Articles

Volume-2, 2021
Issue 6 (Nov & Dec)



Pneumothorax and lung metastases cavitation during cabozantinib treatment for metastatic clear cell renal cell carcinoma: A clinical case with literature overview

Cabozantinib is an oral multikinase inhibitor approved for the treatment of advanced renal cell carcinoma. Radiological response evaluation may be difficult because, like other multikinase inhibitors, cabozantinib causes vascularization reduction and, in the lung, it may be associated with metastasis cavitation instead of a pure size reduction.

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Patient with rare blood group B(A) phenotype: A case report

The ABO blood group system plays a crucial role in transfusion and transplantation practices. Correct identification of ABO blood group in blood donors and transfusion recipients is paramount importance for compatible transfusion of red blood cells because of minor errors can lead to fatal transfusion reactions.

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Löfgren’s syndrome - An uncommon presentation of a common disease

A 24 year old woman presented to our institution with a two week history of multiple discrete, painful, nodular and indurated foci of erythema on her lower limbs against a six week background history of a constellation of more nonspecific symptoms including intermittent dry cough, malaise, migrating arthralgias, subjective fevers, anorexia and weight loss.

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Unusual case of pseudoaneurysm of ascending aorta eroding presternal soft tissue and sternum in a patient with miliary tuberculosis and a bioprosthetic aortic valv

Ascending aorta pseudo-aneurysms that erode into the presternal soft tissue and sternum are rare. The author describes the surgical approach of a bulging pulsatile suprasternal mass caused by a pseudoaneurysm of the ascending aorta in a patient with miliary tuberculosis and a bioprosthetic aortic valve.

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Postpartum chest pain and the Hamman syndrome

A 17-year-old primigravida developed acute onset postpartum pleuritic chest pain following a prolonged second stage. The clinical syndrome rapidly progressed to chest, neck and facial swelling. Clinical evaluation in parallel with urgent investigations led to the diagnosis of Hamman syndrome, a rare though important benign cause of postpartum chest pain and shortness of breath.

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Priapism in a patient with COVID-19: A case report

A pro-inflammatory response in patients with coronavirus disease provokes hypercoagulability and hyperviscosity, following an excessive liberation of acute phase reactants. Thromboembolic complications such as Deep Venous Thrombosis, Pulmonary Embolism, Stroke and Acute Coronary Syndrome were described from the beginning of the pandemic as possible manifestations of this new virus.

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Mask induced mucormycosis: An unexplored possibility?

Mucormycosis is a rare angioinvasive fungal infection attributed to filamentous fungi called mucormycetes. According to reports published during the period between December 2019 and early April 2021. Approximately 71% of the cases of mucormycosis in COVID infected individuals across the globe have been reported from India.

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Mesotherapy vs PRP: Hair loss

Hair loss is a very serious problem that men and women struggle with almost every day. Given that many people suffer from this disease, scientists try to find optimal solutions every year. There are many products and methods that claim to restore hair growth or reduce hair loss. Some of these methods seem to be almost completely useless, while others make significant changes.

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Placement of a metallic Y stent to address a large tracheoesophageal fistula on the carina

We report a case of a 43-year-old woman who presented with a large tracheoesophageal fistula involving the main carina after chemo-radiotherapy for lung adenocarcinoma. A self-expanding fully covered metallic Y stent was placed with the use of both rigid and flexible bronchospopy and fluoroscopic guidance. An esophageal stent was placed subsequently.

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Connatal cyst in a 20 year old girl

Connatal cyst also known as frontal horn cysts, are cystic areas adjacent to the superolateral margins of the body and frontal horns of the lateral ventricles and are believed to represent a normal variant. The other name is coarctation of the lateral ventricles or frontal horn cysts. Sometimes unilateral or bilateral, the incidence of this condition is between 0, 4 and 0, 9%.

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Agenesis of the corpus callosum

The corpus callosum is composed of 4 segments namely the rostrum, thegenu, the body and the selenium 20 weeks all of these components are expected to be present in the midline. It continues to grow in thickness and length and reaches maturity around the age of 9-10 months.

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Intramedullary spinal cord abscess: A grave complication of a dermal sinus tract

Congenital dermal sinus tracts are an uncommon form of spinal dysraphism. If identified and treated early, outcomes are favourable. If missed, complications can be significant. Intramedullary spinal cord abscess is a rare but catastrophic complication. We report the case of an infantile patient with an intramedullary spinal cord abscess occurring 2-months post treatment.

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Moth eaten alopecia as a manifestation of group of skin diseases: Reporting a series of 100 cases

The moth-eaten alopecia is a characteristic clinical pattern usually of multiple small ill-defined patches of hair loss that was originally used to describe alopecia in syphilis but it is not well reported in other skin diseases. To record all patients that present with moth eaten alopecia and to do full clinical evaluation and classification aiming to find skin diseases.

