Articles

   Generally, duodenal polyps are uncommon, they are usually found with Familial adenomatosis polyposis or Peutz-Jegher’s syndrome, but maybe rarely seen as a solitary polyp presenting with gastrointestinal symptoms [1]. Duodenal polyps are usually asymptomatic and symptoms are usually related to size and location and range from dyspepsia, and abdominal pain, to more seriously overt gastrointestinal bleeding, intussusception, and gastric outlet obstruction [2]. CT and MRI are useful for diagnosis, moreover, Endoscopic ultrasonography (EUS) and EGD provide very useful information regarding tumor characteristics [3].

   The main link where the pathological focus of demyelination is formed (in oncological diseases of the nervous system) remains outside the sphere of influence of the existing therapeutic techniques. The need to improve therapeutic methods is also due to the fact that—in addition to primary NTN patients—there are patients with comorbid osteoporosis of the skull bones (OCD) that requires treatment, patients in whom a relapse of pain occurs after successful MIA, cases where the expansion of the channel of the branches of the trigeminal nerve is required, but in which safe expansion cannot be achieved without causing nerve damage due to technical reasons, and cases with medical contraindications to general anesthesia.

   Sebaceous hyperplasia is a benign, not uncommon cutaneous disorder. The disorder is caused by overabundance and proliferation of sebocytes in the sebaceous glands [1]. The proliferation induces enlargement of the sebaceous gland up to several times its regular size, but still keeping the normal anatomical structures. Sebacceous glands have a central duct that may become dilated in sebaceous hyperplasia due to secretion of an oily substance, sebum, which presents flesh- or yellowish coloured [2]. Sebaceous glands are localized everywhere on the skin except for palms and soles of the feet.

   Aortic dissection is characterized by a tear in the intima and media layer of the aorta, producing a dissection flap that separates the true lumen from the extraluminal channel called the false lumen, with the possibility of anterograde and/or retrograde extension of the lesion and limiting the distal flow. Determining the exact prevalence of aortic dissection is s challenging due to its high mortality rate, particularly before reaching the hospital. However, in studies involving the general population, it is estimated than there are between 2.6 and 3.5 cases of aortic dissection per 100.000 people per year.

    Kartagener syndrome (KS) belongs to the group of primary ciliary dyskinesia (PCD), which are a spectrum of genetic disorders. It is an autosomal recessive condition. PCD is characterized by chronic upper and lower respiratory tract disease, infertility/ectopic pregnancy, and situs anomalies, that occur in 50% of PCD patients (Kartagener syndrome), and these may be associated with congenital heart abnormalities [1]. The clinical hallmark of KS is the presence of the triad of bronchiectasis, chronic sinusitis, and situs inversus [2,3,4].

   Insulinoma is a rare type of functional neuroendocrine tumor (NET) characterized by a small insulin-secreting tumor that leads to excessive insulin secretion and subsequent hypoglycemia. Its incidence is exceptionally low, with an annual frequency ranging from 1 to 4 cases per million per year [1,2]. Here, we present the case of a 30-year-old male who presented with recurring episodes of palpitations, sweating, dizziness, and vision difficulties, primarily occurring during periods of fasting and alleviated by consuming food. These symptoms are typical manifestations of hypoglycemia induced by the excessive release of insulin from the insulinoma.

    This 40-year-old previously healthy man presented with sudden onset of cervical pain, vertigo, oscillopsia, and facial paralysis after swim practice. On examination, he had a right Horner's syndrome, skew deviation with right eye hypertropia, left beating pure torsional nystagmus, and left supranuclear volitional facial paralysis. During the interview, when his wife made a joke, he showed an excessive contraction of the left side of his face during spontaneous smiling (a dissociation between the volitional paralysis and the emotional facial contraction - Video 1).

   Among all valvular heart diseases, degenerative calcific aortic stenosis (AS) and mitral valve disease affect 9 and 24 million people, respectively [1]. Asia has the highest prevalence of rheumatic aortic stenosis (AS), with the prevalence of 4.54, 1.86, and 1.3 per 1000 people in India, China, and Bangladesh, respectively. Because of the rising prevalence of AS along with the effects of population ageing, the clinical attention on VHD and particularly on AS has increased considerably. While there are more VHD cases among women than among men globally, it has been observed that large trials included more men [2].

