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Wei Peng, Yin Zhuang, Wei Cui, Wenjin Chen, Rupeng Chu, Zhenzhong Sun, Shujun Zhang Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of ChinaCorrespondence: Shujun Zhang, Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, No. 999 Liangqing Road, Binhu District, Wuxi, Jiangsu, People’s Republic of China, Tel +86-13861741839, Email spine_zhang@vip.163.comAbstract: This study describes a patient with an intradural extramedullary (IDEM) tumor removed entirely using the unilateral biportal endoscopic technique (UBE), achieving satisfactory clinical outcomes. A 60-year-old woman had a diagnosis of meningioma with sensations and motor dysfunction in the lower extremities and perineum and gait disturbances for three years, which has worsened over the last month. Preoperative imaging data showed a sizeable IDEM tumor at the T10 level, significantly compressing the thoracic spinal cord to the right side, with 80% intraspinal encroachment. The IDEM tumor was removed entirely by UBE surgery. To the best of our knowledge, this study may be the first to report the application of UBE techniques for IDEM tumor treatment. In this case, UBE provides a magnified and clear surgical field, greater maneuverability, and a less invasive surgical procedure. The procedure objectives were pathological confirmation, spinal cord decompression, and complete tumor removal; all were met. The patient was satisfied with her dramatically improved clinical symptoms. UBE may be an alternative surgical treatment option for benign IDEM tumors presenting with symptomatic, especially the non-giant lateral and posterior tumors.Keywords: unilateral biportal endoscopy, endoscopic spine surgery, intradural extramedullary, tumor, meningioma

Lanlang Zhang,1 Lixia Huang,2 Shanshan Liu,3 Xiaofeng Sun4 1Department of Haemodialysis, Fuyong People’s Hospital of Baoan District, Shenzhen, Guangdong Province, 518103, People’s Republic of China; 2Department of Gastrology, Fuyong People’s Hospital of Baoan District, Shenzhen, Guangdong Province, 518103, People’s Republic of China; 3Nursing Department, Fuyong People’s Hospital of Baoan District, Shenzhen, Guangdong Province, 518103, People’s Republic of China; 4Department of Ultrasound, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of ChinaCorrespondence: Xiaofeng Sun, Department of Ultrasound, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China, Tel +86-13723457417, Email 350787457@qq.comAbstract: This study aimed to optimize bowel preparation efficacy for colonoscopy in elderly constipation patients. A 71-year-old patient with chronic constipation and a history of poor bowel preparation. To address these challenges, we implemented a personalized strategy combining of PEG administration and walking exercise. The PEG was administered according to a protocol, with intermittent exercise breaks of 10 minute. Bowel cleanliness was assessed using the Boston Bowel Preparation Scale (BBPS). Adverse reactions and tolerance were closely monitored throughout the intervention. The patient’s BBPS score improved from 3 to 8 post-intervention. The exercise intervention was well-tolerated (rating I), and mild nausea was observed only after the first PEG dose. No severe adverse reactions occurred. Subsequent Follow-up revealed symptom relief. The personalized approach combining (PEG and exercise intervention) successfully improved bowel preparation quality in the elderly constipation patient undergoing colonoscopy. This approach considers age-related changes in gastrointestinal function and activity level, offering an effective strategy

Amr Youssef Arkoubi Department of Anesthesia and Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi ArabiaCorrespondence: Amr Youssef Arkoubi, Department of Anesthesia and Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia, Email ayarkoubi@imamu.edu.saAbstract: A glomus tumor (GT) is a rare and usually benign tumor that originates from the glomus body, which is involved in thermoregulation in the skin. Solitary or multiple, digital or extra-digital, these cutaneous tumors can be benign or malignant. This report describes the diagnosis and surgical management of a solitary glomus tumor at the base of the right thumb in a young Sudanese woman. The diagnosis of glomus tumor was confirmed by medical history, sonographic findings and histopathological report. The lesion was excised via direct complete excision under local anesthesia, resulting in a complete resolution of symptoms. Owing to its high sensitivity level, the use of ultrasound is appropriate to evaluate a lesion suspected to be a glomus tumor. A clinician needs to take into consideration the likelihood of glomus tumors when assessing a patient who has a skin lesion on fingers, toes, or extra-digital area, with pain triggered by temperature changes, pressure, or touch. Additionally, this report includes a review of recent globally reported cases of glomus tumor in the hand to highlight the distinctiveness of this report in context to its atypical location in the area of the thenar eminence and underscoring it as a unique report of its kind from Saudi Arabia.Keywords: glomus, digital, extra digital, hand, thumb, solitary, benign

Tuji Mohammed,1 Tesfaye Mulat Jimma,2 Tewodros Tilahun Zerfu,3 Mesfin Etsub Kassaahun3 1Department of Orthopaedic and Traumatology Surgery at St. Paul Millennium Medical College, AaBET Hospital, Addis Abeba, Ethiopia; 2Department of Plastic and Reconstructive Surgery, College of Surgeons of East Central and South Africa, Cure Hospital, Addis Abeba, Ethiopia; 3Department of Pediatric Orthopaedic Surgery, College of Surgeons of East Central and South Africa, Cure Hospital, Addis Abeba, EthiopiaCorrespondence: Tuji Mohammed, Orthopaedic and Traumatology Surgeon, Department of Orthopaedic and Traumatology Surgery at St. Paul Millennium Medical College, AaBET Hospital, Addis Abeba, Ethiopia, Tel +251937525119, Email Tujar5618@gmail.comIntroduction: Thumb hypoplasia is a congenital birth defect in which a child is born with an underdeveloped or missing thumb. It is a rare condition affecting approximately 1 in 100,000 live births and occurs equally in both males and females. Pollicization is a surgical procedure used to treat severe thumb hypoplasia by transferring another finger to the thumb position.Case Presentation: Twin girls aged two years and eight months, born to a 42-year-old para III mother, presented with bilateral thumb hypoplasia. There was no family history of similar complaints, and no consanguinity was identified between their parents. After excluding other associated anomalies, index finger pollicization was performed for all four hands of the children according to modified Buck-Gramcko techniques, with modifications from Ezaki et al.Conclusion: Generally, index pollicization executed with careful preoperative, intraoperative, and postoperative planning will lead to aesthetically and functionally attractive thumbs for children with congenitally severe hypoplasia or absent thumbs.Keywords: pollicization, thumb hypoplasia, congenital, twin baby

Ubah Mumin Ali Osman,1 Selim Turfan,1 Mohamed Farah Yusuf Mohamud1– 4 1Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia; 2Somalia Society for Emergency Medicine (SOSEM), Mogadishu, Somalia; 3Tayo Institute for Health, Research, and Development, Mogadishu, Somalia; 4Faculty of Medicine, Mogadishu University, Mogadishu, SomaliaCorrespondence: Mohamed Farah Yusuf Mohamud, Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Hawa-Abdi Street, Hodan District, Mogadishu, Somalia, Tel +252615591689, Email m.qadar59@gmail.comAbstract: Honeybee bites are a common public health hazard, the incidence of which is gradually increasing. A bee sting incident involving more than fifty stings is categorized as massive envenomation. The clinical manifestations of honey bee stings can range from localized symptoms to severe allergic and systemic reactions.This case study presents a 60-year-old male who experienced multi-organ failure following a severe bee sting incident. According to our research, this is the first documented instance in Somalia of multi-organ failure resulting from a sting by a giant honey bee. The case highlights the potential severity of bee stings, which, while often considered minor, can lead to serious medical complications. Interestingly, despite the patient suffering numerous stings and receiving a substantial amount of venom, an immediate anaphylactic reaction did not occur. Instead, a delayed severe response leading to multi-organ failure emerged within 48 hours of the incident.Keywwords: Honey bee, multi-organ failure, acute kidney injury, acute liver injury, pancreatitis, pulmonary odema

Sintayehu Mekonnen,1,2 Hawi Farris,3 Daniel Azmeraw1 1Department of Internal Medicine, All Africa Leprosy, Tuberculosis and Rehabilitation Training Center, Addis Ababa, Ethiopia; 2Department of Gastroenterology and Hepatology, Addis Ababa University College of Health Science, Addis Ababa, Ethiopia; 3Department of Radiology, Addis Ababa University College of Health Science, Addis Ababa, EthiopiaCorrespondence: Sintayehu Mekonnen, Email sintu04mekonnen@gmail.comAbstract: Congenital pericardial absence is an uncommon heart condition that is usually undiagnosed due to a lack of symptoms and awareness. In this case study, we present a 72-year-old patient who initially presented for medical evaluation due to unexplained weight loss, a displaced cardiac apex, and poor echocardiographic windows. An extracardiac tumor was suspected at first, but it was later determined that the patient had a congenital complete absence of the left pericardium. This case illustrates the possibility for benign pathology to present abnormally and details the clinical features, imaging findings, and management of congenital absence of the pericardium.Keywords: pericardium, congenital defect, echocardiography

