Articles

   Temporomandibular disorder (TMD), a musculoskeletal subpart of orofacial pain conditions, has a recent history full of actions for the organization and standardization of diagnoses and terminologies. Previously called “craniomandibular disorders, orofacial disorders, facial misalignment,” etc., the current TMD field has benefited from the efforts of an academic consortium dedicated to the topic, which remains under constant review and improvement–International Network for Orofacial Pain and Related Disorders Methodology or INfORM (https://ubwp.buffalo.edu/rdc-tmdinternational/).

   A 20-year-old man presented to the clinic for early-onset arthropathy starting by the age of 13. On physical examination he had brachymetatarsia of the fourth toes (panel A). He had normal stature and had no cognitive impairment or dysmorphic features. Phosphocalcic metabolism investigations were normal. Besides knees and hip osteoarthritis and mild platyspondyly, radiographs showed bilateral fourth metacarpal shortening (panel B), leading to the diagnosis of Czech Dysplasia, which was confirmed by genetic analysis.

   Otitis media is the inflammation of the middle ear, and it is synonymous with infections of the middle ear. However, it could also result from allergies and anatomical defects. Chronic Otitis media is a permanent anomaly on the tympanic membrane following an established middle ear infection originating from a previous acute Otitis media. The chronic discharging ear is one with a punctured tympanic membrane and persistent drainage from the middle ear [1,2].

   A 47-year old Chinese woman presented with a 2-year history of multiple small flammulated papilloma-liked lesions on her tongue. She has noted an increase of the size and number of lesions within the past month, with significant harsh feeling, but the taste sensation is normal. The physical examination showed diffusely multiple, florid, and slight raised spots in different sizes, measuring from 1 to 3mm in dimensions, appearing on the dorsal surface and lateral borders of the tongue (Figure A and B).

    Tinea capitis is generally considered a common condition in children, but not in adults. If the infection occurs in adults, it may have an atypical appearance. We present an elderly woman with inflammatory tinea capitis. A 71-year-old rural woman presented with a 2-month history of multiple pruritic, crusted, and pustular lesions on the scalp. She had been treated with antibiotics without any improvement. The patient was not on any immunosuppressant drug and no other family member was suffering from similar disease however an animal contacting history was found .

   Eosinophilic granulomatosis with polyangiitis (EGPA) is a small-vessel vasculitic disease that can present with positive MPO p-ANCA (myeloperoxidase–perinuclear–anti-neutrophil cytoplasmic antibody). It is a rare condition that is often difficult to diagnose. Asthma, nasal polyposis, blood and tissue eosinophilia, and vasculitic inflammation defined a condition that has remained complex and heterogeneous. EGPA is part of the anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis syndromes (AAV).

    Caustic exposure is more common in children than adults, it usually happens accidentally, and seen more often in developing countries and people with low socioeconomic status [1,2]. The risk is increased in children younger than five years of age, especially living in unsafe environment (caustics in unlabeled bottles, drugs within reach, etc) [3].

   A 17-year-old patient was seen at consultation for a large occipital mass evolving since birth. It was subcentimetric at the beginning and progressively enlarged over the years. Upon consultation, the patient was conscious and had no neurological deficit. The mass was firm, painless and adherent to the deep plane. It was large and measured 21 centimeters anteroposteriorly, 31 centimeters laterally and 25 centimeters craniocaudally (A, B).

   The incidence of septic arthritis (SA) in children is 1-5 per 100,000 in developed countries [1]. SA is typically monoarticular, most commonly involved in the hip and knee joints, and its prevalence is high at the ages ≤5 [1, 2]. SA can occur by three different mechanisms: the spread of the pathogen through the bloodstream, the spread through the neighborhood, or the penetration of the infectious agent. The first mechanism is the most frequently described mechanism in children [2].

   Pott puffy tumor is a rare entity, characterized by the association of a subperiosteal abscess and osteomyelitis of the frontal bone. It is often secondary to frontal sinusitis or trauma. We report the case of a 14-year-old child who presented with a Pott’s tumor following frontal sinusitis, complicated by subdural empyema. He was successfully treated with antibiotic therapy and percutaneous drainage of the frontal abscess.

