Introduction:Intensive glycaemic control is essential for managing Type 1 Diabetes Mellitus (T1DM), yet rapid metabolic optimization can trigger Treatment-Induced Neuropathy of Diabetes (TIND). This iatrogenic condition, characterized by acute neuropathic pain and autonomic dysfunction, is increasingly relevant with the use of advanced automated insulin delivery (AID) systems. Case Presentation:A 19-year-old male with a 10-year history of poorly controlled T1DM (baseline HbA1c 13.7%) was transitioned to an automated hybrid closed-loop system (Medtronic MiniMed 780G). Following a rapid HbA1c reduction of 6.3% over six weeks, the patient developed severe, "electric shock-like" neuropathic pain in the lower limbs and upper back without associated autonomic nervous system involvement. Nerve conduction studies confirmed a length-dependent sensorimotor axonal polyneuropathy. The patient's pain was refractory to duloxetine but showed significant improvement with gabapentin alongside clinical recovery observed over 4 weeks. To stabilize glucose levels, the AID system was discontinued in favor of a less intensive multiple daily injection (MDI) regimen. Conclusion:Rapid glycemic correction in patients with high baseline HbA1c carries a significant risk of TIND. Clinicians should consider close monitoring and individualized adjustment of blood glucose descent in high-risk individuals, even when utilizing advanced AID systems, to prevent debilitating neurological complications.
Background:Bicornuate uterus is a rare congenital uterine anomaly that occurs due to incomplete fusion of the mullerian ducts during fetal development, resulting in a single cervix and two uterine horns with partial to complete separation with or without communication between the cavities. Pregnancy in a rudimentary non-communicating uterine horn of a bicornuate uterus is an even rare occurrence, usually due to transperitoneal migration of sperms or zygote, and it is often associated with fetal demise and uterine rupture. We report a case of a bicornuate uterus unicollis with a third-trimester fetal demise in a non-communicating rudimentary uterine horn with focus on diagnosis, investigations and management in a low resource setting. Case Presentation:The patient was a 24-year-old Ugandan, gravida 2 para 0+1 at 29 weeks of gestation who presented with abdominal pain for 3 days. She had a history of dyspareunia, dysmenorrhea, and a first-trimester miscarriage four years ago. Laparotomy for an abdominal ectopic pregnancy revealed a bicornuate uterus with a gravid non-communicating rudimentary uterine horn containing a dead fetus. Resection of the right non-communicating uterine horn was done with preservation of the right ovary. Conclusion:Despite the rarity and difficulty in the diagnosis of uterine anomalies in low-resource settings, it is important for clinicians, especially obstetricians and gynecologists, to be aware of a bicornuate uterus with a non-communicating rudimentary horn pregnancy that can lead to fetal demise and uterine rupture. Early antenatal diagnosis by ultrasonography is crucial in prevention of future obstetric complications in low resource settings.