   Gallstone ileus occurs in only 0.3-0.5% of patient cholelithiasis with the most common site of obstruction at distal ileum, but in 1-3% of patients, it occurs at duodenal bulb or pylorus Bouveret´s syndrome after the publication by French physician Leon August Bouveret in 1896 [1]. Better diagnostic and surgical techniques have reduced mortality, but still ranges 12% [2]. Surgical procedure election is controversial.

   Hepatitis is an infection-related liver inflammation that has a high rate of morbidity and mortality. High levels of infection can spread from through blood transfusions, sexual activity, and vertical routes. patients with end-stage renal disease are more likely to have HBV and HCV infections. These bloodborne which are a source of higher morbidity and mortality may be more infectious in HD patients than in the general population [1].

   Patients with a retained foreign body are a common scenario in healthcare setting. The implantation can be accidental, selfinflicted or a part of a self- embedding procedure. Foreign body retained for a prolonged duration may complicate to cellulitis, deep tissue infections, sinus, restriction of joint movements, necrotizing fasciitis, osteomyelitis or formation of a tumorlike mass [1]. Foreign bodies may be ingested, inserted into body cavities or may enter the body by penetrating injury or iatrogenically. Among penetrating injuries, intravenous drug use is considered to be a world-wide problem responsible for numerous minor to life-threatening and fatal complications. Intravenous drug abusers use peripheral veins as the route for injecting drugs.

   Burns are complex traumatic injuries, and much of the focus of research and clinical treatment has been on the acute trauma, appropriate surgical intervention and survival with reduced scarring [1]. Any injury triggers the process of blood clotting, but thermal injuries, represented by shock, lead to abrupt changes in all coagulation systems. [2-4]. Any damage to the vascular wall, "blood damage", on the one hand, leads to different levels of plasma loss, on the other - can be considered physiological, and then pathological changes in the hemostasis system can lead to spontaneous death of the organism [5,6].

   Renal cell carcinoma (RCC) is the most common solid mass in the kidney constituting 2-3% of all adult cancers [1]. The most common subtype of RCC is clear cell (80%), besides papillary(10%) and chromophobe type RCC(5%) [2]. Common benign renal neoplasms include renal oncocytoma, angiomyolipoma (AML) and renal adenomas. Data on ipsilateral synchronous clear renal cell carcinoma (CCRCC) and papillary renal cell carcinoma (PRCC) is insufficient.

   A 56 y/o M presented with persistent dizziness and associated nausea, non-bloody emesis and diarrhea since the night before admission. He had generalised fatigue, right sided weakness and room spinning sensation unrelated to head position/ movement. He experienced similar episodes the week prior partially relieved with rest. He denied hearing loss, recent upper respiratory tract infection, headache, fever, chills, or food poisoning.

   81-year-old Tai female with a history of hypertension, nonocclusive coronary artery disease, atrial fibrillation and hyperthyroidism initially presented with urosepsis and pneumonia. She required intubation and was admitted to MICU. Once she recovered from the above infections with antibiotics and guideline directed therapy, she was transferred to the floors. However, she acutely decompensated and went into cardiogenic shock requiring reintubation. On physical exam, she appeared cachectic. She had bilateral crackles and coarse breath sounds in 2/3 lung fields and irregularly irregular heart sounds with Grade II/VI systolic murmur at the apex but no extremity edema.

   Tuberculosis (TB) is an infectious disease caused mainly by Mycobacterium tuberculosis, and occasionally by Mycobacterium bovis or Mycobacterium africanum.1 The lungs are usually affected (pulmonary TB), but other sites could also be affected (extra pulmonary tuberculosis) [1]. It is acquired by inhalation of infected droplets coughed out by infected persons and by consumption of unpasteurized milk from infected cow. Tuberculosis thrives where poverty, overcrowding and chronic debilitating illness abound [2]. The true sign of active TB are chronic cough with blood-containing sputum, fever, night sweats, and weight loss [3].

