A 54-year-old African American male presented with pruritic, circular, purpuric lesions, following a cupping service 4 days prior. The patient had a history of eczematoid dermatitis, scalp folliculitis and xerosis cutis. Upon examination, 13 lesions were identified with a diameter of 6 cm each.
Issue 4 (Jul & Aug)
Tracheoesophageal Fistula (TEF) is a rare complication after Minimally Invasive Esophagectomy (MIE). Various surgical methods are available for repairing TEF. In this report, we have shown the importance and feasibility of pedicled Sternocleidomastoid Muscle (SCMM) flap in dealing with TEF.
A 35-year-old male returned from vacation in Hawaii where he went scuba diving and snorkeling. While snorkeling, he stepped on a sea urchin and sustained injuries to the dorsal aspect of his right foot. He began to swim back to shore when he felt significant pain and began removing visible spines when he reached shore.
A 58-year-old male with a past medical history of squamous cell carcinoma and basal cell carcinoma presented to the emergency department with complaints of right facial mass, loss of vision, and frequent falls due to visual disturbances. The mass was also associated with pain and purulent drainage.
Stranger bodies (EC) of the middle ear are among the emergencies least encountered by otolaryngologists (ENT). A 16-year-old patient with no otological history had seen a right chronic otorrhee with otalgia and hypoacousia for 6 months. Microscopic examination of the diseased ear had resulted in purulent secretions with inflammation of the external auditory canal.
Organosilane-based disinfectants have been purported to impart lasting antimicrobial properties when applied to a surface. The implications being dramatic reduction in pathogen transmission via fomites and therefore of great public health importance as a means to limit the spread of outbreaks such as COVID-19. We conducted experiments in our laboratory to assess the efficacy of one such product, which reported anti-microbial protection of up to 120 days, as an operational report for our hospital.
Submucosal laryngeal masses are challenging for ENT specialists as the diagnosis usually remains uncertain until histopathological examination is carried out. We report a case of a 54-year old man complaining of dysphonia and globus sensation. Flexible laryngoscopic examination showed a submucosal swelling in the right anterior laryngeal ventricle.
A 58-year-old man presented with 4-day history of multiple, erythematous, non-itchy, painless, patchy spots, along with fatigue and jaw pain. This rash started around the periumbilical area and then spread over his chest and right upper back. There was no involvement of face, mucous membranes, and extremities.
Torsion of an Accessory Liver Lobe (ALL) is a rare cause of acute abdominal pain. The presence of ALL is associated with congenital abdominal wall abnormalities, such as omphalocele or umbilical hernia, and occurs secondary to abnormal liver morphogenesis and intraabdominal hypertension causing liver hypertrophy.
A case of a healthy young patient which had a spiral fracture of humerus shaft during an arm-wrestling game. Various differential diagnosis should be assessed. Treatment is the same as a fracture of humerus shaft from any other mechanism.
Keloids are frequent connective tissue tumors characterized by a significant proliferation of fibroblasts and collagen with a recurrent and extensive tendency. They can be secondary to a solution of cutaneous continuity: surgical wound; vaccination; burn; hard inflammatory lesion.
LVNC is a relatively new clinical entity, with a significant increase in awareness and diagnosis in recent years. Currently the aetiology and pathogenesis of LVNC remains uncertain, alongside prevalence, however the diagnosis of LVNC appears to be increasing with improving imaging techniques.
A 49-year-old male patient presented to the emergency department with acute onset of painful swelling in the left breast. An unusual diagnosis of breast abscess was made using ultrasound scan, incision and drainage were performed followed by antibiotics, with full recovery.
Acute Longitudinally Extensive Transverse Myelitis (ALETM) poses a problem of etiological diagnosis. The etiologies are diverse; infectious, degenerative, inflammatory and auto-immune.
Air pollution continues to be an environmental problem that poses a lot of health risks to the young and aged. Developed countries have invested heavily to curb this environmental problem, causing severe threats to human lives, yet the results do not look convincing. In developing countries, the situation is difficult than they can imagine, resulting in governments borrowing to fight what looks like a lost battle.
The World Health Organization recommends that malaria treatment should begin with parasitological diagnosis. This will help to regulate misuse of anti-malarial drugs in areas with high transmission. Aim was to assess the prevalence of parasitological confirmed malaria among under five years children presenting with fever or history of fever attending medication at Masogo sub-county hospital.