   Bradyk in angioedema (BAE), of which hereditary C1-inhibitor angioedema is a part, is a rare and potentially serious disease. It is a recurrent subcutaneous or submucosal edema caused by a quantitative and/or qualitative deficiency of the C1 inhibitor of complement (C1-INH). There are hereditary forms (HAE) and acquired forms (AOA).

   Iliac vein agenesis is a rare condition, which can lead to symptoms of chronic venous insufficiency (CVI) of lower limbs and to deep vein thrombosis (DVT) [1,2,3]. The population incidence of this disease is unknown, but the inferior vena cava (IVC) agenesis has an incidence of 0.0005-1% in general population and it is found in almost 5% of patients less than 30 years old with unprovoked DVT [3].

   Three years into this historic pandemic, the scientific and healthcare communities continue to learn a great deal regarding COVID-19, the disease that is produced by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The most urgent and immediate focus has been on vaccine development for disease prevention/mitigation and on identification of effective therapeutic interventions for acute phase of illness. However, attention is increasingly being placed on formulating treatment strategies for individuals who are post-COVID-19 and experiencing a syndrome of persistent cognitive, somatic and behavioral symptoms that is being referred to as long COVID.

   Perforated duodenal ulcers are one of the commonest causes of peritonitis. Classically, a pediceled omental patch was used to “plug” defects in the duodenum [1]. This was later modified by the use of free omental grafts to patch over defects due to perforated duodenal ulcers [2]. However, in case of giant perforated duodenal ulcers, application of primary repair or omental patch repair is deemed inadequate, with imminent post-operative leaks [3,4].

   Rheumatoid arthritis (RA) is a symmetric polyarticular arthritis that initially affects the small diarthrodial joints of the hands and feet. In addition to inflammation in the synovium, which is the joint lining, the aggressive front of tissue called pannus invades and destroys local articular structures [1, 2]. Rheumatoid arthritis is the most frequent inflammatory arthritis, affecting 0.8 percent of the adult population worldwide. Onset frequently occurs between 30 and 50 years of age [3].

   2 hemmed sterile gauzes 10x20 cm, 1/0 gauge silk suture, lubricating cream preparation of the “squid” (internal anorectal swab); lubrication of the fringed tail of the swab (tentacles of the squid) and gentle introduction into the anal canal up to the rectal ampulla (where the fringes of the tail open), taking care not to damage the surgical work just performed; finish the introduction leaving 1 cm of the tip of the internal swab (body of the squid) protruding from the anal margin, anchoring the tip of the gauze with a stich in silk and completely internal introduction also of the tip of the swab beyond the margin anal.

   Small basal drape (positioned under the buttocks and lumbar region of the patient who fixes it with his weight); large drape with adhesive band that is centrally fenestrated for about 30 cm on the lower edge allowing for upper horizontal fixation of the operating field (with the possibility of supporting a sagging scrotum without other maneuvers in men and keeping access to the vagina exposed in women) and two symmetrical or asymmetrical lateral fixings, more or less angled according to the needs of the case.

   Since its outbreak Covid-19 (Corona virus disease-19) has spread over 200 countries in the world and affected over 620,745,929 patients causing death of 6,541,704 patients [1]. Covid-19 has been around for more over 2 years; justifiably thereis ambiguity surroundingits etiology, clinical findings, pathogenesis and treatment. Sars-nCoV-2 (SevereAcute Respiratory Syndrome- novel Corona Virus-2), the virus responsible for Covid-19, spreads from symptomatic and asymptomaticinfected humansby direct contact, aerosol droplets, oro-faecal route and intermediate fomites [2,3].

   Pituitary macroadenomas are the most common suprasellar tumours in adults. Pituitary tumours in particular make a multidisciplinary team approach necessary for good perioperative and postoperative management of the patient. It further imposes challenges when a patient has multisystem involvement. We are reporting successful anaesthetic management of a middle-aged woman posted for transsphenoidal pituitary tumour resection with status post Fontan palliation and now having severe pulmonary stenosis with moderate kyphoscoliosis and pulmonary arterial hypertension.