   Krukenberg is a rare signet ring cell metastatic tumour of a digestive adenocarcinoma mostly originating from the stomach. It is bilateral in more than 80% of the cases and it represents 1-2% of all ovarian tumours (1). Unlike primary ovarian cancer, Krukenberg tumours are more likely to occur in younger women, which can be explained by the high blood supply leading to hematogenous spread. The clinical presentation varies and is not specific. Imaging examinations including ultrasound, CT, and MRI are very contributive in both the diagnosis and prognosis.

   The Human Epidermal Growth Factor Receptor (HER) family member - HER2 is a transmembrane tyrosine kinase receptor that triggers a cascade of cellular responses leading to cell proliferation, survival, and metastasis [1,2]. HER2 expression is often observed to be dysregulated in various malignancies such as those of breast, ovarian, lung, prostate, colorectal and gastric cancer [3-8]. Overexpression of HER2, commonly by gene amplification is observed in 15-30% of breast cancers, wherein an anti-Her2/neu-therapy administering Trastuzumab is directed against the extracellular domain of the Her2/ neu protein and reveals a significant anti-tumour activity [9,10]. It is an established therapeutic target in breast and gastric carcinomas [11,12].

   In setting the prevalence of stroke internationally, review of related literatures and articles are conducted. According to [1], “the worldwide prevalence of cerebral aneurysms is estimated to be approximately 3.2%, with a mean age of 50, and an overall 1:1 gender ratio. This ratio changes significantly after age 50, with an increasing female predominance approaching 2:1, thought to be due to decreased circulating estrogen causing a reduction in collagen content of the vascular tissue. The rate of rupture causing SAH is about 10 per 100,000. This is higher in certain populations such as the Finnish and Japanese. However, this is not due to a higher prevalence of aneurysms in these populations.

   Obesity is a rapidly growing threat and it’s as common as under nutrition, infectious diseases etc. Obesity is known to affect people of all ages and genders [1]. Childhood overweight and obesity has an adverse effect on physical and psychological health [2]. It is also a major risk factor for many chronic conditions (Type2 diabetes, cardiovascular disease, hypertension, cancer, sleep apnoea etc [3]. Environmental factors, lifestyle choices, genetics and cultural environment playan important role in the prevalence of obesity worldwide [4]. Consumption of high energy foods are linked to obesity.

   Hospital readmission has long been a threat to our country’s healthcare system. Acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, and pneumonia were the primary disease conditions which were closely tracked by the CMS for readmission [1]. Sepsis has recently become the number one disease condition resulting in readmissions following an initial inpatient hospital discharge [1]. Out of 49 million people who are hospitalized with sepsis worldwide, 38 million survive (World Health Organization) [2].

   Mature cystic teratomas of ovary are most common benign ovarian neoplasm of reproductive age group [1]. It accounts for 10-20% of all ovarian neoplasms [2]. Most of them are asymptomatic or may present with complaints of abdominal pain when they enlarge. Mature cystic teratomas most commonly present as unilateral cyst, bilateral presentation of mature cystic teratoma is rare and accounts for only 10-15% [3]. Malignant transformation of mature cystic teratomas seen in 0.1-0.2% of cases.

   Schistosomiasis is a chronic disease caused by the genus Schistosoma of the trematode parasites. It is endemic in 78 countries, infecting more than 207 million people worldwide and provoking above 200,000 deaths yearly [1]. Human infection occurs after exposure to contaminated water with schistosome cercariae which penetrate the skin and become schistosomula. They penetrate the wall of a nearby vein and are carried out in the blood circulation, eventually reaching the portal venous system, where they mature and lay eggs. These eggs are either trapped in the tissues and provoke a granulomatous reaction or are passed in the feces, then hatch in water to miracidia which invade the snail and are developed into cercariae to start a new cycle causing schistosomiasis which affects several organs, including the genitourinary, digestive, and nervous systems causing a spectrum of serious diseases [2].

   43-year-old male, with tumor in the anterior region of the right lower limb (figure 1) and biopsy compatible with brown tumor. He presented total serum calcium 12.3 mg/dl and 13 mg/dl (NR: 8.3-10.3), parathormone (PTH) 1057 pg/ml (NR 15-65). With the diagnosis of primary hyperparathyroidism, a 99mTc-MIBI parathyroid scintigraphy with SPECT was requested, which showed hyperfunctioning parathyroid tissue in the projection of the left inferior parathyroid gland. Hand radiographs showed a lytic lesion in punch in the distal phalanx of the first finger of the left hand (figure 2); in the clavicle radiograph: lytic lesion of 10 mm x 8 mm in the right clavicle, no alterations were evidenced in the skull radiograph.