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Evaluation of antenatal care utilization studies in Nigeria from 1990-2020: A narrative review

In Nigeria and other developing countries, there are still recorded high cases of maternal and perinatal mortality rates which can be attributed to the general under utilization of antenatal care (ANC) services which varies across variables. Antenatal care still remains the proven approach targeted to improving the quality and efficacy of ANC and also improving the overall health outcome of mother and child.

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Forehead soft tissue trauma: Concealed by the art of plastic surgery

A 22 year old lady, who is a stage performer presented with a history of trauma to the forehead following a road traffic accident (Figure 1). The post traumatic image of her face was heartbreaking for her. Patient was taken for Plastic surgery procedure under general anaesthesia.

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Clinical presentation and surgical resolution of atypical non-adenomas adrenal tumors

Adrenal tumors are very common in medical practice, including a wide spectrum of etiologies. Although most of them are adenomas, infrequent lesions can become a diagnostic and therapeutic challenge for clinicians. Here we present two atypical cases of non-adenomas adrenal tumors with specific imaging, biochemical profile, and surgical resolution.

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Cardiology fellowship in the era of coronavirus disease (COVID 19)

Since Coronavirus disease (COVID-19) was declared a pandemic on 3/12/2020 by the World Health Organization (WHO), diagnosed cases have continued to be on the rise worldwide, even though rates of new case detection seem to be stabilizing here in the United States.

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An innovative way of teaching electrocardiograms; EKG of the week

Introduced more than 100 years ago by William Einthoven, Electrocardiograms (EKG) remain an essential tool for doctors in diagnosing a variety of conditions. An abnormal EKG remains part of the criteria for diagnosing and activating the response for ST-Elevation Myocardial Infarction (STEMI), one of the most important causes of mortality nationwide.

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In vivo imaging tools for functional assessment of biomaterials implanted bone regeneration

Since the discovery of X-rays and its first use in imaging of a hand, bone tissue has been the chapter of interest in medical imaging. However, X-ray imaging poses limitations nowadays owing to the augmented complexity of implant scaffolds as well as with the advances in bone engineering. As a result, advanced follow-up imaging techniques are of paramount necessity for effective postoperative characterization.

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Definitive guiding flange prosthesis for management of hemimandibulectomy: A case report

Management of segmental mandibulectomy defects present a major challenge to the rehabilitation team. Mandibular discontinuity obliterates the equilibrium and mandibular functions symmetry, which leads to altered mandibular movements, facial disFigurement, incomprehensible swallowing, impaired speech and deviation of the remaining fragment towards the surgical side.

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Pneumomediastinum associated with pneumorrhachis: air in the spinal canal

Pneumorrhachis (PR) is an uncommon phenomenon that is rarely evident on imaging. It is defined as air in the spinal canal and can be iatrogenic via spinal tap and epidural anesthesia, or via traumatic etiologies. We report a rare case of pneumomediastinum associated with PR in a patient with severe emphysema.

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Twin anemia polycythemia sequence (TAPS)

A 33-year-old monochorionic twin gravida was subjected to a cesarean section at 31 weeks gestation due to preeclampsia. The pregnancy was otherwise uneventful. Prenatal diagnosis is based on measurement of the middle cerebral artery peak systolic velocity (that is usually increased in the anemic twin and decreased in the polycythemic twin), but is frequently missed.

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Therapeutic dilemma: When to start anticoagulation for cardiac thrombi in acute ischemic stroke? Lessons from cases

Ischemic stroke has been one of the major reason for morbidity and mortality all over the world. Anticoagulation treatment in patients with cerebral ischemic events caused by cardiac emboli is no longer a matter of debate. The problem is when to start. Because of a recurrence rate of 15 to 20% in the first few weeks after the initial event, direct anticoagulation by means of intravenous heparin followed by oral anticoagulants seems to be indicated.

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A rare case of pediatric intoxication: Bufotoxin bradycardia

The poison contained on the skin and in the glands of the Bufonidae has a digital is toxicity and carries a high mortality. Toad venom was considered responsible for the development of severe clinical manifestations such as vomiting, diarrhea, neurological disorders and arrhythmias.

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3D modeling of human spine and the cobb angle measurement in scoliosis patients

Scoliosis is a disease caused by the abnormal curvature of spine. Generally, curvature above 10 degrees is considered as a scoliosis. About 2-4% of the world population is affected by this disease. Therefore, there is a need for such a tool that can help surgeons and bioengineers to study the behavior of a spine under various conditions.

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Umbilical cord hemangioma diagnosed at 31 weeks of amenorrhea: A rare case report

Umbilical cord hemangioma is a rare benign vascular tumor, not always detected prenatally, several fetal complications can occur such as fetal prematurity, intra uterine growth restriction, fetal malformations, intra uterine death. We describe a case of Umbilical cord hemangioma diagnosed at 31 weeks of amenorrhea complicated with an intra-uterine growth restriction.

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Social accountability in the well-being framework

Social responsibility in the wellbeing area has been elevated as a methodology to work on the quality and execution of wellbeing suppliers in low and medium pay nations. Aggregate activity by residents who request more noteworthy accountability for negligence in community services is frequently alluded to as social responsibility or outer responsibility.