Michael Okello,1,2 Sanjanaa Srikant,2 Dave Darshit,3 Ponsiano Ocama2 1Society of Uganda Gastrointestinal and Endoscopic Surgeons (SUGES), Kampala, Uganda; 2Makerere University College of Health Sciences, Kampala, Uganda; 3Department of Surgery, Lubaga Hospital, Kampala, UgandaCorrespondence: Michael Okello, President - Society of Uganda Gastrointestinal and Endoscopic Surgeons (SUGES), P.O Box 154020, Kampala, Uganda, Tel +256782654770, Email dr.okelloaleleu@gmail.comPurpose: Idiopathic portal hypertension (IPH) also known as non-cirrhotic portal hypertension is an entity of hepatic conditions including disorders of blood vessels that leads to portal hypertension (PHT). Current management of PHT includes medical or endoscopic therapy. A proximal spleno-renal shunt (PSRS) operation has been shown to improve the outcomes of patients with IPH with upper gastrointestinal bleeding refractory to medical and endoscopic therapy in high income countries but the same has not been well described in our resource limited setting.Patients and methods: This study consecutively included patients who were diagnosed with IPH on pre-operative imaging and underwent PSRS surgery. Data on four patients across the time period of 3 years was obtained with a male to female ratio of 1:1 and age range of 7 to 34 years.Results: All patients in this study had features of upper gastrointestinal bleeding and, after an endoscopy they were all diagnosed with grade IV esophageal varices. Symptom duration prior to admission varied between 3 months to 8 years. All these patients had multiple episodes of rebleeding varices with recurrent admissions and were managed conservatively by multiple blood transfusions and propranolol tablets, pre-operatively. Only one patient had previous variceal band ligation done though he developed rebleeding. All four patients underwent both PSRS surgery and splenectomy and were intra-operatively verified to have a normal smooth liver and thus IPH was the cause of the eso

Arief Cahyadi,1,2 Riyadh Firdaus,2 Hansen Angkasa2 1Department of Anestesiology, Univesitas Padjajaran, Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Anesthesiology and Intensive Care, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, IndonesiaCorrespondence: Arief Cahyadi, Hasan Sadikin General Hospital, Pasteur Road, No. 38, Bandung, West Java, 40161, Indonesia, Email ariefcahyadi@gmail.comAbstract: Arnold–Chiari malformation is a displacement of the brain into the spinal canal, often leading to hemodynamic distress. Arnold-Chiari malformation type III (CM III) is a rare and severe type that requires early detection to prevent complications. We aim to report this rare presentation of CM III. A 16-month-old girl with a massive tumor of the occiput suspected to be a meningoencephalocele with CM III was referred to the neurosurgery department. The patient was assessed with class 3 American Society of Anesthesiologist classification, posed challenges due to a difficult airway and the presence of a meningoencephalocele. The patient was scheduled for an elective surgery. Preoperative, the patient was lethargic with an abnormal heart rate and blood pressure. Induction was performed while preserving spontaneous ventilation, but was assisted by an oropharyngeal airway due to a short neck and obesity. The patient later developed laryngospasm thus, muscle relaxant and propofol were administered. A rescue laryngeal mask airway was inserted due to desaturation. Intubation was performed with video laryngoscope. When the surgeon opened the cele and removed the cerebrospinal fluid, the blood pressure began to decline. Resection of brain tissue caused the patient started to bleed, fluid and blood products were administered. At the end of surgery, the patient had stable hemodynamics and was transferred to the pediatric intensive care for monitoring. In patients with massive occipital meningoencephalocele and CM III, an

Yang Liu,1,2,* Hui Yang,1,2,* Xueshu Fu,1,2 Luting Zhong,1,2 Ping Xu,1,2 Fang Fang,1,2 Ying Liu,1,2 Qing Li,1,2 Ya’nan Yan,1,2 Shanchuang Wei,1,2 Junqing Wang,1,2 Chunhua Zhang1– 3 1Department of Gynaecology, Affiliated Hospital of YangZhou University Huai ‘an Maternal and Child Health Care Center, Huai’an, Jiangsu, People’s Republic of China; 2Department of Gynaecology, The Huai’an Maternity and Child Clinical College of Xuzhou Medical University, Huai’an, Jiangsu, People’s Republic of China; 3Department of Integrated Traditional Chinese & Western Clinical Medicine, Macau University of Science and Technology, Macau, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chunhua Zhang, Department of Gynaecology, The Huai’an Maternity and Child Clinical College of Xuzhou Medical University, Huai’an, Jiangsu, People’s Republic of China, Tel +86-13952326117, Email hafyzch@126.comBackground: Multiple primary cancer (MPC) refers to the presence of more than one cancer in an individual. Triple primary malignancies are uncommon.Case: We report the case of a 50-year-old postmenopausal woman in our gynecology department, diagnosed with endometrial cancer, ovarian cancer, and unilateral breast cancer. She carried germline mutations in BRCA2, PALB2, and RECQL4, along with a somatic pathogenic variant in TP53. Endometrial cancer patients harboring germline pathogenic variants in BRCA2 exhibit a heightened risk of ovarian and breast cancer. BRCA2 is known to play a role in the development of ovarian and breast cancer, while PALB2 is identified as a gene associated with breast cancer susceptibility. RECQL4 has been linked to breast cancer, cervical cancer, and other tumors.Conclusion: Genetic testing may be imperative for identifying MPC in endometrial cancer patients. For individuals with BRCA2 and other gene pathogenic variants, routine examination and monitoring of the endometrium, ovaries, b

Longyin Zhu,1,* Huhai Zhang,1,* Jia Fang,1 Shuang Xiao,2 Fu Xiong,3 Caixia Deng,3 Qin Yang,1 Chunxiao Fu,1 Qianguang Pan,1 Hongwen Zhao1 1Department of Nephrology, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China; 2Department of Infectious Disease, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hongwen Zhao; Qianguang Pan, Email zhaohw212@126.com; panqianguang@163.comIntroduction: We report a fatal case of massive airway bleeding caused by pulmonary strongyloidiasis in a patient with a transplanted kidney.Case Presentation: A 47-year-old male, regularly taking immunosuppressants post-kidney transplant, visited our hospital with symptoms of abdominal bloating, nausea, and emesis persisting for three days. After hospitalization, he developed a cough, hemoptysis, and respiratory failure. Sputum analysis confirmed an infestation with Strongyloides stercoralis. Despite receiving albendazole therapy and bronchoscopic management for bronchial hemorrhage, the patient ultimately died due to acute respiratory and circulatory collapse triggered by severe airway bleeding.Conclusion: Patients undergoing immunosuppressive therapy following kidney transplantation are at increased risk for disseminated strongyloidiasis. Consequently, infectious disease screening prior to transplantation, along with essential preventive pharmacotherapy, is of paramount importance.Keywords: strongyloides stercoralis, kidney transplantation, airway bleeding, disseminated infection

Tian Sun,1 Zhong Hao Hu,1 Jin Shi He,1 Yu Chi Chen,2 Yong Xiang Gao2 1Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 2Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People’s Republic of ChinaCorrespondence: Yu Chi Chen, Email 5301@cdutcm.edu.cn; Yong Xiang Gao, Email drgaoyx@cdutcm.edu.cnBackground: Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is clinically challenging to diagnose and has a poor prognosis. It is characterized by symmetric proximal muscle weakness, muscle tenderness, dysphagia, characteristic skin rash (heliotrope rash, Gottron’s sign), elevated muscle enzyme levels, abnormal electromyography, and muscle biopsy findings. DM with positive anti-MDA5 antibodies is mainly characterized by Gottron’s sign, skin ulcers, facial erythema, mechanic’s hands, and V-sign. In this case, the patient presented with the rare manifestation of severe necrotic skin ulcers in association with Gottron’s sign, prompting us to report this case.Case Presentation: A 45-year-old female was admitted to the hospital with systemic joint pain, fatigue, multiple ulcers, and purulent discharge on both hands. Her myositis-specific antibody profile revealed positive anti-MDA5 and anti-SSA/RO52 antibodies. Treatment included a combination of glucocorticoids, immunosuppressants, gastric and liver protection, infection control, and wound care. After two weeks of treatment, the patient showed improvement in symptoms. However, on the 24th day of hospitalization, the wound at the right elbow joint ruptured and became infected, requiring debridement and skin grafting in the appropriate department.Conclusion: There has been limited research and reported cases of dermatomyositis with coexistence of positive anti-MDA5 and anti-SSA/RO52 antibodies combined with severe skin ulcers. Therefore, we present this rare case and emphasize the need for close follow-up on pulmon

Shiro Ono, Kiyomi Yoshimoto, Masaki Matsubara, Nobushiro Nishimura, Hiromasa Kawashima, Ryo Yoneima, Noritaka Yada, Kenji Nishio Department of General Medicine, Nara Medical University, Kashihara, Nara, JapanCorrespondence: Shiro Ono, Department of General Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan, Tel +81-744-29-8905, Fax +81-744-24-5739, Email shiroono0207@naramed-u.ac.jpPurpose: This study aims to investigate the characteristics of Epstein–Barr virus associated-hemophagocytic lymphohistiocytosis (EBV-HLH) and HLH caused by a severe form of infectious mononucleosis (IM-HLH) compared to IM by EBV, and thus also to assist in early diagnosis and providing appropriate treatment.Methods: Data for this analysis were collected from patients at the Department of General Medicine, Nara Medical University, between April 1, 2012, and August 1, 2020. EBV infection was diagnosed using clinical presentation and laboratory tests. HLH diagnosis followed the HLH-2004 protocol, supplemented by plasma EBV DNA detection. A range of clinical and laboratory parameters were collected, including age, sex, clinical outcomes, blood cell counts, hemoglobin, platelets, and various serum values. Plasma EBV DNA levels and flow cytometric analysis (FCM) of bone marrow were performed for HLH cases.Results: Among 1850 hospitalized patients, 14 cases were identified, including 2 HLH cases and 12 IM cases. Comparative analysis revealed distinctive features of HLH, including lower lymphocyte and platelet counts and higher levels of ferritin, soluble interleukin 2 receptor (sIL-2R), and D dimer compared to IM. Notably, one HLH case responded well to corticosteroid monotherapy, while the other case did not, resulting in a fatal outcome. Detection of a cluster of CD5-CD7 lymphocytes in bone marrow is a hallmark of EBV-HLH and useful to distinguish from IM-HLH.Conclusion: This study underscores the importance of early differentiation among EBV-HLH, IM-HLH, and