Hepatic hemangiomas are benign, well-circumscribed tumors often found incidentally on imaging. They are estimated to be prevalent in 0.4-20% of the population. While usually solitary lesions, these tumors tend to not cause any issues for patients. However, when they grow to be larger than 5 cm, there can be associated symptoms including pain.
Autoimmune Thyroiditis (AIT) and Graves’ disease are autoimmune diseases with the opposite state of thyroid function: hypothyroidism and thyrotoxicosis. Typically, thyrotoxicosis can progress to thyroiditis and eventually hypothyroidism. The transformation of autoimmune thyroiditis into Graves’ disease is a very rare event.
Portal cavernoma is the cavernous transformation of the portal vein. It is the consequence of chronic portal vein thrombosis and occurs when collateral branches develop to bypass the portal occlusion. The clinical presentation includes hematemesis due to variceal bleeding, ascites or anemia, and splenomegaly.
Although substance misuse pattern is of growing worldwide concern, European countries have not been left out as they are uniquely going through a dynamic phase of drug misuse pattern. It is perhaps appalling, that little or no attention has been given to university students in aspects of drug policy and adoption of potential interventions necessary to curb this act.
Osteonecrosis is a pathologic process that is associated with numerous conditions and therapeutic interventions. Most commonly the hip is involved but almost any bone can develop osteonecrosis. It can occur in the femoral head, but also affect the femoral condyles, humeral heads, proximal tibia, vertebrae, and small bones of the hand and foot.
We are presenting here a case of polycystic ovarian syndrome, an endocrine disorder, afflicting 5-13% females of reproductive age, causing 70-80% infertility associated with pituitary macroadenoma i.e. size >10 mm & prolactin level >250 ng/mI. PCOS has a higher relationship with metabolic disturbance and hypothalamic-pituitary-ovarian axis function disorder.
Tracheal Squamous Cell Carcinoma (SCC) is a rare primary tumour. Currently, surgery is the main treatment, but it becomes the biggest obstacle to surgery when the tumour invades the trachea for more than 6 cm. A 56-year-old Asian man presented with expectoration and asthma as his initial symptoms.
Epidural Anesthesia (EA) is mainly used for perioperative and postoperative analgesia, usually combined with Spinal Anesthesia (SA) or General Anesthesia (GA). It is safe, easy to perform, and has multiple applications. The benefits of Regional Anesthesia (RA) over general anesthesia include superior analgesia, reduced opioid consumption, reduced pulmonary complications.
32-year-old woman with history of pleurisy and systemic lupus erythematosus presented to the emergency department with shortness of breath and pleuritic chest pain, acutely worse over one day after a six hour flight three days prior. She became dyspneic walking from her hotel bed to the bathroom. She endorsed 3 weeks of right lower leg cramping.
Surgical Site Infection (SSI) is a rare but serious complication following Posterior Spinal Fusion (PSF) for pediatric scoliosis. Several studies have identified patient risk factors for SSI following PSF, including high Body Mass Index (BMI). The purpose of this study was to determine whether Radiographic Skin-to-spine Distance.
Neuroendocrine tumors of the extrahepatic bile duct (EBNETs) are exceedingly rare neoplasms, whose diagnostic and therapeutic process can be challenging. We present the case of a 58-year-old EBNET patient successfully treated at our Institution, followed by a systematic review of the literature on the surgical management of these rare tumors.
A 50-year-old man debuted with right trigeminal neuralgia. In the following years, it became refractory to medical treatment and ipsilateral cluster headache appeared. He was diagnosed with cluster-tic syndrome. A brain magnetic resonance with high-spatial-resolution 3D T2 sequences (FIESTA) excluded the existence of neurovascular conflict.
Managing Solid Waste is always a challenge for any developing nations due to poor infrastructure and awareness. The emergency situation due to COVID-19 pandemic has shifted the dynamics of solid waste generation globally. However, its impact varies from developed world to developing nation.
Sporadic Inclusion Body Myositis (IBM) is the most common acquired myopathy after the age of 45. Often there is a delay in diagnosis as the disease may be mistaken for other inflammatory myopathies and other neuromuscular disorders such as motor neuron disease. One of the hallmarks of the disease is distal finger flexor weakness but non-neurologists who see IBM may not have the expertise to make this assessment.
Zenker’s Diverticulum (ZD) is a herniation of the posterior pharyngeal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle through a natural weakness. The main clinical presentation is progressive solid food and pill dysphagia, with subsequent weight loss, halitosis, and regurgitation, complicated by the occurrence of several aspiration.