   Pityriasis versicolor (PV) is a very common disease in daily practice and it is almost always easily diagnosed by any dermatologist, without the need for further laboratory analysis. However, in the last 10 years we have seen 3 cases of PV with an infrequent presentation, characterized by a single and large lesion located in the neck in all of them, which could hinder the diagnosis. No description of this form was found neither in large series of PV, nor in extensive reviews.

   The incidence of brain abscesses has been estimated at 0.3 to 1.3 per 100,000 people per year but can be considerably higher in certain risk groups, for example, immunocompromised patients [2]. The most common underlying etiology includes 30%-50% contiguous spread, 10% direct invasion due to trauma or surgery, 10% immunodeficiency, and 30% bacteremia [3,4]. Cerebellar brain abscesses account for 9%–28% of all brain abscesses, and 85%–99% of cases result from the contiguous spread of infection from an ipsilateral otogenic or sinus site [5]. Bacterial spread to the cerebellar region is either retrograde, spread through emissary veins draining the middle ear or sinuses or via direct spread from the site of osteomyelitis or osteitis [5].

   Unani System of Medicine is one of the ancient systems of Medicine, in a historical course, the embranchment of sciences have flourished from the very Greek medical knowledge. Now, India is the largest land in which the Unani system of Medicine is still growing with glorious practices of advanced research and provision of health facilities for curing various complex, untreatable diseases.

   A congenital inguinal hernia in the pediatric population is one of the most common conditions requiring surgical treatment, with the reported incidence ranging between 1% and 5% [1, 2, and 3]. It manifests clinically more commonly in younger children, especially premature infants, and the incidence rate is up to 10 times higher in boys. Percutaneous internal ring suturing (PIRS) is a single-port laparoscopic technique used to repair a pediatric indirect inguinal hernia [4]. This technique is still new in the fraternity, and only a few centers practice it. We applied this technique to our patients and found that the duration of surgery was shortened, with smaller surgical incisions, lesser complications and early discharge.

   Cervical spondylotic myelopathy (CSM) is a disorder of the spinal cord due to compression of the cord by degenerative disease depicted at radiological examinations [1]. Myelopathic or upper motor neuron lesion findings (e.g, hyper-reflexia and gait disturbance) are the typical manifestations of this disorder [2]. Patients may also present with radiculopathy due to degenerative process including bulging or tear of annulus, herniation of disc material into the canal causing pressure effect over the spinal cord and nerve roots [3]. Myelopathic hand signs, Grip release sign, Hoffman’s sign, Romberg test along with gait disturbances (broad based and hesitant) are common in advanced conditions.

   Mycobacterium tuberculosis belonging to Genus Mycobacterium is the predominant species causing Tuberculosis (TB), which primarily affects the lungs. It mainly spread through aerosols when the infected cough, sneeze or spit is inhale by an individual. According to the World Health Organization (WHO) 2017 report, the mortality rate has reduced by 37% but still remains top killer due to its antibiotic resistance pattern and co-infection with HIV [1]. Ten million people get sick from TB annually, with 1.5 million people succumbing to TB each year, making it the world’s top infectious killer. World Health Organization (WHO) 2021 reported that children aged below 15 years constituted approximately 12% of 10.4 million new tuberculosis cases in 2020.

   A 37-year-old male presented to the emergency department with headache, confusion, right-sided facial droop, and painful rash. One month prior, he underwent staged resection of an intraventricular neurocytoma and was placed on a postoperative dexamethasone taper. Examination revealed weakness in the right cranial nerve VII distribution (Figure 1A), clustered vesicles with erythema in the right ear canal and conchal bowl (Figure 1B), and scattered vesicles on the preauricular cheek. The right anterior third of his tongue had clusters of pustulovesicles (Figure 1C). The patient was diagnosed with Ramsay Hunt Syndrome (herpes zoster oticus) and urgently started on IV acyclovir.