Cailiang Gao,1 Hu Wang,2 Huiting Liu1 1Department of Nuclear Medicine, Three Gorges Hospital, Chongqing University, Chongqing, People’s Republic of China; 2Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USACorrespondence: Huiting Liu, Department of Nuclear Medicine, Three Gorges Hospital, Chongqing University, No. 165, Xincheng Road, Wanzhou, Chongqing, 404000, People’s Republic of China, Email flyover1818@163.com Hu Wang, Department of neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA, Email biomed_wang@yahoo.comIntroduction: Intramuscular hemangioma (IMH) is a rare type of benign tumor that represents less than 1% of all hemangiomas. Chronic pain and a palpable mass are the most common symptoms. Due to the atypical clinical characteristics of the disease, accurate diagnosis is difficult. Misdiagnosis of IMH as malignancy can occur due to similarities in imaging features between IMH and malignancy. To diagnose IMH accurately, multiple imaging modalities, including X-ray, MRI, CT, and 18F-FDG PET/CT, can be used. However, the final diagnosis of IMH is confirmed through histopathological examination.Case: This case reports a 16-year-old girl diagnosed with IMH in the triceps brachii muscle. Seek medical attention due to pain and discomfort in the left shoulder. Initial imaging with contrast-enhanced MRI and CT suggested synovial sarcomata. The moderate uptake of FDG on positron emission tomography/computed tomography (PET/CT) also raised suspicions of malignancy. The pathological findings revealed an intramuscular hemangioma with thrombosis and thrombus organization.Conclusion: The accurate diagnosis of IMH can be challenging due to the absence of distinct clinical symptoms and imaging findings. When evaluating periarticular intramuscular lesions, IMH should be considered if the MRI shows mixed signals with heterogeneous enhancement. Despite the moderate uptake of FDG seen in some IMH cases, it should

Abdullah Alshammari,1 Basmah Ahmed Qasem,1 Nouf Ahmed Almatrafi,1 Lujain Mofareh Alharbi,1 Abeer Abdulhadi Alhuthali,2 Attiah Abdulrahman Khobrani,2 Mohammed Alnuhait1 1Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 2Clinical Pharmacy Department, King Abdullah Medical City, Makkah, Saudi ArabiaCorrespondence: Mohammed Alnuhait, Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia, Email manuhait@uqu.edu.saBackground: Chemotherapy-induced cardiotoxicity is a significant problem, ranking as the second most frequent cause of mortality in cancer patients. This adverse outcome encompasses many cardiovascular problems, such as heart failure. Sacubitril/valsartan has shown potential in the management of heart failure, however, its effectiveness in treating chemotherapy-induced heart failure has not been extensively explored. We performed a case series to investigate the safety and effectiveness of sacubitril/valsartan in treating chemotherapy-induced cardiomyopathy in Saudi Arabia.Methods: The case series was conducted at a single medical center in Makkah, Saudi Arabia. The data gathered included patient demographics, clinical features, laboratory results, echocardiographic findings, and medication information. The data underwent analysis using descriptive statistics.Results: Out of the total of eight patients who were part of the investigation, a notable majority of six individuals exhibited substantial enhancements in their ejection fraction (EF) after receiving sacubitril/valsartan medication.Conclusion: Our case series provides significant insights by revealing improvements in ejection fraction (EF) in six out of eight patients who had chemotherapy-induced cardiomyopathy after receiving sacubitril/valsartan treatment.Keywords: oncology, sacubitril/valsartan, cardiotoxicity, chemotherapy, Saudi Arabia

Mohammad Mohsin Arshad, Muhammad Mohsin Khan, Ghanem Al Sulaiti, Ghaya Al Rumaihi Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, QatarCorrespondence: Mohammad Mohsin Arshad, Hamad Medical Corporation, PO Box 3050, Doha, Qatar, Tel +974 33159377, Fax +974 44398190, Email marshad3@hamad.qaIntroduction: Upper thoracic spine fractures are rare as compared to other spine segments due to anatomical landmarks. If they occur, they are usually associated with paraplegia or any other neurological dysfunction. We report upper thoracic fracture without neurological dysfunction which is a rare entity along with its radiological imaging, and management plan.Case Description: Forty-years old male presented after RTA. CT spine showed T2 vertebral body fracture with dislocation/locking of the right T2-T3 facet joint. The patient underwent surgical fixation and was neurologically intact.Conclusion: Upper thoracic spine fracture is a rare entity due to its anatomical location. And sometimes it is missed as well. Proper imaging should be considered if there is high suspicion and early surgery is warranted to prevent permanent damage.Keywords: unilateral locked facet, upper thoracic spine, spinal trauma, thoracic dislocation, fracture, spine

Maria Boudina,1 Eleana Zisimopoulou,1 Pantelitsa Rakitzi,1 Sotirios Barbanis,2 Eleni Syndouka,3 Chrysanthi Zouli,1 Aimilia Fotiadou,1 Mariana Stamati Stamati,1 Chrysanthi Balodimou,1 George Christantoniou,1 Alexandra Chrisoulidou1 1Department of Endocrinology, Theagenio Cancer Hospital, Thessaloniki, Greece; 2Department of Pathology, Theagenio Cancer Hospital, Thessaloniki, Greece; 3Department of Radiology, Theagenio Cancer Hospital, Thessaloniki, GreeceCorrespondence: Maria Boudina, Department of Endocrinology, Theagenio Cancer Hospital, Thessaloniki, Greece, Email mariaboudina@gmail.comPurpose: Brown tumors, also known as cystic fibrosa, are rare, benign, osteolytic, fibrotic lesions of the bones that occur secondary to hyperparathyroidism. They are caused by increased osteoclastic activity leading to an abnormal bone metabolism.Case Description: Here, we present the case of a 58-year-old male, who presented with painful bony lesions, initially attributed to metastatic disease. After biochemical workout, imaging and biopsy, the nature of the lesions was revealed. We discuss the differential diagnosis and clinical management of the disease.Conclusion: Patients with brown tumors should be assessed in the differential diagnosis of bony lesions and should always be tested for hyperparathyroidism. An early diagnosis is crucial for the successful treatment of such patients.Keywords: brown tumor, hyperparathyroidism, chronic kidney disease, case report

Jun Cheng,* Jinjin Pan,* Dongmei Zhao, Xuejiao Ma, Qiulin Sun, Jiabin Li Department of Infectious Disease, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiabin Li, Tel/Fax +86-551-62922281, Email lijiabin@163.comAbstract: The global prevalence of hepatitis C virus (HCV) infection is approximately 3%, with a post-infection chronicity rate of up to 50%– 85%. HCV reactivation can occur when anti-HCV positive individuals receive antineoplastic therapy. In this study, we report a case of an anti-HCV positive patient with negative HCV RNA after 12 weeks of direct antiviral therapy. Two months later, sorafenib was used to treat hepatocellular carcinoma, and HCV reactivation occurred after 8 months of the treatment. HCV RNA was negative after 12 weeks of antiviral treatment with Sofosbuvir-velpatasvir. We also discussed the mechanism of HCV reactivation caused by sorafenib and the antiviral treatment regimen after HCV reactivation with the relevant literature.Keywords: hepatocellular carcinoma, sorafenib, HCV-RNA, anti-HCV therapy, reactivation

Hao Wu,1– 6 Xing-Hua Zhang,1,3– 6 Li-Ping Wang,7,8 Hong-Da Tian,1,3– 6 Gui-Rong Liu,1,3– 6 Dong-Hui Yang,9 Shu-Lin Liu1,3– 8,10 1Genomics Research Center (State-Province Key Laboratory of Biomedicine-Pharmaceutics of China), College of Pharmacy, Harbin Medical University, Harbin, People’s Republic of China; 2Key Laboratory of Tumor Biotherapy of Heilongjiang Province, Harbin Medical University Cancer Hospital, Harbin, People’s Republic of China; 3Key Laboratory of Gut Microbiota and Pharmacogenomics of Heilongjiang Province, Harbin Medical University, Harbin, People’s Republic of China; 4National Key Laboratory of Frigid Zone Cardiovascular Diseases, Harbin, People’s Republic of China; 5Heilongjiang Academy of Medical Sciences, Harbin Medical University, Harbin, People’s Republic of China; 6Translational Medicine Research and Cooperation Center of Northern China, Harbin Medical University, Harbin, People’s Republic of China; 7KangYuan Hospital, Harbin, People’s Republic of China; 8Xun-Qi Medicine Clinic, Harbin, People’s Republic of China; 9State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China; 10Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, CanadaCorrespondence: Shu-Lin Liu, Genomics Research Center, College of Pharmacy, Harbin Medical University, Harbin, 150081, People’s Republic of China, Email slliu@hrbmu.edu.cn Dong-Hui Yang, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, People’s Republic of China, Email ydhui@bjmu.edu.cnIntroduction: Pancreatic cancer (PC) is among the deadliest malignancies. Kidney cancer (KC) is a common malignancy globally. Chemo- or radio-therapies are not very effective to control PC or KC, and overdoses often cause severe site reactions to the patients. As a result, novel treatment strategie

