Hydatid cyst of the sacrum :A case report

Introduction: Osteogenesis Imperfecta (OI) is a rare genetic disorder characterized by increased bone fragility and recurrent fractures. OI is classified into types I-IV based on clinical features, with the majority of cases attributed to mutations in the COL1A1 and COL1A2 genes encoding type I collagen. Case Presentation: Here we present the

TitleStaphylococcus aureus subcapsular splenic abscess and associated empyema in the setting of tocilizumab therapy: A case report

Arthrogryposis, Renal dysfunction, Cholestasis (ARC) Syndrome with A Novel Mutation in two siblings

First-trimester exposure to tofacitinib in ulcerative colitis: A case report of a healthy newborn and literature reviewArteen Arzivian1,2, Eva Zhang1, Robyn Laube1, Rupert Leong1,21 Department of Gastroenterology and Hepatology, Macquarie University Hospital, Sydney, Australia.2Faculty of Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia.

IntroductionPostoperative atrioventricular block (AVB) has been reported in 1% to 6% of patients after cardiac surgery and 25% to 60% of these patients will finally need a permanent pacemaker (PPM).1-4To avoid tricuspid valve (TV) malfunction, implantation of transvenous pacing leads is generally not preferred in presence of the tricuspid bioprosthesis.5Leadless pacemakers (LLP) have recently become popular in treatment of heart blocks and bradyarrhythmia due to their proven safety and efficacy.6,7 LLPs have advantages of avoiding complications encountered with conventional transvenous pacemakers including infection, lead malfunction, and tricuspid valve regurgitation.8,9 Epicardial pacemaker is the standard recommendation in the setting of prior tricuspid valve surgery. However, prior cardiac surgeries are usually associated with significant pericardial adhesion and most surgeons prefer not to implant epicardial leads in this setting due to impaired electrical properties of pericardial leads in the setting of pericardial adhesions. Therefore, LLPs can be a safe choice for patients with TV surgeries and postoperative AVB. There is a few data about the LLP implantation in presence of the bioprosthetic TV (BTV).10-12 In this report, we described a case of Micra-VR implantation across the BTV in a patient with repaired congenital heart disease.

Unveiling the Menace of Incidental Insidious Chronic Kidney Disease due to Posterior Urethral Valve - A Case Report

IntroductionVulvovaginitis is inflammation of the vulvovaginal mucous membranes (1) that responsible of some of pediatric gynecology consultations (2). Prepubertal girls commonly experience a gynecologic issue, which is often characterized by symptoms such as vulvovaginal itching, discharge, irritation, burning or skin changes. The development of these symptoms is primarily influenced by anatomic, physiological, and behavioral factors specific to this age group (3). Streptococcuspyogenes , Haemophilus influenzae andEnterobius vermicularis emerge as the predominant pathogens, while fungal and viral infections exhibit lower occurrence rates (4). The presence of genital discomfort or a burning sensation during urination is often observed in cases of vulvovaginitis. This condition, which is more prevalent in prepubescent girls, can caused by a deficiency of estrogen and poor local hygiene leading to infection of the vaginal mucosa. Despite the lack of precise data on its prevalence, these predisposing factors are known to contribute to the development of vulvovaginitis (3).In addition, favor factors of development of this disease include local alkaline pH, thin labia minora and reauctioned estrogen stimulus during the prepubertal period results in thinning of the vulvovaginal epithelium. Among prepubertal girls, the most common clinical presentation is nonspecific vulvovaginitis caused by endogenous vaginal flora (5). One of the most agents of vulvovaginitis is a parasite calledEnterobius vermicularis (E. vermicularis ) (4). This worm exhibits the most extensive geographical distribution among helminths (6). Its induced infection is a global phenomenon and is recognized as the most prevalent form of helminth infection (7). This condition is prevalent across all age groups and socioeconomic backgrounds, although it is particularly widespread among children between the ages of five and fourteen (8, 9). It is important to note that parasitic infections even in children may lead to malnutrition and decreased learning abilities (10). Embryonated eggs can be detected on various surfaces such as fingernails, clothing, house dust and other objects. Once these eggs are ingested, they undergo hatching within the stomach, giving rise to larvae.These larvae then make their way to the cecum, where they undergo further development and eventually reach adulthood as pinworms, measuring approximately 1 cm in length. The gravid adult female worms exhibit a nocturnal migration to the perianal region, where they lay a substantial number of eggs, up to 11,000 in total. These eggs become infective within a relatively short period of time, approximately six hours after being deposited. The lifespan of E.vermicularis typically ranges from 11 to 35 days (8). Transmission of the infection takes place via direct transmission from an infected individual through the oral-anal route, or through the dispersal of airborne eggs from contaminated clothing or bed linen. Upon ingestion, the eggs hatch and release larvae within the intestine (11).Adult worms in girls may also infiltrate the vagina to release eggs and consequently leading to the development of vulvovaginitis. In 1980, Vaughan reported one of the first enterobiasis in direct observation of vaginal region (9, 12). Moreover, these worms possess the ability to invade the endometrial cavity, thereby inducing endometritis and salpingitis in affected patients (9). For diagnosis collection of eggs from infected area (anus or vagina) can be achieved through the use of the cellophane swab or scotch tape swab method. stool examination not be a reliable means of detecting eggs (13). Cases have been documented wherein this worm have traversed the entire of the reproductive system and penetrated the peritoneal cavity by means of the fallopian tubes (9). In this paper we presented a 4 years Iranian girl that suffered of vulvovaginitis caused by E. vermicularis . her family infected by this parasitic helminth too.