   Intussusception is defined as telescoping or invagination of the proximal part of the gastrointestinal tract (intussusceptum) into an adjacent section (intussuscipiens) which results in obliteration of the lumen [1-2]. It is considered as a form of bowel obstruction as it accounts for only 1-5% of cases of bowel obstruction [3]. Intussusception in children can occur at any site in the GI tract, and it often presents similar clinical and radiographic features at all sites. These characteristic features are the key to diagnose intussusception even at unusual sites [4]. While Intussusception is a common diagnosis among children, it is in fact a rare condition in adults with the incidence of approximately 2-3 per 1,000,000 per year [5-6].

   Deep veinous thrombosis is manifested by headache, vomiting, neurological deficit or confusional state. In more severe forms and due to the function of the affected venous territory, it manifests itself by consciousness disorders. The diagnosis is based on imaging. In cases in which a CT scan has been performed as a first-line procedure, it shows both direct and indirect signs [1].

   A 41-year-old woman reports for 5 years a bluish papule on the leg progressively increasing in size and asymptomatic for which she applied by self-medication topical antibiotics without improvement.Clinical examination found a bluish papule subcutaneous with irregular contours on the anterior face of the lower left leg. Dermoscopy revealed an homogeneous pinkish zone without structure (asterisk) and amorphous zone whitish (blue arrow) and bluish (blue triangle), and a lagoonlike appearance in places (red arrow). Histopathologic study was compatible with nodular hydradenoma.

   Total gastrectomy with Roux en Y reconstruction is the mainstay in the treatment of gastric cancer, with survival rates up to 98% for early stage gastric cancer [1-3]. Esophagojejunal anastomotic leak (EJAL) is a potentially fatal postoperative complication with an incidence reported up to 15% and mortality up to 60% [2,4-9]. EJAL may be attributed to patient- related or surgical technique- related factors. Management of the anastomotic defect and optimal supportive care of the patient can be challenging and requires a multimodal approach. Evaluating the size of the defect and monitoring the output of the drains are essential steps towards designing the treatment options [9-11].

   Yoga practice in today’s life: Yoga practice is not restricted now to a few qualified individuals, as it was happened to be in ancient times. Owing to the efforts of the Masters aimed at the welfare of the humanity, the knowledge of yoga practice has reached to every corner of the world. People today are taking interest in yoga, be it for their health, physical flexibility, overall well-being or to experience their spiritual [1,2]. The number of yoga enthusiasts has risen significantly all over the world in recent years especially after the time of covid-19.

   Sarcoidosis is a multi-organ system autoimmune disorder characterized by the presence of non-caseating granuloma formation within one or more organ systems [1]. The majority of cases present with lung involvement, however 30-50% of cases have extra-pulmonary involvement at the time of clinical presentation [2]. These extra-pulmonary manifestations typically involve the skin, lymph nodes and eyes. Rarely sarcoid can manifest in the abdomen; however, this is typically noted in the liver and spleen [3]. Peritoneal sarcoidosis is a rare manifestation of the disease with less than 50 reported cases and it can rarely mimic ovarian or primary peritoneal carcinoma with elevated CA125 levels. There are 5 reported cases reported in the literature.

   Spontaneous, atraumatic, subcapsular and perirenal renal bleeding was first described by Bonet in 1700. Wünderlich defined it as “spontaneous apoplexy of the renal capsule” in 1856 and in 1910, Coenen referred to this condition as Wünderlich syndrome (WS) [1]. Subsequently, Lenk’s characterized it with a triad of acute flank pain (83%), hematuria (19%), and hypovolemic shock (11%) [2]. WS is a rare condition with a total of 165 cases has been reported by 2002 [3]. Its various etiologies include; (a) tumors viz. renal cell carcinoma, angiomyolipomata, metastases, sarcoma, fibroma, adenoma, oncocytoma and transitional cell carcinoma (61%), (b) vasculopathy viz. polyarteritis nodosa and renal artery aneurysms, renal vein thrombosis, renal arteriovenous malformations, fistulas and portal hypertension (17%), (c) infections viz.

   ChatGPT and Bard are both large language models, also known as conversational AI or chatbot trained to be informative and comprehensive. They are trained on a massive amount of text data and are able to communicate and generate human-like text in response to a wide range of prompts and questions. For example, they can provide summaries of factual topics or create stories. ChatGPT is a large language model chatbot developed by OpenAI. It is trained on a dataset of 300 billion words and is able to communicate and generate human-like text in response to a wide range of prompts and questions.