Sura Markos,1 Surafel Nadew Firdawoke,2 Eshetu Dabaro Gagamo,2 Mintesnot Zemedkun Workeneh2 1Department of Internal Medicine, Division of Cardiology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Department of Internal Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, EthiopiaCorrespondence: Sura Markos, Tel +251-910878529, Email surmark430@gmail.comAbstract: Rarely observed during pregnancy and the postpartum period, right side infective endocarditis (IE) is particularly uncommon among non-drug-addicted individuals. Nonetheless, if it does occur, it poses significant health risks for both the mother and the fetus, even in the absence of pre-existing heart diseases. This case report describes a rare presentation of right-sided IE (IE) in a 40-year-old woman from rural Ethiopia with postpartum endometritis. The patient presented with atypical symptoms, making it challenging to identify the underlying cause. Through careful diagnostic evaluation and a multidisciplinary approach, the team successfully diagnosed and treated the patient, highlighting the importance of swift and accurate diagnosis for managing uncommon right-sided IE cases.Keywords: postpartum, right-side endocarditis, postpartum endometritis

Alexander J Sweidan, Haron Y Anaim, Niral M Patel, Javier A Longoria Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, University of California, Irvine, CA, USACorrespondence: Alexander J Sweidan, Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, University of California, 101 The City Dr S, Orange, CA, 92868, USA, Tel +1 714-456-5413, Email asweidan@hs.uci.eduAbstract: SARS-CoV-2 virus has led to an unprecedented amount of tracheal stenosis. Rigid bronchoscopy can serve as a curative measure or bridge therapy to tracheal resection. We also briefly discuss the pathophysiology of tracheal stenosis from prolonged intubation and SARS-CoV-2 virus. This should be differentiated from other forms of airway obstruction such as tracheobronchomalacia which would be considered a pseudo-tracheal stenotic disease. The aim of this study is to evaluate stenosis that is unable to be improved with positive airway pressure or “PAP” therapies and required stenting and/or subsequent tracheal resection. By performing Rigid Bronchoscopy and subsequent stenting of airways, we demonstrated outcomes for long term airway patency regarding patients who were intubated secondary to the SARS-CoV-2 virus. We demonstrate superb outcomes in a consecutive case series of 6 patients managed with rigid bronchoscopy, airway stent and tracheal resection. The patients were all managed from a pulmonary perspective by the physicians mentioned in this study.Keywords: tracheal stenosis, COVID-19 intubation, rigid bronchoscopy

Dagmawi Anteneh Teferi,1 Ayto Addisu Negash,2 Daniel Aman,2 Sisay Hailu,2 Taye Nigatu Tola,1 Yared G/Michael Tarekegn,3 Wubhareg Anteneh Teferi4 1Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 4School of Medicine and Health Science, Wolkite University, Wolkite, EthiopiaCorrespondence: Dagmawi Anteneh Teferi, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Po.Box: 1271, Addis Ababa, Ethiopia, Email dagmawianteneh16@gmail.comBackground: Thyroid gland abscess is a rare pathology with life-threatening complications when there is a delay in diagnosis. However, physicians should be aware of and consider this differential in patients with anterior neck swelling having acute onset compressive symptoms to ensure early diagnosis and management.Case Presentation: A 62-year-old female patient presenting with worsening of painful anterior neck swelling with associated fever, shortness of breath, and difficulty swallowing. The patient was found to have a thyroid abscess causing upper airway obstruction, against a background of follicular nodular disease found on clinical examination, cytology and fluid analysis from aspirate, biopsy, ultrasonography, and computed tomography. The patient was managed with endotracheal intubation and was subsequently discharged after recovery with antibiotic therapy, incision and drainage, and thyroid lobectomy.Conclusion: Thyroid abscess is an uncommon, critical clinical condition with high morbidity and mortality. Thyroid gland abscess should be considered while evaluating patients presenting with acute onset anterior neck swelling. Satisfactory clinical outcomes could be achieved with early diagnosis and proper management.Keywords: thyroid absce

Merga Daba Mulisa,1 Shalom Kassahun Bekele,1 Sebhatleab Teju Mulate,1 Zerubabel Getahun Kiflu,1 Yared Getachew Tadesse,1 Walelign Worku Mamo2 1Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Neurology, School of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Merga Daba Mulisa, Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251912684411, Email mergadaba1995@gmail.comAbstract: Hypermagnesemia is a rare electrolyte abnormality observed in the clinical setting. Patients with this condition can present with a variety of symptoms, depending on the level of serum magnesium. Hypermagnesemia is rarely complicated by weakness of the extremities. We report the case of 32 years old female patient who presented with bilateral upper- and lower-extremity weakness due to hypermagnesemia. Following correction of the serum magnesium level, extremity weakness subsided, and the patient was discharged with improvement. Here, we discuss the delay in the diagnosis and management of this type of clinical presentation.Keywords: hypermagnesemia, extremity weakness, flaccid paralysis

Beria Aksu Selman,1,* Mohamed Sheikh Hassan,2,3,* Rahim Rahimov,1 Saltanat Mert,1 Ayhan Köksal1 1University of Health Science, Neurology Department Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey; 2Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 3Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia*These authors contributed equally to this workCorrespondence: Mohamed Sheikh Hassan, Department of Neurology Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Email dr.m.qalaf@gmail.comAbstract: Todd’s paralysis (TP) is relatively uncommon condition that can occur immediately after an epileptic seizure. It is a heterogeneous clinical syndrome that presents with acute-onset neurological findings, such as paralysis, paresthesia, aphasia, hemianopsia, and an altered state of consciousness. This may be accompanied by cytotoxic edema on diffusion MRI. This case illustrates a 28-week pregnant patient with TP who presented with acute stroke-like clinical and radiological findings. The patient was presented to the emergency room with left side weakness following focal onset generalized seizure. Magnetic resonance imaging demonstrated diffusion restriction which led to the initial consideration of acute stroke. However, after the disappearance of the neurologic deficit and the resolution of the diffusion restriction in the control MRI, the diagnosis shifted away from acute stroke to the postictal TP. It is important to keep in mind that TP may mimic acute stroke even in the presence of an acute brain lesion in the brain MRI. The differentiation is necessary as each of them has completely different treatment and etiology.Keywords: Todd paralysis, acute stroke, magnetic resonance imaging, hemiplegia

Koki Sakata, Takeshi Katsumoto, Tomoyuki Kumagai, Kei Shinoda Department of Ophthalmology, Saitama Medical University, Saitama, JapanCorrespondence: Kei Shinoda, Department of Ophthalmology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan, Tel +81-4-9276-1250, Fax +81-4-9295-8002, Email shinok@saitama-med.ac.jpPurpose: To determine whether 0.025% povidone-iodine (0.025% PI) in the irrigation solution during vitrectomy for endophthalmitis is safe.Methods: Two cases of bleb-associated endophthalmitis were treated with vitrectomy using 0.025% PI in the irrigation solution. The RETevel electroretinographic (ERG) system with skin electrodes was used to assess the physiology of the retina pre- and postoperatively.Case: Case 1 was a 46-year-old man who had atopic keratoconjunctivitis and underwent trabeculectomy with the creation of a bleb after there was a rise in the intraocular pressure. One month postoperatively, a mild filtering bleb-associated endophthalmitis developed, and the eye was treated with intravitreal and subconjunctival injections of vancomycin (VCM) and ceftazidime (CAZ). After three days, the fundus was not visible and B-mode echography showed an area of high brightness in the retina. Vitrectomy with irrigation with VCM and CAZ, and 0.025% PI was performed successfully. Pre- and postoperative ERGs showed an improvement in both the a- and b-wave amplitudes and the b/a ratio was stable at 2.0. Case 2 was a 63-year-old man who had undergone trabeculectomy for glaucoma. Five years later, the eye developed blebitis which was treated with topical and subconjunctival injections of VCM and CAZ. Three days later, vitreous opacities appeared and a high brightness area was seen in the B-mode echographic images. Vitrectomy with VCM and CAZ, and 0.025% PI irrigation was successfully performed. Comparisons of the pre- and postoperative ERGs found that the a- and b- wave amplitudes of the ERGs increased and the b/a ratio was stable at appro

Tawfiq Ahmad Mushkani, Zabih Ur Rahman Roheen Ophthalmology Department, Kabul University of Medical Science, Kabul, AfghanistanCorrespondence: Tawfiq Ahmad Mushkani, Email tawfiqarashmushkani@gmail.comBackground: Coloboma means curtailed in Greek language. It is mainly used when normal tissue of the eye or another organ is not present since birth. Coloboma is a congenital abnormality mainly caused by incomplete closure of the embryonic fissure of the choroid part of eye.Purpose: The aim of this case report is to share the clinical findings in a patient with bilateral iris coloboma, low vision, and headache.Patients and Methods: Case report.Results: An eleven-year-old boy with low vision and headache visited the University Eye Hospital of Kabul University of Medical Science (UEHKUMS) for consultation. Ophthalmic examination revealed a bilateral iris coloboma without concomitant chorioretinal defect, refractive error, and high intraocular pressure in both eyes. The refractive error of the patient was corrected by advising proper glasses, and the high intraocular pressure was controlled by anti-glaucoma drops. After several follow-up visits, the patient no longer complained of headache and low vision.Conclusion: Visiting patients with iris coloboma should be considered for intraocular pressure (IOP) check, and screening of other family members is mandatory.Keywords: iris coloboma, high intraocular pressure, bilateral

