Articles

   Corona virus disease 2019 (COVID-19) is the clinical manifestation of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 was declared a pandemic in March 2020 [1]. In Tunisia the first case was diagnosed in March 2020. Several clinical manifestations were observed. Sincethe disease was discovered, many studies have been done to describe this disease and new symptoms are discovered frequently. The main sign is a respiratory syndrome associated with high rates of critical illness and mortality [1]

   Minimally invasive esophagectomy in prone position is a procedure during which the patient is placed in a prone position during the thoracoscopic approach. The first experiences were published by Cuschieri et al. in 1994 who described this approach to access the posterior mediastinum and the esophagus for mobilization and resection [1,2]. Giant hiatal hernias are more common in older patients and can significantly reduce their quality of life [3].

   Pain, according to the classification subcommittee (Subcommittee of Taxonomy) of IASP (International Association for the Study of the Pain), is defined as a unpleasant aesthetic and emotional experience that is associated with already existing or potential tissue damage or which is described as such [1]. Pain measurement can be used to diagnostic purposes, for therapeutic approaches and to assess the effectiveness of a treatment. Answers to questionnaires can reveal its nature, onset, focus and morphology pain, providing important diagnostic data [2,3].

   Obesity is considered a pandemic disease [1]. In 2016, over eighteen per cent of the world’s population was obese, according to the World Health Organization [2]. Bariatric procedures are the best solution in the management of obesity [3]. In total, 59.4 % of bariatric procedures are sleeve gastrostomies, according to the American Society of Metabolic and Bariatric Surgery’s report in 2019 [4]. However, they are highly successful procedures with outstanding outcomes in obesity and its co-morbidities [5].

    Kaposi’s sarcoma (KS) is an angioproliferative, multi-centric and indolent tumor caused by the Human Herpes Virus 8 (HHV8). It comes in 4 subtypes: Endemic in equatorial Africa, classic non-endemic, epidemic in patients living with HIV and iatrogenic in organ transplant patients [1]. Myelodysplastic syndrome (MDS) is a heterogeneous group of hematopoietic stem cell diseases characterized by abnormal development of one or more myeloid lines with inefficient hematopoiesis and risk of transformation into acute leukemia.

   In practice, the endocrine system is a critical gateway because it connects physical function with the psyche and brain via psychoneuroendocrinology. The endocrine system includes the following glands: the pituitary, pineal, hypothalamus, thyroid, parathyroid, adrenal, pancreas, and genital organs. These glands use hormones (rather than the electrical impulses used by the nervous system) to cause changes in our body, emo- tions, cognition, and energy.

    Health is the major priority in every individual’s life; hence it is a matter of common concern. In fact, all community groups have their own concept of health as part of their culture. The major challenges regarding maintaining a healthy culture are faced by the rural and tribal population due to many factors like the lack of primary health services in these areas and a rise in quack practices. Considering all these factors, the Indian government is promoting many projects for health improvement.

   Cannabis indicates a group of three plants (Cannabissativa, C.indica, and C.ruderalis) having psychoactive properties. Can- nabis is majorly consumed for its calming and relaxing effects. In the United States, cannabis is also indicated for use in a range of medical ailments, including glaucoma, chronic pain, poor appetite etc. Cannabis contains more than 120 constitu- ents, known as cannabinoids. Researchers aren’t able to fully explore effects of cannabinoids [1].

   Illness is one of the most common sources of stress in a developing child’s life. It is very difficult for a child to deal with this situation. Protecting children from COVID-19 is very difficult. While adults are vaccinated, children under the age of 18 are not yet vaccinated in most countries. Therefore, children are unfortunately vulnerable to contracting COVID-19. It is very important to carefully examine this age group [1]. In recent studies, it has been reported that the survival rate of children with COVID-19 positivity has increased, and even a child with COVID-19 experiences COVID-19 positivity again after the disease and its positivity turns negative [2].

   The lumbrical muscles are named after the Latin word “lumbricidae,” meaning earthworm. This is due to their unique appearance. Usually, there are four lumbrical muscles in a human hand. All originate from FDP tendons and insert onto the extensor expansions on the lateral side of the corresponding digits. The lumbricals are unique because although most muscles originate and insert onto bones, LMs both originate and insert onto tendons, giving the lumbricals moveable attachments.