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Contralateral lumbar plexopathy after minimally invasive transforaminal lumbar interbody fusion: A case report

Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF) is an effective treatment for patients with degenerative lumbar spinal disease. This modality was devised to reduce approach-related morbidity and complications of open TLIF. In this report, we describe a unique case of a 40-year-old woman who developed contralateral lumbar plexopathy one day after the MI-TLIF procedure.

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Autopolypectomy

A 50-year-old man with a negative medical history except obesity visited the Emergency Unit because of acute anal blood loss, lower abdominal pain, constipation and a collapse. He mentioned the anal expulsion of a meat chunck prior to the bleeding episode. He carried a glass jar with the collected specimen, which measured 5 X 4 X 2 cm and had a pink-yellowish colour.

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Non-traumatic spontaneous spinal intradural extramedullary hemorrhage (SIEH) associated with rivaroxaban

Non-traumatic Spontaneous Intradural-Extramedullary Hematoma (SIEH) is a rare condition. Rivaroxaban is a Novel Oral Anticoagulant (NOAC), and there are few reports of rivaroxaban-associated SIEH. We report a 72-year-old male who had been taking rivaroxaban for his atrial fibrillation. He presented with sudden-onset paraplegia with a T7 sensory level and absent anal contraction.

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Pulmonary papillary adenoma: A rare benign tumor of the lung

A lung mass found incidentally in a young woman was diagnosed with Pulmonary Papillary Adenoma (PPA). It is important to understand the characteristic pathologic features of PPA to differentiate it from other lung tumors.

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Hyperpigmented skin lesions in a patient with severe combined immunodeficiency and adenosine deaminase gene defect

The patient was a 38-day-old male born to closely related consanguineous parents. The family history was unremarkable except for Down syndrome in his aunt. He was hospitalized due to productive cough (since about two weeks before), failure to thrive, delay in umbilical cord separation, and facial syndromic feature (low-set ear).

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Responding well to corticosteroid in an acitretin treatment-Related acute lung injury patient with psoriasis

Acitretin is retinoic acid derivative that is approved for treatment of severe psoriasis. The side effect of retinoic therapy is all-trans retinoic acid syndrome. Here, we report a case of acitretin treatment associated acute lung injury in a psoriasis patient. Exhibited as a diffuse lung parenchymal injury, the differential diagnosis of infection, heart failure, and alveolar hemorrhage should be ruled out.

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Quality of life assessment in patients with a stoma due to rectal cancer in Morocco

Colorectal cancer is a major public health problem in Morocco, according to the Moroccan. Cancer Registry; it represents the first gastro-intestinal cancer and the third most common cancer in Morocco. The aim of this paper is to compare the quality of life of rectal cancer patients with and without permanent colostomy in the course of rectal cancer treatment.

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Recurrent iodine contrast induced sialadenitis: Case report

Iodine induced sialadenitis is an uncommon condition, induced by exposure to iodine-containing contrast material. Although the condition had been reported in the past, the incidence and pathogenesis of this condition is not well understood, and is thought to be caused by either toxic damage from accumulation of iodine in the salivary glands and ducts.

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Wandering spleen

A 25-year-old female presented to our hospital with severe abdominal pain of two days duration. A routine obstetric ultrasound several years prior had revealed an enlarged spleen, but she was otherwise healthy and had carried two uneventful pregnancies to term. Physical exam on arrival in the emergency room was notable for a tender mass in the subumbilical region.

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Tuberculous peritonitis during pregnancy: Case report

Tuberculous Peritonitis (TP) in pregnancy is a rare condition, and the diagnosis can be deleyed because of the symptoms non specificity. 31-year-old parturient primigravidia at 34 weeks of amenorrhea presented diffuse and intense abdominal pain with vomiting.

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Comparison of the effects of atorvastatin and rosuvastatin on the levels of inflammatory markers and lipid profile in the patients with acute coronary syndrome: Randomized controlled double - blind clinical trial

The role of lipids and inflammation in the patients with cardiovascular complications has been reported. The primary aim of the current randomized controlled double-blind clinical trial was to compare the influence of Atorvastatin and Rosuvastatin on the lipid profile and inflammatory markers in the patients with Acute Coronary Syndrome (ACS).

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Evolution of periodontal attachment apparatus - Fossils to final forms

The study of tooth attachment evolution establishes relationship between living & extinct forms of life which provides useful evidence for general affinities between related species. Human dentition, established very early in evolution, and has persisted with little change from its evolutionary vertebrates.

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Histopathology of patients cyanide toxicity with brugada ECG pattern

Cyanide is a potent and lethal poison which uncouples oxidative phosphorylation in mitochondria. We describe a case due to massive cyanide poisoning resulting in a type 1 Brugada ECG pattern, with full resolution as cyanide levels decreased and histopathology.