   Bronchopulmonary sequestration represents a spectrum of abnormalities [1]. Pulmonary sequestration refers to the situation whereby a portion of lung tissue receives its blood supply from an anomalous systemic artery [2]. Two types of pulmonary sequestration are recognized [3-10], depending on whether or not the malformation possesses its own pleural covering. Intralobar sequestration is an abnormal region within the normal pulmonary parenchyma without its own pleural covering. Extralobar sequestration corresponds to a true accessory lung, with its own pleural envelope. Intralobar sequestration accounts for 0.15% to 1.7% of all congenital lung abnormalities [11].

   A 45-year-old male patient with past medical history of obesity and diabetes presented with complaints of pulsatile, frontal headache evolving in the past two days. His vital signs were normal and he had no meningeal signs or neurologic deficits. Magnetic resonance angiography (MRA) revealed cerebral venous sinus thrombosis (CVST) with intraluminal thrombus in galen's vein, and right rectum and transverse sinuses (Figure1). The patient was administered oral anticoagulation for six months and a brain MRA was repeated with recanalization of the previously documented venous thrombosis.

   The Burkholderia cepacia complex (Bcc) is a group of aerobic Gram-negative rod-shaped bacteria, some of which are opportunistic pathogens [1]. Bcc infection has been rarely reported in patients other than cystic fibrosis. In liver cirrhosis, there are reports of SBP (spontaneous bacterial peritonitis) caused by Bcc [2]. However, to date, no study has reported the systemic presence of these bacilli in the context of decompensated alcohol-associated cirrhosis with acute-on-chronic liver failure (ACLF), in the absence of SBP. Likewise we report a gut microbiota with extremely polarized and frank loss of bacterial diversity associated with a poor prognosis.

   Homocysteine is an intermediary amino acid formed by the conversion of methionine to cysteine. Homocysteinuria is a rare autosomal recessive metabolic disorder caused by a deficiency of enzymes involved in the metabolism of methionine. Homocysteine can be metabolized through two pathways: transsulfuration and remethylation. In the transsulfuration pathway, homocysteine is converted to cysteine with the help of the enzyme cystathionine-beta-synthase. This enzyme requires pyridoxal phosphate, the active form of vitamin B6, as a cofactor. In the remethylation pathway, homocysteine is converted back to methionine. This reaction can be catalyzed by either methionine synthase or betaine-homocysteine methyltransferase.

   Anterior Cruciate Ligament (ACL) is the major internal stabilizing ligament of the knee and its injury generates major instability. Anterior cruciate ligament is the most commonly injured ligament in the body, making ACL reconstruction is one of the commonly performed procedures in orthopedic surgery. In Sudan no exact data or registry available for knee ligament injuries but in America about 250,000 ACL torn patients presented to hospital each year and about 100,000 ACL reconstruction performed per year [1]. ACL tear seriously affects the life of the patient by incapacitating in his daily life activities and affecting directly his quality of life. Patients with a rupture of ACL may report pain, difficulty with athletic performance and/or giving-way symptoms in daily activities [2].

   Uveitis is a serious complication of Juvenile Idiopathic Arthritis (JIA) that can lead to significant visual impairment or even blindness. It is the most common cause of uveitis in children and differs from uveitis associated with spondyloarthropathies by the paucity of its functional signs, resulting in diagnostic and therapeutic delays and affecting visual prognosis. The aim of our study was to identify the epidemiological, diagnostic and prognostic features of patients with uveitis associated with Juvenile Idiopathic Arthritis (JIA), as well as to discuss the complications and best therapeutic alternatives and prognostic data on these cases, shedding light on the challenges of managing this complex condition.

   Epithelioid hemangioendotheliomas are uncommon vascular tumors presenting with different biological behavior and clinical features. It is a pathology that should be diagnosed early because it is seen at earlier ages and can cause distant organ metastases. Due to its rarity, it is often not included in the differential diagnosis of soft tissue masses [1]. In this case, we aimed to present a malignant epithelioid hemangioendothelioma presenting with palpable swelling.