The COVID-19 pandemic has inflicted real suffering in many parts of the world and is expected to impact different sectors. Lockdown is considered to be an effective measure in slowing the spread of coronavirus. The study expects to understand community and healthcare providers’ perspectives on COVID-19 and pandemic responses during and after the lockdown in Nepal.
Being of embryonal tissue origin, the teratomas are rare in adults, typically occurring either in the gonads or in the sacrococcygeal region in infancy and childhood. We present a case of a teratoma in the lesser sac of an adult female managed by en-bloc resection with the infiltrating stomach segment.
Skeletal hydatidosis is extremely rare and involvement of the long bones of the appendicular skeleton is exceptional. We report on a case of a 68-year-old Ugandan woman who presented with a long standing history of a non-healing fracture of the mid-diaphysis of the right humerus. She had undergone multiple surgeries in peripheral health centres during the previous years.
To investigate the difference of clinical outcomes between patients with and without Reactive Cutaneous Capillary Endothelial Proliferation (RCCEP) after camrelizumab treatment. A retrospective, matched case-control study was designed.
The word Metastasis means ‘Meta-transformation, stasis-residence’, is stated as the spread of cancer by invasion in a way that is discontinuous to the primary tumor mass and forms secondary tumor masses in a distant area at the site of lodgment. Metastasis is a feature to distinguish malignant from benign tumors.
Deep vein thrombosis is an important health problem that is frequently encountered in the general population and especially in surgical clinics and has a negative impact on quality of life. In this study, treatment options and results of patients with deep vein thrombosis who have been hospitalized for 12 years in Atatürk University and Erzurum Regional Hospital were examined and discussed.
There is absolutely no doubt that breastfeeding is the best nutrition for the baby. In this article, we discuss why breastfeeding is important. With appropriate preparation and support, the majority of mothers can successfully breastfeed their babies. We discuss some important facts about breastmilk composition as well as some practical aspects that would need attention to ensure the mother is supported adequately to ensure a successful breastfeeding experience.
In Western countries the number of individuals suffering from an autoimmune condition is constantly growing and often patients suffering from autoimmune disease are susceptible to developing a second autoimmune disorder. We report a case of an adult female patient affected by psoriasis vulgaris and treated with tildrakizumab, a humanized monoclonal antibody targeting interleukin-23.
Cowden syndrome (CS) is a rare, autosomal dominant, multisystem disease related to the mutation of Phosphatase and tensin homolog (PTEN) tumour suppressor gene. It is characterized by the occurrence of multiple hamartomas, mucocutaneous lesions, and is associated with a high risk of malignancies.
Acute cardio-cerebral infarction is a rare circumstance characterized by high morbidity and mortality. It represents a management challenge due to the difficulty to choose which condition needs to be treated first. We describe the therapeutic challenge of a patient presenting with ischemic stroke and ST-elevation myocardial infarction.
The objective of this pictorial review is to make radiologists and clinicians familiar with the typical, atypical and rare CT findings of COVID-19 pneumonia to help in diagnosis as well as in monitoring disease. Bilateral ground-glass opacities, whether isolated or coexisting with consolidations, and typically in basal, posterior and peripheral lungs are the key findings in COVID-19 pneumonia.
Primary tuberculosis of the tongue is very rare. The chronic ulceration is commonly misdiagnosed as a cancerous lesion. We report the case of a 44 years old immunocompetent woman who presented with a lingual chronic painful ulceration. The biopsy of the lesion showed a granulomatous inflammation, with caseous necrosis in the center. The ulceration healed after a 6 month tuberculosis treatment.
Bleeding, often catastrophic, is common, however, thrombosis is rare in Acute Promyelocytic Leukemia (APL). Intestinal gangrene is an unusual presentation of thrombosis of mesenteric vasculature. We hereby, for the first time report this unusual presentation of intestinal gangrene secondary to leukaemic infiltration in APL and highlight the importance of prompt therapeutic intervention given its catastrophic nature.
M. bovis and Brucella spp. are zoonotic bacteria that can infect humans. These pathogens are usually seen in people who are primarily engaged in animal husbandry and consume infected animal products separately. Although our country is endemic for tuberculosis and brucellosis, it is rare to detect these two pathogens concomitantly.