   An Endocrine Disrupting Chemical (EDC) is defined by the United States Environmental Protection Agency (EPA) as, “an exogenous chemical substance or mixture that alters the structure or function(s) of the endocrine system and causes adverse effects at the level of the organism, its progeny, and populations or (sub)populations” [1,2]. More than half a century now, there have been a general observation on increase in infertility issues especially among young couples which some even attribute to witchcraft and other diabolical reasons in this part of the world.

   Retroperitoneal extra-organ tumors (RETs), in general, are rare tumors which histopathological characteristics and biological behavior that can be considered benign or malignant. They originate from various tissue elements located in the retroperitoneal space [1]. Approximately 70–80% of RETs are malignant; however, these only account for 0.1–0.2% of all malignancies [2]. The classification of RETs can be based on the type of tissue origin (mesodermal, ectodermal, or embryonic remnants) [3].

   Traumatic brain injury (TBI) can be called a silent epidemic and is not of a degenerative, vascular, infectious, or congenital nature [1,2]. TBI is associated with significant disability and a variety of neurological and physical disturbances including fatigue, dizziness, headaches, chronic pain, balance problems, sensory loss, and sleep problems [3,4] and also it leads to cognitive disorders such as memory, attention, processing speed, word finding and executive functions [2,5].

   BS accounts for 5% of urinary stone diseases in western coun- tries, and it reaches up to 45% in some African countries [1-6]. BS are common in men than in women and children than in adults [4,6,7]. Risk factors that promote BS formation in adults include urinary tract infection (UTI) by urease-producing organisms, chronic urinary retention, and bladder outlet obstruction. These conditions are resultant effects of prostatic diseases, bladder diverticulum, genital prolapse in females, neurogenic bladder dysfunction, urethral stricture, foreign body, and prolonged urethral catheterization [8,9].

   ARDS: Adult Respiratory Distress Syndrome; BLI: Bleomycin Lung Injury; CPAP: Continuous Positive Airway Pressure; DLV: Double Lung Ventilation; FiO2: Fraction Of Inspired Oxygen; HPV: Hypoxic Pulmonary Vasoconstriction; MAC: Minimal Alveolar Concentration; OLV: One-Lung Ventilation; TLC: Total Lung Capacity.

   Rotational deformities of lower limb such as excessive anteversion and tibial torsion are often idiopathic [1]. These deformities resolve spontaneously in 90% with physiological growth [2]. Deformities which persist beyond the age of resolution can cause femoro-acetabular impingement and patellar instability [3]. De-rotational osteotomyiswidely used to correct symptomatic deformities. The ability to translate pre-operative plan to accurate intra-operative correction remains challenging in these situations, aslandmarks in long bones away from osteotomy site are often used in pre-operative planning.

   A 23 year old patient, with no medical history presented with an asymptomatic lesion on scalp that had been evolving for 3 years. Clinical examination showed asmooth, mobile, firm, and well-circumscribed nodulesurrounded by a Well-defined annular patcheof non scarring alopecia (Figure 1), hair pull test was negatif. On trichoscopy we found irregularly broken hairs, black dots and flaming hairs, the rest of the scalp and body hair were without abnormalities.

   It is well generally accepted that extracorporeal shockwave lithotripsy (ESWL) has becoming a safe and useful treatment modality for urolithiasis, since it was first applied in the early1980s [1,2]. Researchers have always believed that the destructive forces, created via the extracorporeal shockwave, would cause damages to adjacent tissues and vessels in the kidney [3]. Only less than 7% patients who receiving ESWL would generate mild Complications, and severe kidney trauma is extremely rare [4].

   Biliary Atresia (BA) is a form of cholangiopathy that affects both the extra- and intrahepatic bile ducts. The incidence is particularly high in Asia (100-500 per 100,000 live births in Taiwan and Japan [1] as compared to Europe (5-25 per 100,000 live births) [2]. The etiopathogenesis of BA is multifactorial and multiple pathomechanisms have been proposed.