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Unilateral livedo reticularis in ruptured abdominal aorta aneurysm

Livedo Reticularis (LR) is a well-known, relatively common physical finding consisting of macular, violaceous, connecting rings that form a netlike-pattern. Generalized livedo reticularis is a common physiological response to cold, but may be a sign of different systemic diseases. In the present case, a 79-year male presented with unilateral live do reticularis in the right leg, secondary to ruptured abdominal aorta aneurysm.

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Gluteal-sacrospinous-vaginal fistula as a complication of sacrospinous ligament fixation after a vault prolapse: A case report

Vault prolapse has a negative impact on womens quality life as a result of associated ano-rectal, urinary and coital dysfunctions. One of the most common surgical procedures for the treatment of vault prolapse is sacrospinous ligament fixation. In this report we present an uncommon case of a gluteal-sacrospinous-vaginal fistula complication after this procedure.

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A rare association of giant congenital melanocytic nevus (bathing trunk nevus) with cryptorchidism and inguinal hernia: Case report

Giant Congenital Melanocytic Nevus (GCMN) are rare cutaneous lesions occurring in 2,00,000 - 5,00,000 births. We are reporting a child who had left undescended testis and inguinal hernia along with GCMN. Along with orchidopexy and hernia repair, a test patch dermabrasion of nevus was done. We review our experience with this rare entity.

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Generalized eruptive keratoacanthomas involving the auricles and external auditory canal: A case report and literature review

The aim of this study was to report a case of Generalized Eruptive Keratoacanthomas (GEKA) involving the auricles and external auditory canal and to review the relevant literature. A patient with bilateral auricles stenosis and External Auditory Canal (EAC) atresia associated with GEKA is described. We performed a systematic review of the literature to identify and compare similar cases.

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Awareness of Saudi population about causes, diagnosis and management of Depression

Depression is one of the most concerning psychological disorder of our modern world, that problem with depression seems to the high incidence of the disease especially among the young population between 20-40 and females. Depression incidence is increasing in the last decades and is widespread in the developed countries as it is in the undeveloped ones.

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Hypercalcemia and multiple osteolytic bone lesions: A rare presentation of acute lymphoblastic leukemia

Hypercalcemia and osteolytic bone lesions are rare initial presentation of adult Acute Lymphoblastic Leukemia (ALL). This presentation is mainly described in pediatric ALL and information about adult ALL-associated hypercalcemia is limited. We describe a 21 years old woman presented with acute kidney injury, hypercalcemia and osteolytic bone lesions who was later diagnosed to have pre-B ALL.

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Posttraumatic intradural caroticocavernous fistula

Posttraumatic Caricocavernous Fistulas (CCf) occur in the intracavernous segment of the internal carotid artery. The authors present an unique case where the CCf developed in the intradural segment of the internal carotid artery. The clinical course and treatment employed are also presented and possible mechanisms for this rare situation are discussed.

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Demographic and biochemical risk factors of Down Syndrome in pregnant women: A pilot study in Sylhet division of Bangladesh

Worldwide research in down syndrome have shown that advanced maternal age (?30 years) at conception, lower folate status and/or impaired folate metabolism, maternal weight gain during pregnancy, low socioeconomic conditions, radiation exposure, use of contraceptive pills, and taking tobacco/smoking are major maternal risk factors for giving birth child with DS.

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Evaluation of ultrasonographic findings in adults with cervical lymphadenopathy

It is very important to distinguish benign and malignant cervical lymph nodes and to make an early diagnosis in terms of treatment and prognosis. Ultrasonography (USG) provides an idea in the diagnosis of reactive or non-reactive lymph nodes but also provides benefits in the differential diagnosis of malignant and benign.

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The feasibility of physical therapy in a patient with Parkinsons Disease and Myasthenia Gravis: A case report

The occurrence for patients who have the co-existence of Parkinsons Disease (PD) and Myasthenia Gravis (MG) is rare. This study attempted to investigate the feasibility of physical therapy on a patient with PD and MG. A 56-year-old male patient had MG for 42 years and PD for 10 years. He received physical therapy, including the 5-minute gait training and balance training, twice per week for 8 weeks.

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PET-CT save a day in deep-seated infection

Ventriculoperitoneal (VP) shunt infection is one of the common reasons of shunt malfunction. However, it is a well-known scenario that most patients with VP shunt infection present with non-specific complaints like fever and abdominal discomfort. Lumbar puncture analysis and blood culture could be unrevealing which may delay the diagnosis and subsequent management.

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The use of low dose methylprednisolone in severe Covid-19 induced ARDS to facilitate oxygen weaning: Results from a case series and mini review

We describe 8 patients with confirmed Covid-19 infection requiring high flow oxygen and respiratory support for adult Respiratory distress syndrome (ARDS) for a mean duration of 12 days. These patients had already received standard treatments for Covid-19, including broad spectrum antibiotics, dexamethasone, heparin and remdesivir along with entry to the recovery trial according to patient choice.

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Two cases of penile fracture with and without associated urethral rupture: Case reports and review of the literature

Penile fracture is a rare lesion that occurs almost exclusively during erection. This lesion may be associated with rupture of the urethra in 20-30% of the cases. We present two cases of a 41-year-old man with a penile fracture complicated by a urethral rupture and a 33 year old man with a penile fracture without urethral rupture. Subsequent repair was done in both cases.