Ghulam Yahia Baset,1 Farukh Seyar,2 Zaker Hussain Hussain Pour,3 Qurban Ali Karimi4 1Faculty member, Department of Emergency Surgery and Trauma, Kabul University of Medical Science, Ali Abad Teaching Hospital, Kabul, Afghanistan; 2Faculty Member, Department of Abdominal Surgery, Kabul University of Medical Science, Ali Abad Teaching Hospital, Kabul, Afghanistan; 3Faculty Member, Department of Maternal and Child Health, Kabul University of Medical Science, Kabul, Afghanistan; 4Department of Research, Kabul University of Medical Science, Kabul, AfghanistanCorrespondence: Ghulam Yahia Baset, Tel +93783676086, Email Yahia.baset4321@gmail.comAbstract: gossypiboma is used to describe a retained surgical swab in the body after an operation. It remains an unwanted complication of surgical practice that increase morbidity and mortality of the patient and profound medico legal problems. Intra-abdominal gossypiboma can migrate in to the ileum, stomach, colon or bladder without any apparent opening in the wall of these luminal organs. Vigilant sponge counting during procedures and thorough exploration prior to closure of the abdomen, are essential practices to avoid such occurrences. Herein we present a case of gossypiboma in a 26-year old woman that was in the lumen of small bowel and caused acute intestinal obstruction.Keywords: Gossypiboma, bowel obstruction, transmural migration, surgical swab, cesarean section

Dano Gutata Quality Improvement Unit, Assosa General Hospital, Assosa, Benishangul-Gumuz, EthiopiaCorrespondence: Dano Gutata, Tel +251917071159, Email danguteta@gmail.comBackground: Malaria can lead to anemia, a condition marked by a reduction in red blood cells or lower than typical levels of hemoglobin. This condition mainly affects women and children and, in severe cases, can hinder the cognitive and motor development of children. It also poses significant risks for pregnant women and their unborn children.Case presentation: An 18-month-old girl and her mother, referred from conflict-affected West Wollega, Ethiopia due to severe malaria, were admitted to Assosa General Hospital, Ethiopia, with critical health indicators. The daughter (case 1) had a hemoglobin level of 0.8 g/dL, a red blood cell count of 0.44 × 10^6u/L, an oxygen saturation of 90%, a body temperature of 36.6 °C, a heartbeat of 132 beats per minute, and a respiratory rate of 48 breaths per minute. She displayed signs of pale conjunctivitis and severe palmar paleness, and weighed 7 kg. The mother(case 2), aged 35, also had a history of severe malaria and presented with a critically low hemoglobin level of 2.5g/dL and a red blood cell count of 0.75 × 10^6u/L, with an oxygen saturation of 89%. Blood transfusion and malaria treatment were administered, and by the end of their hospital stay, both cases’ symptoms had resolved, and they returned to normal baseline vital signs, including their hemoglobin levels.Conclusions: Severely low hemoglobin levels, worsened by severe malaria, present a significant danger in cases of anemia. As far as I am aware, this might be the lowest hemoglobin level recorded. Promoting awareness, economic empowerment initiatives, alongside routine provision of iron supplements and Prompt malaria diagnosis and treatment to create a comprehensive approach that addresses the multifaceted challenges posed by anemia, ultimately leading to improved health outcomes for vulner

Chien-Ching Lee,1,2 Hao-Yu Chuang,3,4 Che-Chao Chang,3,5 Hung-Lin Lin,6 Cheng-Hsin Cheng3,7 1Department of Anesthesia, An Nan Hospital, China Medical University, Tainan, 70965, Taiwan; 2Department of Medical Sciences Industry, Chang Jung Christian University, Tainan, 71101, Taiwan; 3Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan, 70965, Taiwan; 4Department of Neurosurgery, China Medical University Beigang Hospital, Yunlin County, 65152, Taiwan; 5Neurophysiology Laboratory, Department of Surgery, National Cheng Kung University Medical Center and Medical School, Tainan, 70101, Taiwan; 6Department of Neurosurgery, China Medical University Hospital, Taichung, 40447, Taiwan; 7Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, 71101, TaiwanCorrespondence: Cheng-Hsin Cheng, Department of Neurosurgery, An Nan Hospital, China Medical University, No. 66, Sec. 2, Changhe Road, Annan District, Tainan City, 70965, Taiwan, Email u701018.tw@yahoo.com.twBackground and Importance: This video article reports a rare case of a right L5/S1 foraminal root schwannoma that presents the natural course of the disease, imaging findings, treatment protocol, operative procedure, and highlights some of the possible surgical complications.Clinical Presentation: Magnetic resonance imaging (MRI) revealed an intradural, extramedullary, well-enhanced mass at the right L5/S1 level. The operative procedure involved a right minimal L5/S1 laminotomy/foraminotomy posteriorly to open the right L5 root. The facet joints were preserved to prevent spinal instability. The tumor was located along the root after opening the right L5/S1 foramen. Intraoperative electromyography (IOM) was conducted to detect any nerve injury in the patient. After opening the dura, the tumor was carefully separated from the normal root nerve under IOM monitoring. The mass was removed piece-by-piece using mini-forceps.Conclusion: Histopathological examination confirmed the

Zenat Ahmed Khired Department of Surgery, Faculty of Medicine, Jazan University, Jazan, 45142, Saudi ArabiaCorrespondence: Zenat Ahmed Khired, Email zkherd@jazanu.edu.saAbstract: Stress fractures of the femoral neck are rare in young adults and usually happen when the bone is repeatedly put under a lot of stress or because of a bone disease. The incidence of stress fractures is a major health concern for soldiers. Most often, stress fractures affect the metatarsals and tibias, while injuries to the femoral neck are less common. Exertional groin or anterior thigh discomfort that develops gradually over time is often vague and subtle; therefore, a high index of clinical suspicion is indicated. In most cases, the first radiographs will be normal. In order to properly diagnose a stress fracture in the femur, a CT scan is very helpful. Because most femoral neck fractures are not displaced when patients present with them, a diagnosis is often delayed. In conclusion, new military soldiers feeling hip pain should have a thorough medical evaluation to establish an early diagnosis and prevent any consequences.Keywords: femoral neck, stress fractures, young adults, FNSF

Fubin Wang Department of Ophthalmology, Shanghai Bright Eye Hospital, Shanghai, 200336, People’s Republic of ChinaCorrespondence: Fubin Wang, Shanghai Bright Eye Hospital, 899 Maotai Road, Changning District, Shanghai, 200336, People’s Republic of China, Email wfb_528@163.comIntroduction: Optic disc melanocytoma (ODMC) with peripapillary hyperreflective ovoid mass-like structures (PHOMS) is rare. This study reports a case of the characteristics of multimodal imaging and Minimum intensity projection (Min-IP) images.Methods: A 25-year-old male patient was referred to our hospital due to the presence of a dark pigmented tumor located in the optic disc area of his left eye. The patient exhibited normal pupillary reactions and had a best corrected visual acuity of 1.0 (decimal) in both eyes. This patient underwent multimodal retinal imaging examination including color fundus photograph (CFP), B-scan ultrasonography, Fundus autofluorescence (FAF), SD-OCT (spectral-domain optical coherence tomography), OCTA (optical coherence tomography angiography), en-face Min-IP image and fluorescein angiography (FA).Results: CFP revealed a slightly elevated mass lesion in the inferior quadrant of the left optic disc, the lesion appeared black to dark brown in color. B-scan ultrasonography of the left eye confirmed the presence of a hyperechoic small dome-shaped lesion. Fundus autofluorescence (FAF) analysis revealed complete hypofluorescence in this area. SD-OCT (spectral-domain optical coherence tomography) and OCTA (optical coherence tomography angiography) with Min-IP were performed over the tumor and its surrounding areas. SD-OCT showed an elevated tumor mass arising from the optic disc with increased reflectivity. PHOMS appeared ovoid in shape on B-scan OCT image. PHOMS appeared peripapillary hyperreflective bright areas on en-face Min-IP image corresponding to PHOMS on B-scan OCT image. The fluorescein angiography (FA) showed the staining of PHOMS. A diagnosis of optic disc m

Yosef Habtemariam,1 Molla Asnake,2 Misikr Alemu,3 Erkyehun Pawlos Shash,3 Tsegaw Worku Tessema,2 Zerubabel Girma Tesso,1 Michael Hawlet4 1School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia; 2School of Medicine, Adult ICU Unit, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia; 3School of Medicine, Department of Internal Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia; 4Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, Wolkite University, Wolkite, EthiopiaCorrespondence: Molla Asnake, School of Medicine, Adult ICU Unit, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia, Email mollaasnake75@gmail.comAbstract: In 2022, there were 249 million cases of malaria globally, resulting in 608,000 deaths. The majority of cases and deaths occurred in the WHO (World Health Organization) African Region. A study in our region found that, out of 263,476 individuals, 148,734 had P. falciparum, 106,946 had P. vivax, and 7,796 had mixed infections. The prevalence of P. falciparum (Plasmodium falciparum) was 8.97% and P. vivax (Plasmodium Vivax) was 7.94%. Although there have been a few reported cases of cerebral malaria caused by P. vivax, there is currently no comprehensive analysis of such cases. All the cases that have been reported so far involved individuals living in malaria-endemic areas, who presented with symptoms characteristic of cerebral malaria. Cerebral malaria was diagnosed based on the clinical algorithm which WHO used except we used P. vivax instead of P. falciparum The diagnosis of these cases was confirmed through thin blood film examination and Rapid Diagnostic Tests (RDTs). Therefore, this report aims to provide additional data on the occurrence of P. vivax as a cause of cerebral malaria. It also recommends further studies to reassess the curre