   A 34-year young lady with a right-sided euthyroid nodule of 3x5 cm size for one year visited our clinic for surgery. FNAC was reported as colloid goiter. The right hemi-thyroidectomy surgery was planned. Intraoperatively while dissecting the right thyroid lobe, we could not find the right recurrent laryngeal nerve in its normal course, but we found a cord white-like structure running transversely & entering the larynx at the level of the cricothyroid muscle. We dissected it till its origin from the right vagus nerve in the neck.

   A 38 years old male patient came with the history of infertility. His blood reports were normal. He did not have any comorbidities. On ultrasound – there was something behind the urinary bladder which was appearing like uterus. Normal prostate gland was seen in the patient. Patients both kidneys were normal.

   Cancer is a genetic disease. The statement of oncogenes isbeing a significant occasion in beginning phases of cancer development. Oncogenes are actuated through two instruments: either by contamination of cells by growth infections or by transformation of cell proto-oncogenes (which are generally typical) to oncogenes. Then cancers start by oncogenic change of just a solitary cell. A cancers embrace the capacity to get away from the site of their starting point and encroach different pieces of the body.

   A 25- year-old systemically healthy female patient reported with an aesthetic complaint due to a growth in the corner of right upper lip present for 2 months. Clinical examination revealed a solitary spherical-shaped bright red fibrous overgrowth measuring 4x4 mm involving the mucocutaneous line of upper lip (Figure 1A & B). On palpation, it was non tender, smooth in texture, and soft in consistency. Based on the signs and symptoms, a provisional diagnosis of fibroma was made with a differential diagnosis of pyogenic granuloma.

   Solid tumors of gynecological origin in children are rare and represent less than 5%. Ovarian germ cell tumors (OGCTs) are the most frequent. They represent 95% of benign tumors (dermoid cysts) and 5% of malignant tumors.The dysgerminomas represent 33% of all GCTs. They are fast growing neoplasm’s. They can occur at any age but very frequently in children and adolescents, most often in the second and third decade, rarely in the first decade.

   The six schools of theories (psychodynamic, behavioral, cognitive, social, existential and biological) forms the foundation of current day practice for prevention and management of mental disorder [1]. In sociology, mental illness is a deviant behaviour resulted from problem in thoughts, feelings and cognition which is not appropriate for surrounding environment. The positive aspect of such model is that it is based on cultural/social context but the negative aspect is that such approach leads to generalization which is often not the case, as individuals vary from one another in many aspects [2].

   There are two schools of anesthesia that teach and practice spinal anesthesia: one prefers the lateral decubitus position and the other the sitting position to access the subarachnoid space, before the injection of the local anesthetic.The anesthesiologist who remains using only the sitting position cannot offer his patients all the best techniques of spinal anesthesia, as unilateral spinal anesthesia (with hypobaric or hyperbaric solution), posterior spinal anesthesia favoring sensory roots (hypobaric solution) [1-3].

   We were delighted to read high-quality research article by Martino et al. [1], which entitled “Attitude and knowledge of medical students toward donation after circulatory death”. Martino et al. aimed to investigate and analyze the acceptance of organ donation in Brazil. They conducted a survey of medical students in a public university in Brazil through a questionnaire containing 26 goals and Likert scale questions.

   Extracorporeal membrane oxygenation (ECMO) is a lifesaving technique designed to provide mechanicalsupport to the heart, lungs or both [1-4]. ECMO has emerged as a global standard of care in potentially reversible causes of cardiopulmonary collapse or as a bridge to heart and/or lung transplantation [1-4]. Due to favorable results and a steady decline in absolute contraindications, its use is increasing worldwide, but overall survival for pediatric ECMO has remained stable around 50 to 60% [1,5].

   Mitral stenosis (MS) is a form of valvular heart disease characterized by narrowing of the mitral valve orifice and is the most prevalent valvular involvement in developing countries as a sequel of rheumatic heart disease , although, is seen in developed countries, too. The most common manifestations of mitral stenosis (MS) include heart failure, stroke, failure to thrive, and pulmonary hypertension.