   Mitral regurgitation (MR) is the most common valvular abnormality in adults. Mitral regurgitation affects nearly 2% of the total population and nearly 10% of those age ≥75 years [1]. While the most prevalent etiology of primary MR is mitral valve prolapse (MVP) [2], rarer causes include anomalous mitral arcade (MA), also referred to as mitral hammock. Anomalous MA is a rare congenital malformation of the subvalvular apparatus of the mitral valve, characterized by absent or shortened chordae tendineae with thickened and elongated papillary muscles and a fibrous tissue band connecting the anterolateral and posteromedial papillary muscles and/or the free edge of the anterior mitral leaflet [3–5].

   Irritable bowel syndrome is a common functional gastrointestinal disorder that is diagnosed by Rome criteria based on some clinical symptoms including abdominal pain, bloating, and changes in bowel habits [1]. Brain-gut axis and immune system dysfunctions, abdominal hypersensitivity, and gastrointestinal disturbances are associated with IBS [2]. Its prevalence is more common among women and young adults and is between 5 and 20% [1,2].

   Diabetes mellitus (DM) is a significant worldwide well-being problem [1]. According to evaluations of the World Health Organization, there were 422 million individuals experiencing diabetes worldwide in 2014 [2]. The widespread platelet activity is underlined to contribute to forming vascular disorders of this metabolic condition [3]. Platelet volume, a hallmark of the thrombocyte function and activation, is estimated as the average platelet volume (MPV) by hematological analyzers. Patients with diabetes have agreater risk for micro-and macro-vascular diseases, and platelets could be included as a causal agent for changes in platelet morphology and function [4]. The distinction in platelet volume is vividly connected with contrasts in density.

   Low Back Pain (LBP) is a global health challenge, the most prevalent orthopedic condition and one of the major causes of functional limitations [1-3]. Low back pain life time prevalent was reported to be as high as 84%whereas the estimated prevalence of chronic LBP was above 23% [4]. In Africa Louw, et al reported that the prevalence of low back pain among the adolescent was 12% and that of adult was 32% [1]. In southwestern part of Nigeria where nine hundred adults were selected using multisage sampling technique, it was discovered that 40% of the population had low back pain in the last 12months while 33% had low back pain at the time of study[5].

   Obstruction of the superior vena cava is most often secondary to a malignant disease lymphoma, bronchopulmonary cancer, secondary mediastinal adenopathies) which leads to compression or invasion of the superior vena cava; or to thrombosis on a central catheter. To overcome this obstacle, several networks of venous collaterals and anastomoses are engaged to ensure venous return to the right atrium. One of these collaterals, the portacaval anastomosis, is responsible for a characteristic hepatic perfusion disorder that we will illustrate with the case of a child who presents a mediastinal mass compressing the SVC.

   Peripheral nerve sheath tumors, specifically neurofibromas and schwannoma variants, occur both sporadically and in the setting of hereditary conditions, including neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and familial/ sporadic schwannoma [1]. It is a frequent and polymorphic genetic disorder. The severity is related to the complications. The degeneration of neurofibroma is a very rare complication of neurofibromatosis [1]. Neurofibromatosis type 1 is a multisystemic disorder that can affect several organs [2].

   Neck pain occurs commonly throughout the world and causes substantial disability and economic cost with a huge impact on individuals the families, communities, healthcare systems and businesses [1]. Neck Pain is defined by the Global Burden of health 2010 Study as “pain in the neck with or without pain referred into one or both upper limbs that lasts for at least one day” [2]. Risk factors for neck pain share similarities with other musculoskeletal conditions such as genetics, psychopathology (e.g., depression, anxiety, poor coping skills, somatisation), sleep disorders, smoking, and sedentary lifestyle [3] which include a history of neck pain [4] trauma (e.g., traumatic brain and whiplash injuries) and certain sports injuries (e.g., wrestling, ice hockey, football) [3].

   The coronavirus epidemic has become a global problem all over the world due to its organ defects and high mortality rates. The coronavirus S, N, E, M protein is involved in the emergence of infection. It is concluded that the S protein binds to the angiotensin converting enzyme 2 (ACE2) receptor with high affinity in humans and the ACE2 enzyme is expressed in the lung tissue, as well as in the heart, kidney, intestinal epithelium and vascular endothelium, and as a result, it may cause death by causing multiple organ damage.