Zaid A Abdulelah,1 Ahmed A Abdulelah,2 Abdulqader Alsayed Issa,3 Kais Al Balbissi4 1Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; 2School of Medicine, University of Jordan, Amman, Jordan; 3Department of Cardiology, Abdali Hospital, Amman, Jordan; 4Divison of Cardiology, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, JordanCorrespondence: Zaid A Abdulelah, Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Trumpington, Cambridge, CB2 0AY, UK, Email zaidaabdulelah@gmail.comBackground: Pericardial masses are an extremely rare group of diseases which can be classified based on etiology. The presentation of pericardial masses varies considerably from one individual to another, ranging from an asymptomatic presentation with an incidental finding on imaging, to presenting with non-specific signs and symptoms. Due to the enigmatic nature and presentation of pericardial masses, diagnostic imaging is mandatory.Case Presentation: A 69-year-old patient presented to our cardiology clinic complaining of intermittent shortness of breath upon moderate exertion in the absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, dizziness, palpitations, or lower limb edema. The patient’s past medical history was significant because of his history of pericarditis associated with pericardial effusion 6 years prior to presentation at our clinic. Despite adequate medical treatment, the patient complained of a relapsing and remitting pattern of symptoms that mandated the performance of advanced cardiovascular imaging, namely, cardiac magnetic resonance imaging, which revealed the presence of a profound pericardial mass.Conclusion: Despite the fact that relapsing pericarditis is a well-established complication following acute pericarditis, the presentation of a complication such as a fibrous pericardial mass evident on cardiac MRI has essentially been unreported in the liter

Junya Kojima,1 Masanori Ono,1 Koichiro Tasaki,2 Takeshi Nagai,2 Toshitaka Nagao,2 Sho Rinno,3 Yoshihiko Kanno,3 Rie Yoshida,1 Tomoo Suzuki,1 Naoaki Kuji,1 Hirotaka Nishi1 1Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan; 2Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan; 3Department of Nephrology, Tokyo Medical University, Tokyo, JapanCorrespondence: Masanori Ono, Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan, Tel +81-3-3342-6111, Email masaoriono@gmail.comBackground: Pregnancy-related acute kidney injury (Pr-AKI) is associated with significant maternal and fetal morbidity and mortality, with a three- to four-fold increase in perinatal mortality. Pr-AKI can arise from various obstetric complications, such as hyperemesis gravidarum, septic abortion, hypertensive disorders of pregnancy, pyelonephritis, and antiphospholipid antibody syndrome. Therefore, early diagnosis and appropriate intervention, including the identification of the underlying etiology, are important to effectively manage Pr-AKI. Therefore, we report a case of Pr-AKI after early miscarriage in a patient without hyperemesis gravidarum or septic abortion whose renal function gradually improved postoperatively for miscarriage.Case Presentation: A 34-year-old primigravid woman was referred to us for perinatal management at 6 weeks of gestation. Unfortunately, she was diagnosed with miscarriage 1 week later. The patient had no history of hyperemesis gravidarum or septic abortion; however, she developed oliguria, and her serum creatinine and blood urea nitrogen levels were abnormally increased. Consequently, she underwent a renal biopsy to evaluate renal dysfunction, which indicated tubulointerstitial damage. The patient also underwent manual vacuum aspiration for a miscarriage. Postoperatively, her urine output increased, and her renal function improved. She was determined to

Shadi Zari Department of Dermatology, College of Medicine, University of Jeddah, Jeddah, Saudi ArabiaCorrespondence: Shadi Zari, Department of Dermatology, College of Medicine, University of Jeddah, Saudi Arabia, Email Shadizarimd@gmail.comAbstract: This case report presents a rare occurrence of herpes zoster (HZ) outbreak in a 50-year-old male following botulinum toxin (BTX) type A injections. The patient developed burning swollen lesions on the left forehead four days after receiving BTX injections. Physical examination revealed papules and erosions in a dermatomal distribution. He was diagnosed with HZ and promptly treated with oral acyclovir. The lesions resolved within two weeks without complications. Previous literature reports a few similar HZ outbreaks following aesthetic treatments with BTX injections. The exact mechanism triggering varicella reactivation in these cases remains unclear. Prompt diagnosis and treatment of HZ are crucial in order to minimize outbreak duration and reduce complications. Physicians should maintain awareness of HZ as a potential complication following BTX injections.Keywords: botulinum toxin, complications, herpes zoster, shingles

Harty Elouise Ashby,1 Grayson N Jones,1 Oon Leedhanachoke,2 Phillip Jen,3 Noah Helphenstine,3 Fadi Al Akhrass4 1Department of Pathology, Pikeville Medical Center, Pikeville, KY, USA; 2Department of General Surgery, Pikeville Medical Center, Pikeville, KY, USA; 3Department of BioMedical Science, University of Pikeville, Pikeville, KY, USA; 4Department of Infectious Diseases, Pikeville Medical Center, Pikeville, KY, USACorrespondence: Phillip Jen, Department of BioMedical Science, University of Pikeville, 147 Sycamore Street, Pikeville, KY, 41501, USA, Tel +1 704 488 8258, Email phillipjen@upike.eduAbstract: Merkel cell carcinoma (MCC) is an extremely rare and aggressive tumor. Here we report an unusual MCC that manifested as an abruptly enlarging, painful skin lesion over the right antecubital fossa and masqueraded as an epidermal cyst in a 42-year-old male. The lesion was surgically excised and subjected to histopathologic and immunohistochemical examinations. The subsequent analysis allowed for the diagnosis of MCC. Clinicians should always be cognizant of MCC, which can be easily misdiagnosed. Early diagnosis and appropriate treatment are keys to improving the survival rates of MCC patients.Keywords: Merkel cell carcinoma, histopathologic, immunohistochemical, polyomavirus

Fitrah Utari Bakti,1,* Tenny Setiani Dewi2,* 1Oral Medicine Residency, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia; 2Oral Medicine Department, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia*These authors contributed equally to this workCorrespondence: Fitrah Utari Bakti, Oral Medicine Residency, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan No. 1, Bandung, West Java, 40132, Indonesia, Email fitrahutari@ymail.comIntroduction: Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction with various etiological factors, including herpes simplex virus type 1 (HSV-1) infection, known as herpes-associated erythema multiforme (HAEM). Oral health-related quality of life (OHRQoL) is a multidimensional concept of biopsychosocial aspects related to oral health. OHRQol contains information for patient-centered treatment plan development. The OHRQoL measurement instrument widely used by clinicians is the oral health impact profile-14 (OHIP-14). This case report aimed to evaluate OHRQoL in HAEM patient, which only manifests on the lips and oral cavity.Case: A 25-year-old male patient came to the Department of Oral Medicine with the chief complaint of painful canker sores on the lips. Extra-oral examination revealed serosanguineous crusts on the lips that were painful and easily bleed. Intra-oral examination showed diffused and painful irregular erythematous lesions on the upper and lower labial mucosa. The anti-HSV1 IgG test was positive. The patient was diagnosed with HAEM.Case Management: Pharmacological therapy included triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, and 0.9% NaCl. Non-pharmacological therapy included advice on maintaining good oral hygiene, avoiding spicy and sour foods, and breaking the bad habit of licking the lips.Conclusion: The patient’s physical, psychological, and social conditions showed improvement and returned to normal

Pan Gao,1,2 Xinyu Li,1,2 Ziqiu He,1,2 Hongbo Zhang,1,2 Zhi Zhang,1,2 Zonglai Liu1,2 1Department of Urology, Second People’s Hospital of Yichang, Yichang, Hubei Province, People’s Republic of China; 2Department of Urology, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of ChinaCorrespondence: Zonglai Liu, Department of Urology, Second People’s Hospital of Yichang, Second People’s Hospital of China Three Gorges University, 21 Xiling One Road, Yichang, 443000, Hubei Province, People’s Republic of China, Email 85538230@qq.comAbstract: Immune checkpoint inhibitors (ICI) have become a new hope for many patients with advanced cancer by blocking tumor immune escape. Bladder cancer is a common malignant tumor of the urinary tract epithelium that often relapses and metastasizes after surgery, chemotherapy, and radiotherapy. Immunotherapy has dramatically improved patient survival rates and clinical benefits as a new, potentially effective therapy. However, avoidance of various immune-related adverse events (irAEs) remains an implausible idea. ICI-induced myocarditis is different from viral myocarditis, and mortality is still high with the current treatment. We report the case of an 82-year-old female patient with ICI-induced fulminant myocarditis and myasthenia gravis. Although she actively accepted the current mainstream treatment for immune-related myocarditis and myasthenia, she died of heart and respiratory failure. Analyzing and reporting the patient’s disease development process and the changes in related indicators may help peers gain a deeper understanding of immune-related adverse events and reduce the mortality of immune-related myocarditis.Keywords: immune checkpoint inhibitors, immunotherapy, heart failure, multiple organs failure