Frans Arvindo Irapanussa,1 Arif Satria Prabowo,2 Raden Kania Praharsini11Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital - Padjadjaran University, Bandung, Indonesia; 2Department of Obstetrics and Gynecology, Slamet General Hospital, Garut, IndonesiaCorrespondence: Frans Arvindo Irapanussa, Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital-Padjadjaran University, Pasteur 38, Bandung, Indonesia, Tel +6282115726908, Email arvindoirapanussa@gmail.comBackground: Pelvic organ prolapse (POP) results from weakness of pelvic floor support structures and may significantly impair quality of life. Multiparity and vaginal delivery are major risk factors for uterine prolapse. We report a rare case of stage IV uterine prolapse in a primiparous postmenopausal woman, highlighting the potential contribution of advanced age and postmenopausal status despite the absence of multiparity.Case Presentation: A 58-year-old primiparous (P1A0) postmenopausal woman presented with a two-year history of a vaginal bulge that had progressively worsened over the preceding two months and became irreducible. She reported incomplete bladder emptying, straining during micturition, weak urinary stream, and persistent vaginal discomfort after pessary insertion. Pelvic examination revealed stage III anterior vaginal wall prolapse, stage IV uterine prolapse, stage III posterior compartment prolapse, and cervical elongation. The patient underwent total vaginal hysterectomy (TVH) with anterior colporrhaphy. Her postoperative course was uneventful, with stable clinical condition, adequate pain control, no significant bleeding, and satisfactory recovery.Discussion: Surgical management was selected because of advanced prolapse, persistent symptoms, and unsuccessful conservative treatment with a pessary. In this postmenopausal patient, uterine preservation was not a priority. The transvaginal approach enabled direct management of the prolapsed uterus while simultaneously restoring apical and anterior compartment support.Conclusion: Total vaginal hysterectomy with anterior colporrhaphy can effectively treat advanced uterine prolapse involving multiple compartments in postmenopausal women with persistent symptoms following unsuccessful conservative treatment.Keywords: uterine prolapse, pelvic organ prolapse, total vaginal hysterectomy, anterior colporrhaphy
Claudia Corda,1,* Filippo Lixi,1,2,* Antonio Budroni,1 Mara-Ioana Tomi,3 Alina-Gabriela Gheorghe,3 Giuseppe Giannaccare11Ophthalmology Unit, Department of Surgical Sciences, University of Cagliari, Cagliari, 09124, Italy; 2Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, 09124, Italy; 3Department of Ophthalmology, Clinical Institute of Ophthalmological Emergencies, Bucharest, 010464, Romania*These authors contributed equally to this workCorrespondence: Giuseppe Giannaccare, Full Professor of Ophthalmology and Chairman of Eye Clinic, Director of Ophthalmology Residency Program, Ophthalmology Unit, Department of Surgical Sciences, University of Cagliari, Cagliari, 09124, Italy, Tel +0039 3317186201, Email giuseppe.giannaccare@gmail.comPurpose: To report a case of refractory herpes simplex virus keratitis (HSVK) complicated by keratolysis and severe stromal thinning in a patient with rheumatoid arthritis (RA) under treatment with methotrexate (MTX).Observations: A 79‑year‑old patient with a history of HSVK and RA, treated with weekly MTX, presented with pain and photophobia in the right eye. Best‑corrected visual acuity (BCVA) was limited to counting fingers. Slit‑lamp examination revealed a supero-nasal corneal ulcer (area of 2.98 mm2) with deep stromal involvement and keratolysis. A recurrent episode of HSVK was diagnosed, and treatment with 3 times daily oral acyclovir, 4 times daily 0.15% ganciclovir ophthalmic gel, and 3 times daily 0.15% topical dexamethasone was started. After one week, the picture worsened with corneal thinning (corneal thinnest point [CTP] 82 μm) and anterior chamber fibrin. Cycloplegic therapy 3 times daily was added. Considering the refractory course, the history of recurrent HSVK, and the concomitant systemic immunomodulation, the MTX injection scheduled for the subsequent weeks was interrupted. After 2 weeks, conjunctival hyperemia improved (Efron grade II) and a progressive increase of corneal thickness (CTP 199 μm) was documented. Two months later, complete healing was achieved with no signs of active inflammation or recurrence; BCVA improved to 0.4 LogMAR, with mild residual stromal thinning and opacity (CTP 231 μm).Conclusion and Importance: This case underscores how systemic immunomodulatory treatment may play a clinically relevant role in patients with recurrent HSVK. In selected cases, a conservative, surgery‑sparing approach through the optimization of systemic therapy can help promoting viral load control and corneal healing.Keywords: herpes simplex virus keratitis, herpes virus, stromal herpetic keratitis, rheumatoid arthritis, corneal ulcer, methotrexate