   Otitis media is the inflammation of the middle ear, and it is synonymous with infections of the middle ear. However,it could also result from allergies and anatomical defects. Chronic Otitis media is a permanent anomaly on the tympanic membrane following an established middle ear infection originating from a previous acute Otitis media. The chronic discharging ear is one with a punctured tympanic membrane and persistent drainage from the middle ear [1, 2]. It may often be accompanied by complications such as septicemia, meningitis, brain abscess, and facial paralysis, and it is believed to be responsible for more than two-thirds of deafness in children [3].

   Early phospho calcicum metabolism difficulties brought on by chronic kidney failure gradually lead to secondary hyperparathyroidism, which is accompanied by other disorders such acidosis, nutritional issues, loss of mobility, and chronic inflammation. According to the severity of kidney failure, each of these factors has negative effects on the bone to varied degrees [2].

   IgG4-related disease (IgG4-RD) is a rare multi-system, autoimmune disease first described in 2003 [1]. It causes chronic inflammation, obliterative phlebitis and fibrosis in the pancreas, salivary glands, and intraperitoneal and retroperitoneal structures. It tends to form a mass in the affected organs and thus can mimic malignancies. IgG4-RD may or may not be associated with high serum IgG4 levels. Diagnosis is via biopsy and histopathological examination of the affected tissue. Sclerosing mesenteritis (SM) refers to a benign, idiopathic, primary inflammatory, and fibrotic process affecting the mesentery and is a rare presentation of IgG4-RD.

   In recent years, universities have actively launched and participated in various discipline-based competitions due to their professional, practical, competitive, and innovative nature to cultivate students’ comprehensive abilities. Furthermore, disciplinary competitions have effectively enhanced university students’ comprehensive ability, developed their scientific thinking ability, exercised their practical operation ability, cultivated their humanistic spirit, and heightened their social competitiveness [1].

   Mitral regurgitation (MR) is the most common valvular abnormality in adults. Mitral regurgitationaffectsnearly 2%of the total population and nearly10% of those age ≥75 years [1]. While the most prevalent etiology of primary MR is mitral valve prolapse (MVP) [2], rarer causes include anomalous mitral arcade (MA), also referred to as mitral hammock. Anomalous MA is a rare congenital malformation of the subvalvular apparatus of the mitral valve, characterized by absent or shortened chordae tendineae with thickened and elongated papillary muscles and a fibrous tissue band connecting the anterolateraland posteromedialpapillary musclesand/or the free edge of the anterior mitral leaflet [3-5].

   A 46-year-old lady, known case of hypertension, dyslipidemia and hypothyroidism, presented with history of progressive dyspnea on exertion and chest discomfort at exertion which progressed to rest for past 4 days. She had a recent admission 3 weeks prior to presentation, during which CT showed infarct in right insula and capsuloganglionic region, and MR venogram confirmed cerebral sinovenous thrombosis (CSVT) (Figure 1). Thrombophilia workup includinganti-nuclear antibody, anticytoplasmic antibodies and antiphospholipid antibody workup were negative.

   Vestibular schwannomas also called acoustic neuromas, are extra-axial slow-growing benigntumors developing from Schwann cells of the vestibular portion of the 8th cranial nerve. These tumors account for ~8% of all primary intracranial tumors .They are due to an overproduction of Schwann cells .The tumor, which develops in a closed and rigid environment (bone, skull), will compress the nerve fibers intended for the auditory systems usually causing unilateral or asymmetric hearing loss.

   Septic arthritis of the gleno-humeral joint is more common in the elderly and immune compromised [1], and post vaccination arthritis has been reported few times [2]. Our case draws attention to the importance of MRI, in case of an insidious onset of symptoms, or persistent pain or inflammation after an episode of vaccination. This imaging modality has been increasingly used to evaluate soft tissue, synovial reaction and marrow changes. It allows early detection of complication, especially osteomyelitis.

   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.

   Contusive ocular trauma is very frequent in our context, often secondary to aggression, professional or domestical accidents [1]. These contusive traumas can cause lesions on all tissues of the eye [2]. The lens is an organ frequently affected by contusive trauma due to anteroposterior and longitudinal forces, causing either cataract or crystalline dislocation, these dislocations are often in the anterior chamber or in the posterior segment [3], subconjunctival lens dislocation remains an uncommon complication [4].