INTRODUCTIONSince its discovery by Robert Koch in 1882 (CDC, 1982), tuberculosis (TB) has and is still one of the leading causes of morbidity and mortality globally. In 2022 alone 10.6 million people were infected with TB and 1.3million died. It is the second leading infectious killer after COVID-19 (World Health Organization, 2023).Tuberculous pleuritis or pleurisy (TBP) is the second most common form of extra-pulmonary tuberculosis. It affects the pleura, in both immunocompetent and immunocomprised persons (Cohen and Light, 2015) (Nanyoshi et al. , 2022) in as high as 25% of tuberculosis(TB) cases (Porcel, 2009). TBP usually presents as a unilateral pleural effusion, although about 10% of cases are bilateral (Wang et al. , 2015).Effusions in TBP have long been postulated to be due to a delayed hypersensitivity reaction to mycobacterium antigens from raptured sub pleural caseous material; however recent advances have demonstrated a likelihood of paucibacillary bacterial infection within the pleural cavity (Morné J. Vorster, 2015).In high TB endemic areas prevalence of TBP has been shown to be higher in young people (mean age 34) (Porcel, 2009) compared to elderly population(>65years) in low endemic areas (Baumann et al. , 2007). The most common symptoms for TBP are pleuritic chest pain which precedes a non-productive cough; then fevers, night sweats, weight loss and malaise (Wang et al. , 2015).The gold standard for diagnosis of TBP is the demonstration of Mycobacterium tuberculosis  in the pleural biopsy specimens, pleural fluid or sputum (Gopi et al. , 2007); the challenges to this include scarcity of thoracoscopy services, paucibacillary nature of effusion and lack of sputum (since the cough is usually non-productive). However, presumptive diagnosis can also be achieved with reasonable certainty, by showing parietal pleura granuloma (through biopsy and histology) or elevated levels of pleural fluid adenosine deaminase (ADA) or interferon-γ, considering the clinical context of the patient (Trajman et al. , 2008).Since its discovery in 1978, adenosine deaminase(ADA) test on pleural fluid has become famous in diagnosis of TBP, more so in patients with exudative and lymphocytic pleural effusion in high TB endemic areas (Aggarwal et al. , 2019). The test is simple, affordable, rapid and minimally invasive (LIGHT, 2010). ADA levels greater or equal to 40 IU/L are associated with a sensitivity of 87.8 to 97.6% and specificity of 90.4 to 92.4 % (Huan et al. , 2021). However, in low and middle income settings the test hasn’t been embraced because of laboratory inadequacies and lack of knowledge about it, and fear of false positives, majorly malignancy, empyema, Para-pneumonic, collagen diseases, (Valdés et al. , 1993) and rheumatoid pleuritis (Hooper, Lee and Maskell, 2010).We present and discuss a case of TBP diagnosed by pleural ADA, in a 28-year-old woman who acquired symptoms during pregnancy through delivery. We also put forward the advantage and applicability of this test amidst lack of thoracoscopy services in Uganda and other low resource settings.

Dry Needling in the Management of Chronic Tension Type Headache Associated with

A document by Estiven Crespo Vizcaíno. Click on the document to view its contents.

Cerebral venous sinus thrombosis in patient of Immune thrombocytopenic purpura managed with mechanical thrombectomy: an anecdotal endovascular experience from Lower middle income country Corresponding author:Sagun Ghimire, MBBS,Department of Neurosurgery , B and B hospital, Gwarko, Lalitpur, Nepal, +977 9846709636, [email protected] list :1Sagun ghimire,MBBS,Department of Neurosurgery, B and B hospital,Gwarko, Lalitpur, Nepal1Shikher Shrestha,MBBS,FCPS, Department of Neurosurgery, B and B hospital, Gwarko,Lalitpur,Nepal1Dinuj Shrestha,MBBS,FCPS, Department of Neurosurgery, B and B hospital, Gwarko,Lalitpur,Nepal1Kajan Ranabhat,MBBS,MD, Department of Radiology, B and B hospital, Gwarko, Lalitpur,Nepal1Suman Bhattarai,MBBS,MD,Department of neuroscience, B and B hospital, Gwarko, Lalitpur,Nepal1Ananta maharjan, MBBS,MS,Department of Neurosurgey,B and B hospital, Gwarko,Lalitpur,Nepal2Bibek Jaiswal,MBBS,Department of Neurosurgery ,B and B hospital, Gwarko,Lalitpur, Nepal2Prabin chaudhary,MBBS,Department of Neurosurgery,B and B hospital, Gwarko, Lalitpur, NepalAbstract:Key Clinical MessageThe concurrent association of cerebral venous sinus thrombosis and immune thrombocytopenic purpura is one of the rarest occurrences. There exist very scarce evidence based medical literature regarding pathophysiology resulting cerebral venous sinus thrombosis in patients of immune thrombocytopenic purpura hence there lacks standard guidelines guiding prompt management in such cases.Keywords: Cerebral venous sinus thrombosis, Immune thrombocytopenic purpura, Mechanical thrombectomy