   Abernethy syndrome was first described by John Abernethy in 1793. As a congenital extra hepatic portosystemic shunt (CEPS), when splanchnic blood flows straightly into the inferior vena cava (IVC) [1]. Extra hepatic shunts are commonly accompanied by other congenital anomalies and are further divided according to Morgan and Super in a into three types [2]. Type 1 represents complete shunting of the portal venous blood (i.e., end-to-side shunt) with severe hypoplasiaor total absence of the intra hepatic tree. In CEPS type 2 portal vein isintact, but a side-to-side anastomosis with the IVC leads to shunting [3].

   Developmental dysplasia of the hip (DDH) involves abnormal development of the acetabulum and femoral head due to mechanical instability of the hip joint [1,2]. If left untreated, DDH can lead to pain, a vascular necrosis, osteoarthritis, discrepancy in leg length, abnormal gait, and reduced mobility by early adulthood [3,4]. DDH is often detected by abnormal physical exam findings in the early postnatal period and if diagnosed appropriately and treated successfully, many children are able to develop a normal hip joint without functional limitation [5].

   Cancer is a non-communicable disease that emerged without any definite cause [1]. According to [1] nearly 10 million deaths in 2020 due to cancer accounted for one in six deaths. There are several types of cancers, such as breast, lung, colon, rectum, and prostate cancers [1]. WHO (2022) had reported one-third of the causes of cancer are due to poor lifestyle choices such as tobacco smoking, high body mass index, alcohol intake, low fruit and vegetable intake, and lack of physical activity.

   Pseudowords are words that may be read using the graphemephoneme rule but have no sense or meaning. A pseudoword, according to [1], is a string of letters that looks like a real word in terms of orthographic and phonological structure but does not exist in the language. During non-linguistic visual feature detection task, the visual field will activate extensive widespread brain areas [2]. Pseudoword recognition necessitates the proper functioning of subcortical structures, in addition to intact cortical structures.

   Sarcoidosis is an idiopathic, multisystem disorder that can affect any organ system and is mainly characterized by pulmonary, dermatologic, and ocular involvement. Its pathological hallmark is non-caseating granulomatous inflammation. Ocular involvement has been reported by different studies at a rate of 25-60% [1,2]. Although anterior uveitis is the most common manifestation of ocular sarcoidosis, any orbital structure can be involved. Lacrimal gland involvement is the most common form of orbital sarcoidosis [1,3].

   The mortality and morbidity associated with COVID-19 have raised increasing concerns around the world. Although efforts to recognize and manage COVID-19 have been focused on evaluating the respiratory complications, it has now become aware that COVID-19 infection occasionally involves atypical presentations, such as gastrointestinal manifestations and thrombotic complications [1]. Many Studies have reported that patients infected with COVID 19 are prone to coagulopathy, however, the exact mechanism for the thrombosis is yet to be clarified [2].

   Australia is a land of vast proportions. It spreads across nearly 7.6 million square kilometres, much of it far beyond the trim of coastal borders. It is home to almost 26 million people [1], 70% of whom will live, learn and labour within the sprawl of urban development. Australia is a land of many nations. We are home to many cultures and peoples of variegated backgrounds. Indigenous Australians and Torres Strait Islanders comprise approximately 3.2% of the total population [2]. Indigenous and Migrant Australians comprise just over 32% of all Australians.

   A 20- years old female patient, diagnosed case of right cerebellum medulloblastoma, post excision, adjuvant chemotherapy, and radiotherapy in 2018. Presented with right eye swelling in 2021. Brain MRI revealed aright frontal parasagittal mass lesion and left lateral cerebellar mass, highly suggestive of disease recurrence. Total spine MRI showed interval development of new intra-axial lesion at the level of the cervical medullary junction, highly suggestive of Intramedullary spinal cord metastasis (Figure 1).