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Drugs used against COVID-19

Viruses are small obligate intracellular parasites, which by definition contain either a RNA or DNA genome surrounded by a protective, virus-coded protein coat. Viruses range from the structurally simple and small parvoviruses and picornaviruses to the large and complex poxviruses and herpesviruses.

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Cerebral abscesses in Marfans disease

A 43-years-old woman was hospitalized with headaches progressing over the 10 preceding days and an epileptic seizure. The patient had a Marfan disease which required two cardiac surgeries - the last one in 2014 with the installation of an aortic tube and a mechanical aortic valve.

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Injection of methylene blue in the lungs during laparoscopic cholecystectomy

In a surgical setting, intraoperative methylene blue usage is a safe and effective technique in detecting gastric leak during laparoscopic abdominal surgery. A Nasogastric (NG) tube is commonly used to empty the stomach and to monitor the occurrence of bowel occlusion after major abdominal surgery. The incidence of misplacement of NG tubes into the airways ranges between 0.3% and 15%.

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Bilateral staged ureteral stenosis secondary to Wegeners disease: A case report

Wegeners disease is a rare vasculitis characterized by inflammation of the endometrium of blood vessels. Ureteral stenosis is a rare manifestation of granulomatosis with polyangiitis (formerly known as Wegeners granulomatosis). We report the case of a 38-year-old woman with acute renal failure in which bilateral hydronephrosis due to staged ureteral stenosis was the second manifestation of the disease after necrotico-inflammatory skin lesions.

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Liver dysfunction in norovirus gastroenteritis in a child with cerebral palsy: A case report

Norovirus is the common cause of gastroenteritis in humans. There is no report of liver dysfunction in children caused by norovirus infection. Baclofen has been used mainly to treat spasticity in children with cerebral palsy. Hepatotoxicity of baclofen has not been previously described in children. This report describes the case of acute liver dysfunction in the course of norovirus gastroenteritis in a child with cerebral palsy (CP) on baclofen.

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Association between REM sleep and strengthening memory: A mini review

Getting a sufficient quantity of sleep is an important aspect of maintaining a healthy sleep pattern. A good night-sleep is the natural cure for all health problems. Sleeping disorders affect people of all ages, although adults (18-60) are the most common sufferers these days. If a person does not get enough sleep during the day, he or she may develop major health problems such as high blood pressure, high sugar, and drowsiness most of time.

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Anesthesia management in a Down syndrome patient with difficult intubation: Case report

Down syndrome is the common chromosomal abnormality and involves multiple organs. So cardiac and respiratory examinations and management of anesthesia in the patients with this syndrome are essential. Also cardiac and respiratory complications intraoperatively are common. Our case is a 11-year-old patient with Down syndrome who underwent atlas and axis cervical subluxation surgery (C1-C2).

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Antenatal care service utilization among women of recent delivery: Analysis of the determinants of quality of care in selected health facilities in Burayu Town, Oromia

In Ethiopia, although the use of maternal health services, including antenatal care has improved, most of the mothers do not attend and use a minimum number of four visits and the six-core set of items of ANC services respectively recommended by the World Health Organization (WHO). Therefore, the objective of the study was to investigate determinants and quality of ANC in the Burayu Healthcare center, Ethiopia.

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Haemosuccus pancreatitis: A rare cause of GI bleed, diagnosis on CT Angiography Case series & review of literature

Haemosuccus pancreatitis also known as Pseudohaemobilia or haemoductal pancreatitis, is defined as upper gastrointestinal hemorrhage originating from the pancreatic duct into the duodenum via the Ampulla of Vater, or major pancreatic papilla. A triad of epigastric pain, intermittent gastro intestinal bleeding and hyperamylasemia.

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piRNAs and PIWI proteins as potential biomarkers in colorectal cancer

PIWI-interacting RNAs (piRNAs) are another subgroup of small non-coding RNAs emerging as key players in different biological activities, including regulating gene and protein expression, epigenetic silencing of transposable elements, and controlling the spermatogenesis by interacting with PIWI proteins.

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Retroperitoneal bronchogenic cyst treated by open surgery: A rare case report

Bronchogenic cyst is considered to be a benign morphological abnormality in the development of the primitive foregut, which usually occurs in the thorax, particularly in the mediastinum. Subdiaphragmatic and retroperitoneal locations in particular are unusual. It is usually asymptomatic.

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Radiologic diagnosis of an atypical multilocular Stafne bone lesion

The typical patient diagnosed with a Stafne cyst is male and 40 to 60 years old. The ovoid cavities are usually located lingual in the molar region of the lower jaw underneath the inferior alveolar nerve and appear unilateral. The bone lesion is most probably caused by the pressure of the submandibular gland against the lower jaw bone.