Wearable cardioverter-defibrillator (WCD) is an excellent treatment option for patients with temporary increased arrhythmic risk. In presented case, 68-year-old patient was treated with WCD due to acute myocarditis. Telemonitoring revealed recurrent wide-QRS complex tachycardia which led to urgent hospitalization and clinical reevaluation. In electrophysiological study, orthodromic atrio-ventricular reentrant tachycardia with aberrancy

Epidermolysis Bullosa Pruriginosa Treated with Baricitinib：A Case ReportZhe He1, PhDQian Dong1, PhDYue Xi 1, PhDRui Zheng2, PhD1 Shanxi Medical University, Taiyuan, Shanxi, China; 2Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.Correspondence: Rui Zheng, Email:[email protected]: Epidermolysis Bullosa PruriginosaJAK-STAT: Janus kinase-signal transducer and activator of transcriptionJAK: Janus kinaseDEB: Dystrophic Epidermolysis BullosaVAS: The Visual Analogue ScalAbstract : Introduction: Fewer than 100 cases of Epidermolysis Bullosa Pruriginosa(EBP) have been reported to date. Numerous inflammatory dermatoses are driven by soluble inflammatory mediators, which rely on Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling, and inhibition of this pathway using Janus kinase (JAK) inhibitors might be a useful therapeutic strategy for these diseases. Chronic inflammation is a hallmark of Dystrophic Epidermolysis Bullosa (DEB), thus upregulation of inflammatory cytokines and JAK signaling may play a role in DEB-related pruritus. EBP is a persistent, recurring disease that seriously affects quality of life. Patient concerns: A male patient, 28 years of age, was admitted to our hospital because of recurrent papules, nodules, and intense itching on the trunk and extremities for 12 years. Repeated large and intense itching for 12 years has seriously affected the patient’s normal life.Diagnosis: The patient was diagnosed with Epidermolysis Bullosa Pruriginosa based on examination results. interventions: Oral baricitinib tablets (2 mg, once a day) + Oral desloratadine citrate disodium tablets (8.8 mg, once a day) combined with topical compound flumethasone ointment and Fucidin cream. outcomes: The patient’s skin rashes had subsided and flattened significantly, and his itching was markedly relieved. The Visual Analogue Scal (VAS) itching score of the patient had gradually declined from 8–9 points to 2–3 points. Conclusion : this study confirms that baricitinib is effective and feasible in treating EBP, especially in significantly relieving itching, which rendered new ideas for therapeutic approaches for EBP in the future.Keywords: Epidermolysis Bullosa, kinase inhibitors, Baricitinib Treatment

IntroductionEpithelioid hemangioendothelioma (EHE) is a rare vascular tumour that originates from vascular endothelial or pre-endothelial cells. Its demographic characteristics are unclear and there is no racial and sex predilection,8The overall incidence of EHE is 0.230 per 1000000 person-years.8 EHE in general affects patients in the age range 16-74 years but EHE of the bone is more prevalent in the third and fourth decade of life.2,3,5EHE can develop in any part of the body but is reported to more frequently in the liver (34%), lungs (21%), bone (19%) and other sites (26%). 1.,2 It was first described and named in 1982 by Weiz and Enzinger and is classified in the 2020 WHO classification of bone tumours as a low-to-intermediate grade neoplasm.2.,3 Malignant vascular bone tumours are rare and constitute less than 1% of primary bone tumours.3 Bone involvement usually involves the lower extremity (62%), upper extremities (14%) and vertebra (10%)3. As such primary EHE of the spine is very uncommon, with the thoracic spine most likely to be involved followed by cervical, lumbar, and sacral levels in order of decreasing frequency3.Here we report on a 26-year-old female with thoracic T2 and T3 lesions in keeping with primary EHE of the spine, her clinical presentation, work up including laboratory, immunohistopathological and imaging studies. We also conclude on her management and current condition. There are currently no prior clinical case reports on primary EHE of the spine in South Africa or Africa as a whole.

Magnesium sulfate poisoning treated with hemodialysis: a case report

A document by Walaa Abu Alya. Click on the document to view its contents.

Oropharyngeal Burkitt lymphoma masquerading as oropharyngeal carcinoma in an adult: A diagnostic challengeDr. Sudeep KC1 | Dr. Himani Poudyal2