Articles

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

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

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

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

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

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

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

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

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

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

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

   This study is based on the growing interest in personalized medicine for the treatment of schizophrenia (SCZ), a complex psychiatric disorder that affects approximately 1% of the global population [1]. Despite the availability of several antipsychotic medications, response rates vary widely, and treatment is often characterized by a trial-and-error approach [2]. This approach can lead to suboptimal outcomes, including prolonged illness, relapse, and poor quality of life [3].

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

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

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

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

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

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

   A newborn was examined. The patient was born to 29-yearold women at 38 weeks and 5 days via normal spontaneous vaginal delivery. Prenatal care was uncomplicated. Fetal anatomy ultrasound and labs were within normal limits. Vital signs were stable and physical exam revealed atypical genitalia (Figure 1 and 2). Urinary incontinence with palpation of the abdomen was noted. Given the findings of absence of the dorsal aspect of the urethra and overlying skin we made the diagnosis of epispadias. Diagnosis is based on clinical and physical exam findings during routine newborn examination.

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

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

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

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

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

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

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

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

   Maxillary sinus mucocele is a rare and benign lesion that accounts for approximately 10% of all paranasal sinus mucoceles [1]. Although it is a slow growing tumor, it can cause bone erosion and remodeling [2] resulting in facial asymmetry, pain and other symptoms depending on its extension. We report in this study a case of spontaneous maxillary mucocele causing facial and hard palate deformity.

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

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

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

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

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

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

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

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

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

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

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

   Thimble bladder is a small, contracted, thick urinary bladder after chronic infection, inflammation, and fibrosis following genitourinary tuberculosis. The bladder is involved when tubercle bacilli are excreted in urine from the Kidneys. Small capacity urinary bladder presents with frequency, incontinence, and deranged creatinine.

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

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

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