   Thyroid disorders are prevalent globally and affect people of all ages. Thyrotoxicosis, also known as hyperthyroidism, is a common endocrine disorder characterized by increased secretion of thyroid hormones resulting in elevated basal metabolic rate, weight loss, tachycardia, and sweating [1]. It is usually diagnosed by clinical examination, laboratory tests, and imaging studies, including Technetium-99m (Tc-99m) pertechnetate thyroid scan [2]. Tc-99m pertechnetate is a radioactive tracer that is taken up by the thyroid gland and visualized using nuclear medicine imaging [3].

   Masāmīr/Tha’ālī are Arabic words used in the Unani System of medicine for a diseased condition called warts. Indeed, it is a hard, grainy skin growth fastened in between the dermis and underneath muscles, its colour is whitish, it is oval or rounded in shape, and it is placed inversely in the skin as a nail; that’s the reason it is called Masāmīr [1]. Its commonest site is the fingers of the hands and soles, because this person gets trouble walking and touching [1]. Type of mass hard growth on the body, when its margin is rounded to be called Masāmīr (nail), but meandering and irregular imagination is called Qarn (corn/horn). Its material is thick, phlegmatic, and sticky [2].

   Here we present a description of severe COVID-19 infection with extrapulmonary manifestation in infant at a time when the prevalent SARS-CoV-2 strain was the so-called Omicron variant. A male infant, born at 38 weeks' gestation, was admitted to the emergency department on January 31, 2022 due to congenital pneumonia. A chest X-ray showed interstitial pneumonia, however, RT PCR of the patient’s nasopharyngeal swab sample was negative for SARS-CoV-2, as well as for other respiratory viruses. The most common causes of congenital pneumonia, including TORCH-infections, chlamydia, and other pathogens that colonize the mother’s birth canal, were ruled out.

   Head lice (Pediculus humanus capitis) are considered as the most prevalent parasitic infestation of humans in the developed and developing countries, where the parasitic insects live on the scalp and neck hairs of humans and feed on human blood, causing social distress, discomfort, anxiety, and embarrassment [1,2]. The most likely targets for invasion by head lice are kindergarten and school-aged children between 3 and 11 years and occur commonly each year in all socioeconomic statuses [3-5]. In the United States, each year about 6-12 million kids lose their lost school days due to the infestation of head lice and treatment costs of more than US 500 million/ year [6].

   Diabetes mellitus (DM) is known as one of the largest global health challenge in current century. Diabetic patients have a higher mortality risk due to cardiovascular diseases, and ischemic heart disease (IHD) is considered the leading cause of death among this population [1]. Serum insulin and glucose levels can affect the sympathetic nervous system and norepinephrine release [2]. Autonomic nervous system stimulation triggers hemodynamic changes, including tachycardia, increased peripheral systolic blood pressure, myocardial contractility, stroke volume, cardiac output, and decreased peripheral arterial resistance and central blood pressure.

   The formation of blood clots in the brain’s venous sinuses leads to a condition known as cerebral venous sinus thrombosis (CVST). CVST, also known as cerebral venous thrombosis (CVT), results in the breaking of the blood cells causing blood leakage into the brain tissues, thereby resulting in hemorrhage [1]. Symptoms of CVT are nonspecific, which makes the diagnosis difficult [2,3]. The symptoms include focal neurological disturbances/loss, headaches, nausea, vomiting, altered consciousness, dizziness developing over days to weeks, cranial nerve palsies, papilledema, and seizures resulting in coma in some patients [4-6]. Deep venous thrombosis in patients leads to increased intracranial pressure, with an estimated mortality due to CVT of 5%-30%. However, early diagnosis and treatment can lead to favorable recovery, with about 80% of patients leading a normal life [7].

   Angioid streaks are often associated with a systemic condition, most frequently pseudoxanthoma elasticum, Paget’s disease and sickle-cell anemia. They are described as visible, linear, irregular, cracklike dehiscences of Bruch membrane, which may be unilateral or most commonly bilateral. Several diagnostic methods are useful to diagnose, evaluate, and monitor angioid streaks, and various treatment modalities have been used, with promising results.