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Two case series of Chiladiti syndrome and a review of literature

Chilaiditis syndrome was repeatedly an unforgettable case in Emergency Department due to its various symptoms. This case report consisted two reported cases of Chilaiditi syndrome. Then, we followed the methods of PRISMA for systematic review.

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Adverse local tissue reaction after ceramic-on-ceramic total hip arthroplasty

Outside of cobalt-chromium alloy articulations, the development of adverse local tissue reaction (ALTR) after total hip arthroplasty (THA) is uncommon but remains a significant complication [1]. ALTR is used to describe a granulomatous or destructive cystic lesion that develops around a THA.

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Geographic variation of antibiotic resistance in E. coli isolated from drinking water and foodstuffs in Sylhet division of Bangladesh

Geographical variation of antibiotic resistance (ABR) is a great difficulty for the empirical antibiotics prescription for infectious diseases. The development of ABR in bacteria is believed in associated with some risk factors. In addition, ABR against antibiotic drugs due to its associated risk factors has been linked with various negative health outcomes.

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Revealing innumerable occult lesions with T1-weighted 3D-black-blood-imaging in the detection of intracranial metastatic melanoma under BRAF therapy

In the setting of melanoma, brain metastases are very common and contribute to a large number of different neurological deficits as well as death. In recent years, the general prognosis for patients with intracranial metastatic melanoma has improved due to progress in imaging and therapeutic management. The addition of a contrast-enhanced T1-weighted MSDE sequence.

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COVID-19 pregnant woman with widespread neurofibromatosis and suprasellar craniopharyngioma presenting for in labour: A challenging scenario

A 29 year old G3P2L2 presented at term in active labour and was tested to be COVID-19 positive. On examination she had multiple papules all over the limbs /abdomen; groin freckles and caf au lait spots on the abdomen/lower limbs. She was evaluated for these lesions for the first time in this pregnancy.

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Incidental finding of situs inversus totalis in a patient of carcinoma ovary

Situs inversus totalis is a very rare congenital defect with incidence rate of about 1:10,000 live births. It is characterised by transposition of abdominal and thoracic organs, viscera and vasculature. It results from rotation inopposite direction of viscera and organs during organogenesis.

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Can SARS-CoV-2 infection trigger Parkinson Disease? A case report

SARS-CoV-2 infection typically produces respiratory manifestations, although multiple neurological manifestations (seizures, stroke, etc.) have also been reported, it is postulated that SARS-CoV-2 (like most ?-coronaviruses), has neurotropic potential. We present a case of Probable Parkinsons Disease (PD) after SARS-CoV-2 infection.

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Desmoplastic fibroma of bone: Amorphological and immunehistochemical characterization

Desmoplastic Fibroma (DF) of bone is a locally aggressive and infrequent benign neoplasm. Recently was described a role of vascular endothelial growth factor in the interstitial fibrotic processes. A 13-year-old female presented with pain, swelling and limitation of movements in right forearm. An osteolytic lesion at the distal end of the right radius was shown.

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Atypical cellular blue nevus: A case report and review of literature

Blue nevi are benign neoplasms of many variants which have several similar histological, clinical and immunochemical features. The two most frequent types are dendritic/common blue nevus and cellular blue nevus. Atypical blue nevus is a rare variant of cellular blue nevus whose characteristics are usually confused with malignant blue nevus.

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A look into Outlining the challenges of Covid-19 health crises in Africas maritime industry: The case of maritime operations in marine warranty surveying practice: Discussing three pillar challenge

While the relevance of carrying out Marine Warranty Surveys (MWS) as a mandatory insurable practice towards mitigating associated operational risks within the offshore oil and gas industry in Africa through the 2020 Covid-19 crises, examined against the potential health risk and risks associated with various Covid-19 restrictions.

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Pulmonary mucormycosis: A rare entity. Cases with bronchial necrosis and bronchomediastinal fistula

Mucormycosis is a rare fulminant fungal infection associated with high morbidity and mortality rates. It is usually associated with diabetes mellitus, hematologic malignancy, renal failure, or immunosuppression. Of the various clinical manifestations pulmonary involvement is the second most common presentation after rhino orbital cerebral disease.

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Bone metastases from renal cell carcinoma: A case report and literature review

Management of bone metastases from Renal Cell Carcinoma (RCC) has significantly changed after the era of targeted therapy that improved the overall survival. This has sucked the different interveners in their management to push the surgical indications in order to improve outcome and quality of life for these patients.

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Acute pulmonary embolism: Tell tale signs

Acute Pulmonary embolism is one of the major preventable causes of in hospital mortality. It is commonly seen in ICU setting in chronic bed ridden patients. It has wide spectrum of clinical presentation ranging from asymptomatic stage to severe hemodynamic decompensation so diagnosis requires high degree of suspicion.

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Loratadine syrup is successfully used to fix Covid-19 induced respiratory distress and chest pain

COVID-19 disease is a highly transmissible viral infection caused by the SARS-CoV-2 coronavirus. This virus can cause lung damage, acute respiratory distress syndrome and death. In this case, How Covid-19 in a pregnant patient which didnt respond well to Vancomyci + Caftazidime + Dexamethasone + Heparin for 7 days was finally responded to Loratadine syrup, and the patient was cured is going to be presented.

