ligament. The disease process was first described after Forestier discovered radiographic changes in elderly males with spinal stiffness [1]. The prevalence of DISH increases with age, affecting 25-27% of men over 50-years-old and 12-15% of women over 50-years-old [2-4]. DISH is diagnosed by the presence of flowing vertebral ossifications at four contiguous vertebrae, preserved intervertebral disc height, absent ankylosis at the facet-joints, and absent sacroiliac joint changes [5].

   Many extra-intestinal manifestations of inflammatory bowel disease (IBD) have been well described, including uveitis, conjunctivitis, seronegative arthritis, and erythema nodosum. Clinically overt IBD-related pulmonary disease is rare, despite estimates of subclinical pulmonary disease as high as 40-60% [1]. Reported pulmonary manifestations of IBD, especially ulcerative colitis (UC), include bronchiectasis, bronchitis, tracheobronchitis, bronchiolitis, and interstitial lung disease [1]. In UC, large airway involvement is unrelated to bowel disease activity and may present with or without gastrointestinal symptoms.

   Granulomatosis with polyangiitis (GPA), commonly known as Wegener’s Granulomatosis, is an autoimmune granulomatous inflammatory disease of unclear etiology affecting small and medium sized blood vessels [1-4]. Presenting rhinologic symptoms commonly associated with GPA include rhinorrhea, ulcerations of the nasal mucosa, and chronic rhinosinusitis [1, 5]. Although the nasal cavity and paranasal sinuses are the most common zones of GPA involvement in the head and neck, 45% to 60% of patients experience involvement of the soft tissues of the orbit [1, 6].

   Antibiotics are principally prescription and consumed for treatment of bacterial infections in human and animals and furthermore used in livestock animal production as growth promoters [1]. Many antibiotics are negligibly metabolized in body [2,3], being excreted with their main component and transferred to wastewater. Existence of antibiotics in aquatic systems has become a main concern for scientists to discover efficient ways to eliminate these pollutants from water.

   Anal cancer only constitutes 4% of all the cancers of lower gastrointestinal tract. The main etiology is infection with human papilloma virus (HPV). Patients infected with Human Immunodeficiency Virus (HIV) is an independent risk factor in developing anal cancer. The increasing trend of patients with squamous cell carcinoma (SCC) of anus is a reflection of high prevalence of HPV in the population.

   Follicular dendritic cell (FDC) sarcomas are often confused with other tumors and even inflammatory processes. Diagnosis requires the use of broad-spectrum FDC markers (eg, CD21, CD23, CD35, clusterin, CXCL13, podoplanin), especially given that tumor antigen loss is common. It can be divided into two types: conventional FDC sarcoma and inflammatory pseudotumor-like follicular dendritic cell (IPT-like FDC) sarcoma. In addition to its unique histopathological and clinical features, IPT-like FDCs also have the characteristic that tumor cells are positive for Epstein-Barr virus, which is necessary for diagnosis [1,2].

   Benign fibrous histiocytoma occurs as an exceptional, painless, subcutaneous, mesenchymal, fibrohistiocytic neoplasm devoid of dermal incrimination. Additionally designated as deep dermatofibroma, deep seated benign fibrous histiocytoma commonly emerges within subcutaneous tissue, deep seated soft tissue or parenchymal organs. Generally, benign fibrous histiocytoma arises in adult males > 25 years and appears between 6 years to 84 years with a median age of disease emergence at 40 years.

   Tuberculosis is still one of the most common infectious diseases in developing countries, including Indonesia. World Health Organization (WHO) reported a total of 10, 4 million cases of Tuberculosis globally, with 1,7 million died annually in 2016. Tuberculosis is also registered as the top ten cause of mortality in 2016 [2]. The Ministry of Health in Indonesia reported 320.000 cases of Tuberculosis in Indonesia [2]. Most of the morbidity and mortality are caused by the complications of Tuberculosis, including spondylitis tuberculosis.

   The progression from an in situ lesion to invasive cancer is widely recognized in many different forms of malignancies. Mesothelioma in situ (MIS) although having existed as a concept for many decades has only recently emerged as a distinct diagnostic entity. This is primarily due to the historical controversy surrounding its existence, as many early descriptions came from cases that also harbored foci of invasive disease, which led to the belief that the in situ component did not represent true in situ disease but rather spread of the invasive cancer along a mesothelial lined surface [1,2].

   Cupping therapy is a customary medical innovation for a great many years. It is a critical segment of reciprocal and alternative medicine in the universe as needle therapy. It is mainstream in numerous nations, particularly in China, Korea, Japan, Saudi Arabia, and even Sudan [1]. Cupping therapy can be employed in spacious curable disease, and a few enhancements in the technical research of cupping therapy has been Made [2]. More heeds are intensive on the adverse event statement and exhorted proposal or standard. Cupping therapy is compelling in numerous sorts of sicknesses.