Abdisamed Mohamoud H Ali,1,2 Ahmed Osman Mohamed,2 Khadar Jama Ibrahim1,21Emergency Department, Hargeisa Group Hospital, Hargeisa, Somaliland; 2School of Medicine and Surgery, College of Health Sciences, Amoud University, Borama, SomalilandCorrespondence: Abdisamed Mohamoud H Ali, Email 13988@amoud.edu.soBackground: Lithopedion is an exceptionally rare complication of abdominal pregnancy in which a deceased fetus becomes calcified following prolonged retention in the maternal abdomen. Because of its indolent course and nonspecific symptoms, it is frequently diagnosed late, particularly in resource-limited settings.Case Presentation: We report a 42-year-old multiparous woman (gravida 4, para 3) who presented with a three-year history of chronic lower abdominal pain and progressive abdominal heaviness. She had a remote history suggestive of an untreated pregnancy that spontaneously ceased without medical evaluation. Clinical examination revealed a firm, irregular, non-mobile abdominopelvic mass extending to the umbilical level. Laboratory investigations revealed mild anemia (hemoglobin 9.0 g/dL), while serum β-hCG was < 5 mIU/mL (negative). Ultrasonography demonstrated a calcified abdominopelvic mass with an empty uterine cavity. Contrast-enhanced computed tomography with three-dimensional reconstruction demonstrated a well-defined calcified extrauterine fetal skeleton consistent with lithopedion. Intraoperative findings met Studdiford’s criteria; however, because these criteria were applied retrospectively several years after the index pregnancy, the underlying gestation is described as a presumed primary abdominal pregnancy.Management and Outcome: The patient underwent exploratory laparotomy with complete surgical excision of the calcified fetus without intraoperative complications. Postoperative recovery was uneventful, and the patient demonstrated complete resolution of symptoms at follow-up.Conclusion: Lithopedion should be considered in women presenting with chronic abdominal or pelvic symptoms and a history suggestive of prior untreated pregnancy. In this patient, cross-sectional imaging, and particularly CT with three-dimensional reconstruction, was valuable for characterizing the lesion and planning surgery, although ultrasonography and magnetic resonance imaging may be sufficient in other circumstances. Surgical management in symptomatic cases can result in excellent outcomes even in resource-limited settings.Keywords: lithopedion, abdominal pregnancy, ectopic pregnancy, calcified fetus, CT imaging, resource-limited setting
Background:Spinal mucormycosis is a rare but potentially fatal fungal infection that is often observed in immunocompromised patients, particularly in those with poorly controlled diabetes or other systemic conditions. Early diagnosis and treatment are crucial for improving patient outcomes. Case Presentation:A 55-year-old male with poorly controlled diabetes mellitus presented with throat pain, chest tightness, and dyspnea. Over the course of one year, the patient experienced repeated hospitalizations for pneumonia and pleural effusion, and subsequently developed a spinal abscess following a traditional cupping procedure. Imaging revealed severe spinal cord compression and abscess formation, extending from the thoracic spine. Initial treatment with antibiotics did not yield a significant improvement, and further imaging suggested possible tuberculosis. However, histopathological examination after thoracic spinal laminectomy confirmed the presence of mucormycosis. Management:The patient was initially started on empiric intravenous fluconazole, which was discontinued upon confirmation of mucormycosis. Definitive therapy with intravenous liposomal amphotericin B was then initiated, along with broad-spectrum intravenous antibiotics for possible secondary bacterial infection. Thoracic spinal laminectomy was performed; however, despite treatment, no recovery from paraplegia was observed, and the patient was discharged after several months of care. Discussion:Mucormycosis can present insidiously, mimicking bacterial or tuberculous infections, making early diagnosis difficult. In this case, delayed identification and treatment of the fungal infection allowed it to spread, leading to severe complications. The importance of maintaining a high index of suspicion for fungal infections in immunocompromised individuals is emphasized, particularly when standard therapies fail. Conclusion:Spinal mucormycosis is a rare but serious condition that requires prompt diagnosis and aggressive management. This case underscores the need for early recognition and a multidisciplinary approach for managing infections involving both medical and surgical interventions. Timely initiation of antifungal therapy is critical for improving patient outcomes and reduce mortality.