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A rare entity of malignant insulinoma diagnosed after 30 years of clinical manifestation of hypoglycemia: A case report and literature review

Malignant insulinomas, a rare life threatening pathology, exists in literature as an entity that constitutes 10% of all insulinomas and often present as multi-centric macro nodules with multiple lymph nodes or liver metastases before diagnosis. We report a rather rare case of a 68 year old male with a 30 years history of uninvestigated severe hypoglycemic attacks that improved on glucose intake.

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Saber sheath trachea: A radiological sign of severe airway obstruction

A middle-aged man, chronic smoker, presented with complaints of productive cough & exertional breathlessness (mMRC grade III) for 3 years with frequent episodes of exacerbation in the past. There was no other comorbidity or significant past history. His chest radiograph showed narrowing of trachea.

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Unilateral colonization of fungal infection presenting as renal mass in young patient: A case report

Fungal ball or fungal bezoar is the saprophytic colonization of a pre-formed cavity by a conglomerate of fungal mycelia without invasion of the adjacent tissue. Fungal bezoar is seen commonly in immunocompromised individuals. We present a case of urinary tract infection, complicated by unliateral fungus balls in a 25-year old female whose imaging findings (USG and CT scan).

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Endocarditis following an unsuccessful attempt to remove a gastric GI stromal tumor by laparoscopic endoscopic cooperative surgery

Gastrointestinal Stromal Tumors (GIST) are the most common subepithelial lesions of the gastrointestinal tract. Treatment of lesions greater than 2 cm in diameter is by laparoscopic wedge resection. We report a 77-year-old man who was diagnosed with a 2.3 cm diameter gastric GIST. He had a thickened mitral valve, severe mitral annular calcification, mild mitral regurgitation and moderate aortic stenosis.

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Vanishing hyperintensity in MRI: Vascular or epileptic origin?

Status Epilepticus and epilepsy-related MRI vanishing changes have been reported in the literature since the 1980s; hypoxia and hypoperfusion have been related to these image modifications. These alterations and their disappearing characteristics can cause trouble among work up and their diagnosis, especially if there is no exact etiology of what is causing seizures.

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Intracavernosal ephedrine for management of intraoperative penile erection during urological procedure under general anesthesia

Intraoperative penile tumescence during urological procedure can occur after regional or general anesthesia. It is a rare event but can cause delay or defer of the surgery. Pathophysiology of intraoperative erection is mainly due to autonomic imbalance during anesthesia. Various physical and pharmacological management of tumescence have been tried with variable success and complication.

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Variations in treatment of an anastomotic leakage after Ivor Lewis Esophagectomy

Anastomotic Leakage (AL) after Ivor Lewis Esophagectomy (ILE) is a severe complication that often needs immediate treatment. However, there is no consensus on the optimal treatment. The aim of this study was to describe the outcomes of the different treatment options in patients with either contained or uncontained AL after ILE.

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The role of beta-agonist therapy for chronic obstructive airway disease in patients with coexistent atrial fibrillation: Literature review

New advances have been made in medicine, but the incidence and prevalence of Chronic Obstructive Pulmonary Disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature.

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Dead man sign of ECG: An unique predicting sign of acute coronary syndrome

Coronary artery disease is the most common cause of morbidity and mortality worldwide. Acute coronary syndrome which includes STEMI, NSTEMI and unstable angina commonly diagnosed with the help of 12 lead in ECG in ER with or without elevated biomarkers. Inferior wall myocardial infarction is common cause of ST elevation myocardial infarction with low mortality rate.

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Severe obesity in a patient on long-term treatment of chronic myeloid leukemia with imatinib: Body composition, associated disorders and outcome

Chronic Myeloid Leukemia (CML) is a highly curable malignancy with tyrosine kinase inhibitors (TKI) as target therapy. As treatment is usually prolonged, there is a need to improve our knowledge about the impact of comorbidities in this context. Severe obesity is among the common comorbidities in these patients.

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A pneumatocele observed in the thoracic cavity after bronchoalveolar lavage

A 76-year-old man was admitted to the respiratory medicine department with 5 days of a non-productive cough and exertional dyspnea. A computed tomography revealed multiple mild patchy consolidations in both lungs (Figure 1). Despite antibiotic therapy, there was poor improvement in laboratory and radiological parameters.

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Presumed topography of basal ganglion: Derived from TRODAT images in a case of hemorrhagic stroke complicated with asymmetrical cogwheel rigidity

Systemic maps of basal ganglion lesion corresponding to clinical symptoms are lacking at present. Only the framework of functional domains in striatum was presumed. We present a case with asymmetrical cogwheel rigidity which is related to the lesion site of the basal ganglion in his functional brain image.