Gabriel Kakuru Shamavu,1 Kumbowi Kumbakulu Patrick,1 Franck Katembo Sikakulya,2 Odong Richard Justin,1 Everest Tukamushaba,3 Simon Odoch,1,3 Baanitse Munihire Jeannot,2 Juliet Adongo Ocol1,3 1Department of Pediatrics, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; 2Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; 3Department of Pediatrics, Lira Regional Referral Hospital, Lira, UgandaCorrespondence: Gabriel Kakuru Shamavu, Faculty of Clinical Medicine and Dentistry, Department of Pediatrics, Kampala International University Western Campus, PO.Box 70, Ishaka-Bushenyi, Uganda, Email gabrielshamavu@gmail.com; shamavu.kakuru@studwc.kiu.ac.ugIntroduction: This report details the exceptional survival of a female newborn buried alive by her own mother after a clandestine and unassisted birth. Despite spending over six hours underground, the newborn remarkably survived without exhibiting signs of perinatal asphyxia or major complications, and did not require advanced resuscitation measures.Case Presentation: Rescued following a shocking discovery in a garden and rushed to the hospital, this newborn experienced transient hypothermia, mild to moderate respiratory distress, and scattered skin bruises. After five days of hospital care, she was discharged in clinically stable condition with no infectious complications, displaying age-appropriate normal neurological examination findings and excellent feeding.Conclusion: This case not only defies established expectations but also illuminates perinatal physiological adaptation complexities. It highlights a fortunate and exceptional outcome in dire circumstances, presenting a captivating enigma within scientific realms. This report sheds light on the critical importance of early intervention and timely rescue efforts in cases of neonaticide, emphasizing the significance of

Samson Dires Gashaw, Waltengus Demissie Birhanu, Fitsum Alemayehu Department of Otolaryngology, Head and Neck Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Waltengus Demissie Birhanu, Email waltebirh@gmail.comBackground: Intranasal mucosal melanoma is a rare form of melanoma. Presenting as the features of occult malignancy and rapid in its progression. Presented with nonspecific symptoms. So far, no specific risk factor has been identified. The histopathological and immunohistochemical examination helps to confirm the diagnosis. Here, we present a case of primary intranasal melanotic mucosal melanoma and literature review.Case Report: The authors present a patient with primary right intranasal melanotic mucosal melanoma.Conclusion: An endoscopic medial maxillectomy was done, and the patient was linked to the oncology department for radiotherapy.Keywords: mucosal melanoma, ectodermal, endoscopic medial maxillectomy

Jinchun Liu,1 Zhijun Yu,2,3 Guohua Wang2 1Department of Medicine, Henan Vocational College of Nursing, Anyang, Henan Province, 455000, People’s Republic of China; 2Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, 226019, People’s Republic of China; 3Department of Thoracic Surgery, Nantong Second People’s Hospital, Nantong, Jiangsu, 226001, People’s Republic of ChinaCorrespondence: Guohua Wang, Email wgh036@hotmail.comAbstract: Coronary artery fistulae (CAF) are a rare anomaly characterized by abnormal connections between a coronary artery and a cardiac chamber or a great vessel, with most patients remaining asymptomatic. Despite being predisposed to severe complications like heart failure, patients with CAF infrequently experience severe stenosis in the coronary artery. This study delineates a case involving a 46-year-old male presenting with a fistula bridging the right coronary artery (RCA) and right atrium (RA), manifesting a pronounced 99% stenosis at the right extremity of the coronary artery proximal to the fistula. Concurrently, the individual exhibits six conventional risk factors: age over 40, male gender, hypertension, diabetes, smoking, and hypertriglyceridemia. Following pharmaceutical intervention, the patient was discharged and subjected to extended follow-up. This case highlights the dual processes of “accelerating damage” and “retarding renewal” in the progression of atherosclerosis. Factors such as shear stress, smoking, and hypertension are posited to expedite endothelial cell damage, while aging and diabetes may impede the renewal and repair of these cells. Together with the concept of secondary atherosclerotic plaque healing, this case prompts the introduction of a “Double Endothelial Healings” hypothesis, proposing a potential pathogenetic mechanism for coronary artery atherosclerosis.Keywords

Yeng F Her,1 Ryan T McWilliams,2 Erik A Ovrom,3 James C Watson1 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA; 2Family Medicine, Alaska Native Medical Center, Anchorage, AK, USA; 3Mayo Clinic Alix School of Medicine, Mayo Clinic Hospital, Rochester, MN, USACorrespondence: Yeng F Her, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA, Email her.yeng@mayo.eduAbstract: Arachnoiditis is difficult to treat. Patients are often left frustrated after many failed trials of conservative therapies without symptom resolution. Surgery may provide symptom relief for a short period of time, but their pain often returned. Herein, we present three cases of acute arachnoiditis following three different pain procedures: epidural blood patch, IDDS implant, and epidural steroid injection. The patients were diagnosed and treated with corticosteroids within 10 days of the procedure. Two patients were treated with the same oral steroid regiment, while the third patient was treated with both oral and IV steroid. All three patients had good outcomes at the completion of their steroid therapy. This case series may provide insight into treating acute and subacute arachnoiditis from pain interventions.Keywords: arachnoiditis, epidural blood patch, intrathecal pain pump, epidural steroid injection, corticosteroid therapy

Yodit Abraham Yaynishet,1 Shimalis Tadasa Fayisa,2 Bereket Amare Dencha,3 Samuel Sisay Hailu1 1Department of Radiology, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Radiology, Mizan Tepi University, Mizan, Ethiopia; 3Department of Pathology, Bahir Dar University, Bahir Dar, EthiopiaCorrespondence: Yodit Abraham Yaynishet, Department of Radiology, Addis Ababa University, P.O. Box: 9080, Addis Ababa, Ethiopia, Email yodit.abraham@aau.edu.etIntroduction: Adamantinoma is an infrequent, low-grade malignant bone tumor, predominantly affecting the tibia and often presents diagnostic challenges due to its nonspecific radiographic characteristics.Case Presentation: A 55-year-old military personnel, with no history of trauma, who presented with a one-year history of right leg swelling and pain. Radiological examination showed right anterior tibial, mid diaphyseal lytic expansile lesion with internal trabeculations and excisional biopsy led to the diagnosis of adamantinoma. Below knee amputation was done as a definitive management.Conclusion: Despite diagnostic challenges adamantinoma presents, the patient was referred to oncology and underwent amputation, underscoring the importance of considering adamantinoma in differential diagnosis for persistent bone lesions.Keywords: adamantinoma, bone tumor, Ethiopia

Hassen Mohammed Areys,1 Nour Hies Omer,1 Osman Ali Osman2 1Department of Gynecology and Obstetrics, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia; 2College of Medicine and Health Science, Jigjiga University, Jigjiga, EthiopiaCorrespondence: Hassen Mohammed Areys, Department of Gynecology and Obstetrics, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jigjiga, Ethiopia, Tel +251-915218641, Email budul414849@gmail.com Osman Ali Osman, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jigjiga, Ethiopia, Tel +251-915003112, Email osmana122@gmail.com; osman.ali@jju.edu.etBackground: Primary rupture of an unscarred uterus is rare. Spontaneous rupture of an unscarred bicornuate uterus is a life-threatening obstetric emergency with high morbidity and mortality in the mother and fetus; however, it most commonly occurs in the first trimester of pregnancy.Case: A 20-year-old primigravid woman at 22 weeks of gestation, with no prior surgery, presented with severe abdominal pain, anemia, and hemodynamic instability. With a preoperative diagnosis of uterine rupture, she was transfused with three units of cross-matched whole blood and underwent emergency laparotomy. Intraoperative findings showed a ruptured bicornuate uterus and a dead fetus in the abdomen with huge hemoperitoneum. Postoperative recovery was smooth, and the patient was discharged after being counselled on family planning and subsequent pregnancy.Conclusion: A bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid women at any stage of pregnancy. Each obstetrician should have a high index of suspicion for a rare condition like ruptured bicornuate uterus, especially for a pregnant woman presenting with acute abdominal pain and hemodynamic instability. Early ultrasonography plays a key role in the evaluation, follow-up, and management of these patients.Keywords: uterine rupture, bicornu

Ali Alsuheel Asseri,1 Ahmad A Alzoani,2 Mohammed Almahdi,3 Hussein Almahdi,4 Nouf Almushayt,3 Noha Saad Alyazidi,3 Basmah Mohammed Al Mufarrih5 1Department of Child Health, King Khalid University, Abha, 61421, Saudi Arabia; 2Department of Neonatology, Abha Maternity and Children Hospital, Ministry of Health, Abha, 62521, Saudi Arabia; 3Department of Pediatrics, Abha Maternity and Children Hospital, Ministry of Health, Abha, 62521, Saudi Arabia; 4College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia; 5Department of Obstetrics and Gynecology, Abha Maternity and Children Hospital, Ministry of Health, Abha, 62521, Saudi ArabiaCorrespondence: Ali Alsuheel Asseri, Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia, Tel +966500186013, Fax +9662418139, Email alsoheel11@kku.edu.saAbstract: Jeune syndrome, or asphyxiating thoracic dystrophy (JATD), is a rare autosomal recessive skeletal dysplasia with heterogeneous genetic and clinical phenotypes, which primarily affects cartilage and bone development. Herein, we report a patient with a lethal form of SRTD3 without polydactyly (JATD), which led to severe restrictive lung disease and fatal respiratory failure. A full-term boy was born to a 30-year-old mother who was known to have hypothyroidism and was on thyroxine. The parents were first-degree cousins and had one healthy older son. Fetal ultrasound showed a cephalic fetus, normal amniotic fluid and a fundal placenta. All long bones and ribs were below the 1% percentile. The femur was bowed with no fractures or signs of significant demineralization at time of imaging. Head and abdominal circumference were within normal range. An echocardiogram on the 2nd day of life showed severe pulmonary hypertension (PHTN). Nitric oxide was started due to the presence of persistent hypoxia and severe PHTN. The patient continued to require high cardiorespiratory support, but the medical condition worsened, and respiratory failure per