   An ‘audit’ is defined as ‘the review and the evaluation of the health care procedures and documentation for the purpose of comparing the quality of care which is provided, with the accepted standards’. Studying the prescribing audit is that part of the audit which seeks to monitor, evaluate and if necessary, suggest modifications in the prescribing practices of medical practitioners. Prescription Audit offers the most comprehensive overview of performance, detailing parameters as per the check list of prescription audit. Prescription writing is an important means of therapeutic intervention by the doctor and reflects his approach towards safe prescribing.

   An 18-year-old boy, the result of a non-consanguineous marriage, was brought to the endocrinology clinic by his parents due to concerns about his short stature, which had been noticeable for the past 8 years. The patient did not have a history of headaches, visual difficulties, hearing impairments, joint pain, chronic cough, altered bowel habits, bone pain, or fractures. There were no reported cases of short stature, psychiatric disorders, or behavioural abnormalities in the family.

   While uniportal video-assisted thoracic surgery (U-VATS) is a viable minimally invasive surgical approach [1], it may restrict the control of surgical instruments. Surgery for lung cancer with silicosis and inflammatory lymph nodes is always difficult, and U-VATS is not considered to be a good indication for such cases. In general, inflammatory lymph nodes cannot be dissected easily, so the vessels and bronchi are cut at the periphery while avoiding these lymph nodes via approaches such as open thoracotomy or multiport VATS.

   Human toxocariasisis a cosmopolite parasitic infection due to an helminth Toxocara canis (T.canis) and Toxocara catis (T.catis) transmitted by dogs and cats, respectively. It represents one of the main causes of hypereosinophilia but it is misdiagnosed. It can affect all sites. It’s often an asymptomatic and benign infection and can be recovered without treatment. But some forms are serious and can be life-threatening. Visceral larva migrans constitutes a rare and doubtful form. Clinical signs and radiologic features are not specific, which can mislead the positive diagnosis.

   The disease is endemic in many developing countries, including Tanzania. Leprosy can cause severe disabilities, and its diagnosis and treatment require specialized skills and resources. Leprosy is considered as one of the oldest human endemic diseases.is at least 4,000 years old. It was reported in 1873, when Doctor Armauer Hansen discovered Mycobacterium leprae as the causative agent of leprosy in Bergen, Norway therefore confirming the infectiousness of leprosy [1]. Leprosy is a chronic infectious disease caused by Mycobacterium leprae and one of the world’s most neglected diseases [2].

   Pityriasis Amiantacea (PA) (synonyms: Tinea amiantacea, asbestos scalp,) is an uncommon papulo-squamous condition of the scalp which presents with thick yellowish, silvery, asbestos-like scales attached to the hair shafts. This condition was first described as asbestos-like tinea by Baron Jean-Louis Alibert of France in 1832 [1]. Etio - pathogenesis of this condition remains unclear and it represents a reaction pattern of the scalp to various inflammatory diseases.

   Erythema nodosum (EN) is a type of panniculitis, which is an inflammation of the subcutaneous fat. It is characterized by tender, erythematous nodules on the lower legs, although it can occur on other parts of the body as well. EN is a relatively uncommon condition that is most commonly seen in young adults, and it is more prevalent in females than males [1]. The exact etiology of EN is not well understood, but it is believed to be associated with a hypersensitivity reaction to various triggers, such as infections, medications, autoimmune disorders, and malignancies. Infections are the most common cause of EN, with streptococcal infections being the most commonly identified pathogen. Other infectious causes include tuberculosis, Epstein-Barr virus, and hepatitis B and C.

   Spontaneous hemoperitoneum is a rare cause of acute abdominal pain. When it happens, it may be fatal. The etiology includes generally hepatic, splenic, gynecologic, vascular causes, and bleeding disorders [1]. Gastrointestinal stromal tumors (GIST) are uncommon tumors with a diverse malignancy potential, habitually detected in the stomach and the small intestine [2]. This entity is exceptionally responsible for a spontaneous hemoperitoneum [3].

   With an increase in migration and travel, physicians should have an index of suspicion for parasitic infection. Parasitic worms that can affect the lung include trematodes, protozoa and nematodes [1]. Diagnostic investigations such as serology are prone to cross-reactions [2]. Blood eosinophilia may be absent in immunocompromised patients with Strongyloides hyperinfection syndrome [3]. In addition, Ascaris eggs are only passed in the stool following pulmonary symptom resolution, and many non-infectious causes of pulmonary eosinophilia have been described [1].