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Intrabiliary papillary myxoma: A case report

In 2010, the World Health Organization (WHO) classified intraductal papillary mucinous tumor (ipmn-b) as a solid tumor of the liver producing mucinous bile, which is rare and difficult to diagnose. We reported a 71 year old female patient with ipmn-b due to abdominal pain. Through the description of the causes, diagnosis, treatment and prognosis, we can get a better understanding of the disease.

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Extramedullary plasmacytoma of the tongue: A case report

Tongue extramedullary plasmacytoma is a very rare pathology. Despite rare cases, extramedullary plasmacytoma should be considered as a differential diagnosis in case of a mass in the tongue. A total of 19 cases were reported with EMP in English literature along with the case we will address.

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Implant mobility: Revisited

The success lies in achieving and maintaining the stability of a dental implant. However, implant failures are common and among them the most serious issue is the implant mobility. This paper reviews on the implant mobility, its causes, methods to detect mobility and also possible treatment approaches.

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Tineariasis (or plaque-psoriasis induced by Terbinafine)

Terbinafine is an anti fungal drug used worldwide to treat dermatophytosis. Although generally is well tolerated, several cutaneous side effects have been described. One of them is the induction or exacerbation of psoriasis, especially the pustular type. We describe a case of plaque-psoriasis induced by terbinafine in a young patient.

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MIS-A associated myocardial injury: The art of diagnosis and follow-up

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe condition in adults with a clinical course similar to that described in children (MIS-C) following infection with the SARS-CoV-2 virus. Here we describe a case of a 21-year-old, otherwise healthy female who presented with chest pain and signs of sepsis six weeks after recovering from coronavirus disease 2019 (COVID-19).

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Anal canal epithelioid sarcoma: Case report and literature review

Soft tissue tumors account for less than 0.1% of colon and rectum malignant neoplasms. Epithelioid sarcoma is a subtype of undifferentiated soft tissue neoplasia that makes up 1% of this category; it is characterized by a slow progression, commonly affecting young male adults, with little or no response to chemotherapy and radiotherapy, leaving surgical resection their main therapeutic option to reduce recurrence.

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Repeat percutaneous tracheostomy in a COVID-19 patient

A 73-year-old man with history of hypertension and chronic obstructive pulmonary disease was admitted to the emergency department with acute respiratory failure from COVID-19. After 10 days of mechanical ventilation (MV) the patient underwent a successful trial of extubation. However, 3 days later his neurological status deteriorated and required re-intubation.

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Endotracheal tube mal-insertion via Zenkers diverticulum to trachea

An 86-year-old woman with chronic respiratory failure was under endotracheal tube insertion and mechanical ventilator support for 2 months due to previous intra-cranial hemorrhage. She presented with difficult nasogastric (NG) tube insertion after changing endotracheal tube and was transferred to our emergency room.

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Diplopia and skin rash in a patient treated with immunotherapy nivolumab regimen

This is a case report of an 80-year-old caucasian male patient with metastatic urothelial bladder carcinoma and bone/liver metastases, who was being presented with diplopia, raynauds syndrome and skin rash on both legs, in response to immunotherapy with anti-PDL-1 Nivolumab regimen. An 80-years old patient is being diagnosed with metastatic urothelial bladder carcinoma with liver, bone metastases and para-aortic lymph nodes.

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Cesarean scar pregnancy (CSP) successfully treated with dilatation and curettage after failed local methotrexate treatment: A case report and updated mini-review

Caesarean Scar Pregnancy (CSP) is a very rare form of an abnormal pregnancy that implants in a Cesarean section scar. The incidence is mainly increasing due to increasing number of Cesarean sections. This condition is associated with substantial morbidity and even mortality. Because of its rarity, currently, there is no consensus on the preferred mode of treatment or follow up of CSP.

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A systematic review of the neglect of non-COVID patients amidst COVID pandemic

The rapidly evolving health concern for COVID-19 has considerably overshadowed the non-COVID ailments. Ranging from delays in diagnosis and treatment, neglect of mild-moderate diseases resulting into their progression, adverse pregnancy outcomes and many others, an array of the collateral damage of this pandemic is still evolving.

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Mental retardation and oral health: An insight

Mental Retardation (MR) is a genetic disorder mainfested in significantly below average overall intellectual functioning and deficits in adaptive behaviour. It is a particular state of functioning that begins in childhood and is characterized by decreased intelligence and adaptive skills and also is the most common developmental disorder, often missed by clinicians.

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Löfgren’s syndrome - An uncommon presentation of a common disease

Löfgren’s syndrome is a variant of acute-onset sarcoidosis, characterized as Hilar Lymphadenopathy (HL), Erythema Nodosum (EN) and bilateral arthritis or arthralgia, with elevated serum Angiotensin Converting Enzyme (ACE) and calcium level. It is relatively common in Caucasians, but rarely reported in Asian countries.

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Catheter knotting in a neonate

A 36-week preterm neonate with anal atresia and recto-perineal fistula was catheterized with a size 6F Foleys catheter when she underwent anoplasty on the second day after birth. When the patient recovered from anesthesia, it was decided to remove the catheter. While the catheter was being removed, resistance was felt halfway through the procedure.

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