Obesity Is Global Problem Which Begins From Early Childhood. Early Exclusive Breastfeeding (EBF) without foods or Milk Formula (MF) before 6 months, with continued breastfeeding for two years are optimal feeding practices. To review studies conducted to assess the nutritional status of preschool children with a focus on obesity and stunting and their association with EBF vs MF feeding.
The researchers conducted a thorough review of the American Dental associations (ADA), Advisory Taskforce on Dental Practice Recovery, CDC (Centers for disease controls & Prevention, USA) guidelines for providing dental care during Covid-19 pandemic to protect the dental personal.
Tenosynovial Giant Cell Tumor (TGCT) is a rare benign synovial tumor arising from the tendon sheath, bursae, synovium or adjacent soft tissue. TGCT typical occurs in intra-articular site but can be rarely extra- articular. A 50-years-old woman already affected by malignant melanoma was submitted to PET/CT scan for routine diagnostic examinations.
The vertebral arteries originate from the root of the neck as the first branches of the subclavian arteries. Variations of vertebral arteries are congenital anomalies occurring during embryonic development. Anatomic variations of the left vertebral artery are clinically symptomless and recognized incidentally during angiographic assessments or imaging techniques so the diagnosis of these anomalies is a serious challenge.
Reduced access to routine care can lead to higher morbidity and mortality among older adults. We assessed the extent of reduced access to care among older American adults during the COVID-19 pandemic, identified predictors and reasons for reduced access. Using publicly available data from the COVID-19 module (interim release) of the Health and Retirement Study, we undertook descriptive analyses of older adults stratified by socio-demographic characteristics.
Ovarian torsion is a cause of acute abdomen in pregnancy with an incidence of less than 1% occurring most commonly in the first trimester. The symptoms are non-specific with a propensity for missed or delayed diagnosis which may worsen the morbidity associated with this condition. Management is mainly surgical and pregnancy outcome is usually satisfactory.
Lung cancer is a leading cause of cancer incidence and mortality worldwide with more than 2 million newly diagnosed cases in 2018. The disease is usually diagnosed in stage 3 or 4 with extensive clinical symptoms, which is a bad prognostic factor. Around 40% of patients with brain metastases are with a primary lung cancer, which shows the importance of this pathology.
Seminal vesicle anomalies are rare. It includes agenesis, hypoplasia, duplication, fusion and cyst. Agenesis of seminal vesicle is usually associated with anomalies of ipsilateral kidney and can be the cause of infertility in male. We report a case with seminal vesicle agenesis with ipsilateral renal hypoplasia.
Anxiety and fear about dentistry are a global problem that affects a large number of people around the world. Music, as a soothing method, can be used as a relaxing treatment to relieve anxiety and discomfort pain of the patient. This analysis aimed to check the instrumental music therapy effect on anxiety and pain levels in patients undergoing surgical treatment of an impacted third molar.
Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5–4% of all cases of fibroadenomas. Giant fibroadenomas are rare variants and represent only 0.5% of all fibroadenomas, usually occurring in girls between the ages of 10 and 18.
Pure autonomic failure is considered to be a degenerative condition of the autonomic nervous resulting from accumulation of alpha-synuclein in autonomic ganglia. Lack of CNS involvement distinguishes this disorder from other synucleopathies with CNS involvement like MSA, DLB and PD.
Multidisciplinary professional care for adolescents with type 1 diabetes mellitus has been supported by detailed international consensus guidelines since 1995. However, several professional authors have argued that it takes more than excellent guidelines to give good care also in a moral sense in daily practices.
Cardiac pseudoaneurysm is rare and appears mostly as tardive complication of Acute Myocardial Infarct (AMI). Its apical localization is also scarce as it is usually described in posterior or lateral wall of left ventricle. Its diagnosis is based on cardiac imaging. We report a case of a hypertensive, diabetic and smoking 64-year-old man with a past history of anterior AMI.
Coronavirus disease 2019 (COVID-19) has been taking a heavy toll worldwide. Since its outcome, different therapeutic strategies have been formulated against COVID-19. Unfortunately, none of them alone or in combination has come out successful against this pandemic. Current review discusses the measures applied so far against COVID-19 and suggests future aspects for the betterment of the humankind.
Medical bodies should take a neutral stance on the issue of assisted dying and should not be publicly opposed to or support any change in legislation that may allow assisted dying for terminally ill, mentally competent adults. At the heart of the case of neutrality is the principle that the decriminalization of assisted dying.