   PA 70-year-old man consulted for abdominal distention and cachexia with hematuria. An abdomino-pelvic CT scan performed showing a heterogeneous and vascularized tissue mass of the right kidney protruding into the right renal vein, the inferior vena cava and the right atrium with no sign of hemodynamic obstruction and an echocardiography showing an Intra-OD tumor-thrombus measuring 45*29mm, related to the extension of the renal tumour. Due to the advanced stage of the neoplasm and the severely altered clinical condition, the patient was placed in palliative care.

   Peripheral T-cell lymphomas (PTCL) are a heterogeneous group of lymphoproliferative disorders originating from mature T cells [1]. They account for 15% to 20% of aggressive lymphomas and 5% to 10% of all non-Hodgkin’s lymphomas (NHL) [2,3]. One of the most common subtypes of PTCL is a heterogeneous group of nodal and extranodal mature T-cell lymphomas that do not fit into any of the specifically defined T-cell entities in the World Health Organization classification and are therefore termed PTCL, not otherwise specified (NOS) [4].

   It is known that NSAIDs act though inhibition of cyclo-oxygenase (COX), the enzyme responsible for prostanoid biosynthesis, with COX-1 predominantly regulating protection in the GI and renal environment [1], while suppression of COX-2 is primarily responsible for the anti-inflammatory effects of NSAIDs [2]. Suppression of COX-1, with decreased PGE2 and increased leukotrienes is thought to cause the majority of both respiratory and dermatologic reactions to NSAIDs [3]. It has been implied that in the absence of an ASA-induced respiratory syndrome [3], COX-2 inhibitors may be used safely given the low risk of cutaneous reactivity [4,5].

   Taeniasis is the intestinal infection of humans by the adult stages of cestode parasites under the genus Taenia. Taenia solium, Taenia saginata, and Taenia asiatica are the principal cestode specious important to cause taeniasis in human. Human acquires the adult stage and acts as a definitive host of the parasite through different risk factors. Outback human defecation and eating of raw or undercooked beef and/or pork are the primaries exposing factors [1]. Intermediate hosts of tapeworms could get cysticercosis, a disease caused by tissue infection of tapeworms, by ingestion of Taenia eggs.

   A 45-year-old woman with no previous pathological history who was referred to the physical medicine unit for lumbago that had been evolving for 9 months and was interfering with sitting and activities of daily living. There was no vesicosphincter disorder, nor limitation of walking perimeter. The neurological examination and peripheral joints were normal. Standard radiographs of the lumbar spine showed ossification of the lumbar posterior longitudinal ligament at the D12 and L1 level.

   A 26-year-old-women, with a history of cutaneous Rosai Dorfman disease treated with oral corticosteroids and methotrexate, presented with a 5 months history of multiple gray-brown papules and small well-defined patches located symmetrically on her vulval labia and around the anus (Figure 1). Genital warts, a verrucous nevus and Bowen disease were suspected among our clinical diagnosis.

   In a former study it was demonstrated in two clinical cases, that regional aggressive cervical resorption was caused by neuronal virus infection in the jaws during early childhood [1]. Virus infection can spread along the peripheral nerves, illustrated schematically on a panoramic radiograph with peripheral nerves innervating different tooth groups [2], as demonstrated in (Figure 1).

   Tuberculosis is a major public health problem. It has a high annual incidence in Africa and Asia. The estimated number of new cases of tuberculosis is constantly increasing. The estimated number of new cases of tuberculosis (TB) is constantly increasing and will reach 10 million in 2019 [1]. Osteoarticular tuberculosis is rare and represents only 10-15% of extrapulmonary localisations. It is most often the result of haematogenous dissemination of BK.

   This paper, which is one of the few in the world dealing with this topic, presented the work of a high school psychologist based on the concepts of mentalization and internal working models (IWMs) of attachment, with an adolescent girl who was prone to nonsuicidal self-injury. Mentalizing is a form of imaginative mental activity that consists of interpreting observed human behaviour based on intentional mental states such as needs, desires, feelings, beliefs, goals, purposes and reasons [1-4].