   A 75 years-old metastatic castration-resistant prostate cancer(mCRPC), Gleason score = 4 + 4, initial pTNM = T3bN1M0,was referred to our center for PSMA-targeted radioligand therapy (PRLT). The patient previously received docetaxel, followed by enzalutamide and showed evidence of both biochemical and radiographic progression on these agents. His 68Ga-PSMA-11 PET/CT before PRLT showed multiple bone and lymph nodes metastasis with intense PSMA avidity while the PSA levels were 7.62ng/ml at the time of imaging. This finding was not surprising since PSA and PSMA uptake have moderate to strong association [1].

   A 42 year old gentleman who had a recto-sigmoid carcinoma and was operated six months ago presented with a fungating lesion at the right iliac fossa region. The fungating lesion was about 5x5 cm in size with contact bleeding. The patient defaulted his chemotherapy regime and claimed that the lesion grew in size progressively over the time. Onfuther examination we noted that the lesion was originating from the previous blake drain site that was inserted during the first operation. Biopsy of the lesion done and it confirms that it is adenocarcinoma from the colon.

   A 61-year-old man, ex-smoker, with previous history of multiple myeloma and tetralogy of Fallot non surgically corrected. Admitted to the Pulmonology Department for worsening dyspnea in the last week. During physical examination, the patient presented peripheral oxygen saturation of 58% and exuberant digital clubbing (Figure 1A). Arterial blood gas analysis revealed respiratory acidemia (pH 7.31, pO2 28, pCO2 49, HCO3- 24.7) and analytical study on peripheral blood showed polyglobulia and thrombocytopenia.

   A 64 -year-old female was admitted to our inpatient clinic with a 4-month-history of dyspnea and chest pain both at rest and on exertion. One year ago, she had coronary artery by-pass surgery due to triple vessel disease. Electrocardiogram displayed ST segment elevation in leads V2, D1 and aVL (A). A series of cardiac enzyme tests showed no signs of acute myocardial damage. Chest x-ray revealed mild cardiomegaly with a mass image adjacent to the left ventricle (B, arrow).

   Lipomas are a very common benign neoplasm, the most common soft-tissue tumor, consisting of mature fat cells enclosed by a capsule. They are mostly superficial and located at the subcutaneous tissue of any part of the body [1]. However, they can be found at other sites, such as the central nervous system, abdominal solid organs and also in a subepithelial presentation in any part of the gastrointestinal (GI) tract [2-4].

   Pediatric primary renal malignancies, aside from the very common Wilms tumor or nephroblastoma, account for less than 1% of all childhood malignancies [1]. Further, the malignant rhabdoid tumor (MRT) is only 1.8% of renal neoplasms [2]. This understudied tumor of the kidney is a rare malignancy that most commonly occurs in children less than two years old, typically ranging between 11 and 18 months [3]. The tumor course is generally aggressive and fatal. Local and distant metastasis occurs early in the disease course and is often resistant to chemotherapy [3-6].

   A perinephric abscess is a collection of pus in the perinephric space, and represents an unusual complication of urinary tract infection, mainly caused by gram negative organisms and anaerobes [1]. The clinical presentation is usually fever and flank pain, and diagnosis is often established by computed tomography (CT) imaging [2] together with positive urine cultures [3]. Treatment is often based on antimicrobial coverage, drainage of collections, and correction of any treatable underlying predisposing cause [4].

   Parietal endometriosis is a rare condition with a reported incidence of 0.03% to 0.4% [1]. It occurs, on average, within three years after gynaecological surgery [2], most often following a caesarean section [3-5]. The pathophysiology of the disease is not yet well understood [6] but the main hypothesis is that it is the result of intraoperative dissemination of endometrial cells [7]. It is associated with pelvic endometriosis in only 5 to 15% of cases [3], making them two relatively distinct entities. The predominant symptomatology is cyclic catamenial scar pain.

   Pneumonia of unknown cause detected in Wuhan, China was first reported to the WHO Country Office in China on 31 December 2019. officially named by the World Health Organization as COVID-19, appeared in Wuhan, Hubei Province, China, WHO is working 24/7 to analyse data, provide advice, coordinate with partners, help countries prepare, increase supplies and manage expert networks. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020.