Josef FinstererNeurology & Neurophysiology Center, Vienna, AustriaCorrespondence: Josef Finsterer, Email fifigs1@yahoo.de
Abubakr Sowilem,1 Hebatallah Nasser Fadhl,2 Muhammad Taha Zaman,3 Shatha Ahmad Alhawawreh,4 Shehab Hashem Elsoghier,5 Preeny Treesa Pauly,6 Mohammed Ali Saghir7,81Department of Endocrinology, Al Sabah Hospital, Kuwait City, Kuwait; 2Faculty of Medicine, Al-Fajr College for Science and Technology, Khartoum, Sudan; 3Coventry University, Coventry, UK; 4Jordan University of Science and Technology (JUST), Irbid, Jordan; 5Faculty of Medicine, Modern University for Technology & Information (MTI), Cairo, Egypt; 6Sarat Abeidha General Hospital, Aseer Cluster, Sarat Abidah, Saudi Arabia; 7Faculty of Medicine and Health Sciences, University of Saba Region, Marib, Yemen; 8Epidemiology and Public Health, Graduate College, University of Bahri, Khartoum, SudanCorrespondence: Mohammed Ali Saghir, Faculty of Medicine and Health Sciences, University of Saba Region, Marib, Yemen, Tel +967775133235, Email moh.saghir2019@gmail.comIntroduction: Intensive glycaemic control is essential for managing Type 1 Diabetes Mellitus (T1DM), yet rapid metabolic optimization can trigger Treatment-Induced Neuropathy of Diabetes (TIND). This iatrogenic condition, characterized by acute neuropathic pain and autonomic dysfunction, is increasingly relevant with the use of advanced automated insulin delivery (AID) systems.Case Presentation: A 19-year-old male with a 10-year history of poorly controlled T1DM (baseline HbA1c 13.7%) was transitioned to an automated hybrid closed-loop system (Medtronic MiniMed 780G). Following a rapid HbA1c reduction of 6.3% over six weeks, the patient developed severe, "electric shock-like” neuropathic pain in the lower limbs and upper back without associated autonomic nervous system involvement. Nerve conduction studies confirmed a length-dependent sensorimotor axonal polyneuropathy. The patient’s pain was refractory to duloxetine but showed significant improvement with gabapentin alongside clinical recovery observed over 4 weeks. To stabilize glucose levels, the AID system was discontinued in favor of a less intensive multiple daily injection (MDI) regimen.Conclusion: Rapid glycemic correction in patients with high baseline HbA1c carries a significant risk of TIND. Clinicians should consider close monitoring and individualized adjustment of blood glucose descent in high-risk individuals, even when utilizing advanced AID systems, to prevent debilitating neurological complications.Keywords: diabetes mellitus, glycemic control, neuropathic pain, iatrogenic and automated insulin delivery
A rare case of a late-diagnosed life-threatening second-trimester uterine rupture in a 26-year-old nulliparous woman (G2P0) with a non-scarred uterus at 20+4 weeks of gestation. Her history was significant for a spontaneous abortion, 17 months prior, managed by instrumental curettage. Initially managed as threatened miscarriage over 10 days, the patient was transferred in Stage IV hypovolemic shock. Ultrasound and diagnostic abdominal paracentesis revealed a massive hemoperitoneum and a non-viable fetus in the peritoneal cavity. An emergency laparotomy identified an anterofundal arcuate rupture on a suspected fundal placenta percreta spectrum. We performed a subtotal hemostatic hysterectomy. Five episodes of cardiac arrest complicated the procedure. Following intensive resuscitation and transfusions, the patient stabilized and was later discharged in good condition. Prior curettage was the plausible cause of focal decidual defects, facilitating deep trophoblastic invasion with a placenta percreta spectrum. High index of suspicion for an eventual mid-gestation spontaneous uterine rupture must be considered in patients with prior instrumentation history.