Mutation in LMNA accounts for 10% of Dilated Cardiomyopathy (DCM). It is characterised by progressive conduction system disease, arrhythmia and systolic impairment, lamin A/C heart disease is the most malignant gene common in DCMs especially in man. It is likely to be an under-recognised cause of this cardiomyopathy.
The purpose of this study was to evaluate the effect and possible mechanism of electroacupuncture on Premenstrual Syndrome (PMS). From May 2018 to December 2018, 60 participants who met the criteria were selected and divided randomly into either the Electroacupuncture (EA) group or the Placebo (PA) group.
Particle beam treatment for esophageal cancer can produce a better local therapeutic effect than can conventional radiotherapy. However, events that occur in the esophagus during or after the treatment of other cancers after that are unknown. The first patient, a 64-year-old woman, had undergone heavy ion radiotherapy for esophageal cancer. Endoscopic submucosal dissection was performed for local residual tumor.
Klebsiella pneumoniae, a Gram-negative bacillus which exists widely in nature, is generally colonized in the human intestine and oral cavity and does not cause disease. However, the emergence and global expansion of hypervirulent and multidrug-resistant clones of K. pneumoniae have been increasingly reported in community-acquired and nosocomial infections.
Hypertension is a major modifiable cause of cardiovascular and cerebrovascular disease affecting more than one billion individuals worldwide. Adherence to recommended antihypertensive medications is central to control hypertension. The purpose of this study was to assess medication adherence and its influencing factors.
Though many studies have been made - sometimes even blaming - to optimize the communication between doctor-patient-caregiver in oncology, very little work is focused on the intra-familial aspects of the communication. Clinical experience shows us how much communication between cancer patients and their loved ones can also be impacted by cancer.
In 2020, the World Health Organization declare a SARS-CoV-2 pandemic. There are currently more than 10 million people infected. Mao et al  demonstrated that 36.4% of hospitalized patients diagnosed with Covid-19 have presented neurological manifestations, where the most severe patients are more likely to develop said manifestations.
Thyroglossal duct cyst carcinoma is uncommon. Its prevalence is less than one percent. Papillary carcinoma is the most common pathologic finding of the thyroglossal duct cyst carcinoma. Metastasis of the cervical lymph node is less common. Its prevalence is less than 8%. A 38-year-old woman presented with a complaint of painless mass in the midline of the neck.
Recent pandemic surge of Covid-19 has made it necessary to further understand a detailed neurological association with the virus in-relation to sub-clinical picture. Additionally, in the presence of a sweeping corona virus wave throughout the globe, pre-liminary studies have indicated a strong association of severe acute respiratory syndrome coronavirus 2.
Anaplastic Lymphoma Kinase (ALK) gene fusions are detected in approximately 5% of lung adenocarcinomas, and data on double ALK fusions remain scarce because of their low occurrence rate. To date, there have been only a small number of case reports on double ALK fusions.
A Male, 11-Years-Old, Admitted In March 2019 With Chronic myelogenous leukemia (CML) in treatment with Imatinib. Three months after diagnosis in outpatient visit was observed increase of splenomegaly and appearing of inguinal and cervical adenomegalies. Bone marrow apiration revealed 70% of blasts, some of them with hemophagocytosis.
Peripheral Giant Cell Granuloma (PGCG) considered one of the commonest oral giant cell lesions and gingival epulis. It is probably a non neoplastic lesion but rather reactive in nature which originates from the periodontal membrane or the periosteum as a reaction to chronic trauma or local irritation.
Primary Malignant Cardiac Tumours (PMCTs) of the heart and pericardium are extremely rare. The incidence rate of both malignant and benign primary tumours is 0.02%, however only one quarter of these are malignant. The reason why these specific malignancies are so uncommon is not yet well understood. This review aims to determine why the heart and pericardium are such inhospitable hosts to PMCTs.
Hamangioma is a benign, local malformation of blood vessels and grow along with the same rate as the adjacent tissues, they do not invade underlying structures but may involute over a period of time resulting in fine telangiectasia or scarring. Haemangioma can occur anywhere in the body and also in the oral cavity.
Our patient is a 78-year-old lady with known metastatic papillary urothelial carcinoma that presented for evaluation of left foot pain. Imaging studies revealed an aggressive appearing mass measuring approximately 4.8 cm that was subsequently biopsied with pathology consistent with her known diagnosis of urothelial carcinoma.