   Preeclampsia is one of the leading causes of maternal and neonatal mortality rates in low and middle countries. Currently, evidence has demonstrated that abnormal placentation and uterine hypoxia are linked with a high prevalence; likewise, studies have pointed to adolescent pregnancy as a significant cause-related [1,2]. Therefore, early detection of hypertensive diseases during pregnancy could reduce adverse health outcomes and the impact on the health system in terms of mortality, cost, and quality care.

   Gastrointestinal polyps originating from the mucosa and submucosa are mass-forming proliferative and neoplastic lesions [1]. Gastrointestinal system (GIS) polyps are more common in the colorectal region. Polyps detected as a result of colonoscopic examination may be stalked or sessile, and their sizes are variable [1]. Colorectal polyps are classified as non-neoplastic polyps [hyperplastic (metaplastic) polyps, hamartomatous polyps (juvenile polyposis, peutz jegher syndrome, Cronkhite-Canada syndrome, Cowden syndrome), inflammatory polyps], neoplastic polyps adenomas (tubular, vibullous) [2].

   Thyroid nodules are generally seen in 5% of patients and are detected incidentally [1]. Non-palpable, unrecognized thyroid nodules can be detected at a rate of 20-67% along ultrasound scanning [1,2]. Approximately 5-24% of detected nodules are diagnosed as malignancy [3]. Papillary cancer is seen in 80% of thyroid malignancies [4].

   Childhood Apraxia of Speech (CAS) is a very intriguing yet complicated motor speech disorder. It is a disorder that stems from neurological insult to the developing brain due to causes ranging from pre, peri and post natal complications. The salient features of CAS include inability to voluntarily produce speech in the absence of any evident weakness, sensory deficits or lack of language skills. Based on a number of studies, it is clear that the fundamental problem with CAS is a lack in planning and programming, which prevents the affected child from speaking at will [1,2,3,4,5].

   Ewing’s sarcoma is the second malignant bone tumor after osteosarcoma among children and adolescents or in a range between 5 and 25 year old according of the other studies. The commonest location of Ewing’s sarcoma is the upper limb, lower limb, pelvis, spine and can affect anyone [1,2,3]. The orbital, conjunctival and lacrimal gland malignant tumors are infrequent and increasing with increasing age, also they are higher in incidence among males than females [4]. The orbital metastasisis extremely rare [2,5].

   Recently an outbreak is just ticking at the door of the ravaged world at a time when it just started to recover from the aftermaths of the global Covid-19 situation. A zoonotic disease with a similar appearance to smallpox named Monkeypox (MPX) has started to appear and spread globally in recent times. Monkeypox is endemic to central and western Africa and most concentrated in the Democratic Republic of Congo [1,2].

   A male in his forties presented with painful, persistent, non healing ulcers in the buttocks for two months with history of inadvertent weight loss and loss of appetite. History of high risk sexual behavior including anal intercourse was present. On examination, the patient appeared cachexic with a body mass index of 15kg/m2. A shallow, tender, non-indurated, perianal ulcer of size around 10 x 7cm, with irregular margins, unhealthy granulation tissue and slough was noted

   Taste is the sensory modality that guides organisms to identify and consume nutrients while avoiding toxins and indigestible materials. For humans, this means recognizing and distinguishing sweet, umami, sour, salty, and bitter-the so called” basic” tastes. There are likely additional qualities such as fatty, metallic and others that might also be considered basic tastes.

   A 24-year-old male with no significant past medical history presented to the emergency department with four days of diarrhea which progressed to chest pain. The patient start- ed to have loose stool twice a day, progressively worsening to diarrhea that started from yellow color to red, and then green. The patient denied any foul smell but reported gener- alized abdominal pain localizing to the periumbilical region characterizing it as crampy pain.

   Tubercular disease (TB), infection from the Mycobacterium tuberculosis, is a global health problem, with the highest prevalence in south-east Asia [1,2]. Abdominal tuberculosis (ATB) is defined as the TB infection in the gastrointestinal (GI) tract, intraabdominal solid organs or peritoneum [3]. ATB is one of the relatively more common non-pulmonary TB infection-sites in low-income societies, affecting in particular populations in their third and fourth decades of life [1,2,4,5].