Ablaikhan Kazbekov,1,2 Olzhas Bekarisov,1 Kairat Tazhin1 1National Scientific Center for Traumatology and Orthopedics Named After Academician N.D. Batpenov, Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan; 2Astana Medical University, Astana, KazakhstanCorrespondence: Ablaikhan Kazbekov, Email ablaikhankazbekov@gmail.comIntroduction: Poland syndrome is a rare congenital syndrome that is characterized by partial or complete unilateral absence of the pectoralis major muscle, congenital malformation of the hand and deformation of the chest. Often the patients has abnormalities of the nipple-areolar complex. Here, we present a case of surgical treatment of local chest deformity with patient with Poland syndrome.Case Presentation: We observed a patient, an 18-year-old man. The parents noticed the deformation of the chest from birth. The patient did not receive any treatment until adulthood. The patient contacted our clinical research center to correct chest deformity. After clinical and diagnostic procedures, the patient underwent surgical operation: open thoracoplasty with installation of a wire-frame construction. The early postoperative period was uneventful. Early postoperative outcome was assessed 6 months after surgery.Conclusion: Our experience shows that thoracoplasty using a wire-frame construction is a good method for correcting local chest deformities in patients with Poland syndrome.Keywords: Poland syndrome, chest deformity, surgery, case report

Merga Daba Mulisa,1 Shalom Kassahun Bekele,1 Sisay Bekele Woldemichael,2 Sitota Ganjula Gaito,3 Fadil Nuredin Abrar,4 Betelhem Gebreamlak Hailu4 1Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Cardiothoracic Unit, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia; 3Cardiology Unit, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia; 4Department of Pathology, School of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Merga Daba Mulisa, Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251912684411, Email mergadaba1995@gmail.comAbstract: Left atrial masses are commonly caused by atrial myxomas and metastatic tumors. Primary cardiac sarcomas are rare. Patients present with symptoms related to the tumor location. There are only a few case reports on this rare disease. We report the case of a 17 years old male patient presented with shortness of breath for 2-month duration. Echocardiography revealed a left atrial mass that was later surgically excised and histopathology confirmed a primary cardiac sarcoma. We discuss the diagnostic and therapeutic challenges encountered in the management of this rare disease. To the best of our knowledge, this is the first case reported in East Africa.Keywords: primary cardiac sarcoma, atrial mass, atrial myxoma

Michael Teklehaimanot Abera,1 Henok Dessalegn Damtew,1 Yodit Abraham Yaynishet,1 Amanuel Yegnanew Adela1– 3 1Department of Radiology, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Radiology, University of Gondar, Gondar, Ethiopia; 3Ethiopian Federal Police Commission Referral Hospital, Addis Ababa, EthiopiaCorrespondence: Michael Teklehaimanot Abera, Addis Ababa University, College of Health Sciences, Department of Radiology, P.O. Box 9080, Addis Ababa, Ethiopia, Email michael.thaimanot@aau.edu.et; th.miki8441@gmail.comAbstract: Pancreatic pseudocysts are benign lesions that typically originate within the pancreatic parenchyma, or peripancreatic tissue. They commonly occur following recurrent episodes of pancreatitis or trauma. In this article, we present a case of a giant pancreatic pseudocyst with unusual trans-spatial extensions and spontaneous size decrement in a 40-year-old male patient with a history of alcohol abuse. He presented with chronic epigastric pain, and a physical examination showed only mild abdominal tenderness. Initial computed tomography showed a giant (18.4cm in its largest axis) pancreatic pseudocyst with left subdiaphragmatic and gastrohepatic extensions and concurrent splenic cysts. On follow-up ultrasound, the pseudocyst showed a significant spontaneous size decrement to less than half of its initial size. The giant size and trans-spatial characteristics of the pseudocyst, along with a relatively benign symptomatology and subsequent spontaneous shrinkage, constitute unique aspects of this case.Keywords: pseudocyst, giant pseudocyst, pancreatitis, multiplanar CT, spontaneous drainage

Bizunesh Dires Fenta,1 Alazar Berhe Aregawi,2 Teketel Tadesse Geremew,1 Berhanu Kelemework Fenta3 1Department of Pathology, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia; 2Department of Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia; 3Department of Internal Medicine, Yanet Internal Medicine Specialized Center, Hawassa, Sidama, EthiopiaCorrespondence: Alazar Berhe Aregawi, Tel +251911914624, Email alazarberhe@hu.edu.etAbstract: One kind of angioproliferative disorder is Kaposi’s sarcoma (KS). Growth of spindle-shaped cells, edema, inflammation, and neoangiogenesis are its defining features. Because it lacks the typical indicators of malignancy, it is classified as an intermediate neoplasm. People who are immunocompromised, receiving organ transplants, or receiving antiretroviral therapy are linked to KS. Although lymph node involvement by KS is extremely uncommon, when it does occur, it usually manifests as either the epidemic form in (Human Immuno-deficiency) HIV-positive patients or the endemic form in Africans. There are four primary clinical manifestations of KS that have been documented: endemic, epidemic, iatrogenic, and classic. The diagnosis of KS is made by history, physical examination, and tissue biopsy. When treating localized disease, highly active antiretroviral therapy (HAART) may be sufficient to either improve or completely eradicate the illness. Nonetheless, chemotherapy and HAART would be necessary in the case of widespread illness. Here, we present the case of a 28-year-old female patient who is HIV positive and has a viral load that is not detected. She presented with generalized lymphadenopathy of 8 months duration. She had no cutaneous manifestations. The lymphadenopathy involved the tonsils, axilla, inguinal, and an unusual site, intraparotid on both sides. After a pathologic examination of the lymph nodes, she was found to have epidemic-type KS and was treated wit

Milena Barbosa Porto,1 Geovanna da Mata e Castro,1 Samara Socorro Silva Pereira,2 Elza Maria Gonçalves Santos Uchoa,2 Raffael Zatarin,3 Lysa Bernardes Minasi,1 Aparecido D da Cruz1– 3 1Graduate Program in Genetics, School of Medical and Life Sciences, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil; 2Federal University of Goiás, Graduate Program in Genetics and Molecular Biology, Goiânia, GO, Brazil; 3Clinical Genetics Service, Center for Rehabilitation and Readaptation Dr. Henrique Santillo, State Health Secretary of Goiás, Goiânia, GO, BrazilCorrespondence: Aparecido D da Cruz, Email acruz@pucgoias.edu.brAbstract: Baker-Gordon Syndrome (BAGOS) is a genetically determined 4 (NDD), represented by a phenotypic spectrum of moderate to severe intellectual disability, resulting from mutations in the synaptotagmin 1 (SYT1) gene. Its prevalence is estimated at 1:1,000,000 and the known gene variants have indicated complete penetrance with variable expressivity. SYT1 is a membrane trafficking protein in presynaptic vesicles, which exerts a complex influence on synaptic transmission, with fundamental roles in the release of neurotransmitters and facilitators of endocytosis, impacting both neurotransmission and neuron plasticity. The current case report describes the first Brazilian male patient diagnosed at 17-year-old, and the 39th reported case globally using whole-exome sequencing. A de novo heterozygous missense mutation at chr12q:79448958 (NM_005639.2; c.1103T>C; p.Ile368Thr) in the SYT1 was found and classified as a pathogenic variant. The proband’s clinical phenotype was compatible with BAGOS, involving behavioral changes such as irritability and severe intellectual disability. Knowledge about the mechanism of action and the extent of the genotypic and phenotypic presentations of the mutations in the SYT1 is still unfolding. Thus, we aimed to describe additional genotype–phenotype correlation for BAGOS, contributing to the expansion of th

Akebom Gebremichael,1 Hale Teka,2 Kidus Kebede Abadi,3 Melkamu Siferih,4 Menberu Moges,5 Muhudin Arusi,1 Abel Shiferaw6 1Department of Obstetrics and Gynecology, St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia; 2Department of Obstetrics and Gynecology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia; 3Department of Obstetrics and Gynecology, Riwyet Maternal and Child Health Center, Tigray, Ethiopia; 4Department of Obstetrics and Gynecology, Debre Markos University, Debre Markos, Ethiopia; 5Department of Obstetrics and Gynecology, Tayo Hospital, Baidoa, Somalia; 6Department of Obstetrics and Gynecology, Dessie Comprehensive Specialized Hospital, Dessie, EthiopiaCorrespondence: Akebom Gebremichael, Email kidanemariamakebom@gmail.comBackground: The intrauterine device is a popular and highly effective form of long-acting reversible contraception. Although generally safe, complications could happen. One of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include, but are not limited to, postpartum period, breastfeeding, levels of experience, and excessive force exerted during insertion. This case is significant because it demonstrates risk factors for uterine perforation, how to handle missing strings, and care in places with little resources.Case Presentation: We discuss the case of a 27-year-old black Ethiopian woman who presented with chronic pelvic pain and had a perforated intrauterine device discovered in the cul-de-sac. The device had been inserted at six weeks postpartum. The client was unable to feel the strings three months after insertion, and a wrong diagnosis of expulsion was made. After one year of insertion, the intrauterine device was located on a plain abdominal radiograph and removed via laparotomy without complications.Conclusion: Although uterine perforation is a rare complication of intrauterine device insertion, special attention should be paid to women