Introduction:Penetrating gunshot injuries to the head are among the most severe forms of traumatic brain injury and are associated with high morbidity and mortality. This case report describes a 40-year-old female who presented to the emergency department 2 hours after sustaining a penetrating cranio-cerebral gunshot injury. The patient experienced loss of consciousness at the time of injury. On admission, with a Glasgow Coma Scale score of 10/15 and no focal neurological deficits. Vital signs were stable.Non-contrast head CT of the brain revealed a retained bullet in the parietal lobe without evidence of intracranial hemorrhage, mass effect, or midline shift, although image interpretation was limited by metallic artifact. The patient underwent an emergency craniotomy for removal of the retained intracranial bullet. Extreme caution was exercised to preserve the superior sagittal sinus and avoid vascular injury during the procedure. The surgery was completed without complications, and the patient was subsequently monitored in the intensive care unit). Follow-up CT imaging confirmed complete bullet removal and preservation of the superior sagittal sinus. Clinically, the patient showed neurological improvement, with her GCS increasing to 15/15. Conclusion:This case highlights the importance of early clinical stabilization, rapid neuroimaging, and timely neurosurgical intervention in improving outcomes following penetrating cranial gunshot injuries. Favorable neurological recovery can be achieved through surgical planning and timely intervention, even when a retained intracranial bullet is located in close proximity to critical neurovascular structures.
The accidental ingestion of automotive lubrication grease presents a distinct clinical challenge due to its high-viscosity semi-solid matrix and thickener profile. They are chemically complex, characterized by long, open carbon chains, a metallic salt group, and potentially toxic polycyclic aromatic hydrocarbons (PAHs). Given its common domestic availability, automotive grease represents a source of potential accidental poisoning. This report details the case of a 5-year-old girl who ingested automotive lubrication grease and subsequently developed acute gastroenteritis. Her symptoms included abdominal pain, excessive bowel movements, excessive salivation, and belching. At presentation, she was fully conscious but displayed irritability and stress. Initial investigations proved inconclusive, failing to yield a definitive diagnosis. Patient stabilization was successfully achieved through oral water intake for irrigation and intravenous fluid administration. Significant improvement was observed following the administration of ondansetron and prednisolone. A complete remission occurred once the ingested substance was passed in the stools. This is a rare and significant clinical presentation of pediatric ingestion of automotive grease with successful conservative management. The case emphasizes the importance of timely intervention and meticulous follow-up in managing unusual toxic exposures in emergency settings.
Background:Acute Stanford type A aortic dissection carries 1-2% hourly mortality if medically managed. Misdiagnosis as hypertensive emergency delays surgery. In African settings without immediate computed tomography angiography (CTA) access, bedside echocardiography guides triage. Case Presentation:A 58-year-old man with uncontrolled hypertension presented to the emergency department of the Federal Teaching Hospital, Owerri, Nigeria, with sudden tearing chest and back pain, diaphoresis, and dyspnea. Blood pressure was asymmetric at 210/115 mmHg in the right arm versus 180/100 mmHg in the left arm, with a new grade 2/6 early diastolic murmur of aortic regurgitation. Electrocardiography showed nonspecific ST-T changes. Chest radiography revealed cardiomegaly (cardiothoracic ratio 0.65) and mediastinal widening exceeding 8 cm. Serial troponin I remained negative at presentation and at 3 hours. Transthoracic echocardiography demonstrated aortic root dilatation to 5.4 cm, ascending aorta dilatation to 6.3 cm with intimal flap visualization, severe aortic regurgitation (vena contracta 0.70 cm), and mild pericardial effusion findings highly suggestive of suspected Stanford type A aortic dissection. Intravenous labetalol reduced heart rate to 55-60 beats per minute, followed by nicardipine titrated to systolic blood pressure 120-130 mmHg, stabilizing the patient for surgical referral. Conclusion:Blood pressure asymmetry, aortic regurgitation murmur, chest radiographic widening, and echocardiographic intimal flap enable recognition of suspected type A aortic dissection without CTA, preventing misclassification as hypertensive emergency.
Bwire Innocent,1 Fardowso Dahir Warsame,1 Ayan Hussein Hashi Snr,1 Fatima Abdallah Noor,1 Mohamed Abdi Deheyeh,1 Qabul Isse Omar Snr,1 Namujju Josephine,1 Okurut Emmanuel,1 Baruti Petrus,1,2 Theoneste Hakizimana,1 Adam Abdrahim Suliman Ebaid11Department of Obstetrics and Gynaecology, Kampala International University-Teaching Hospital, Ishaka, Western Region, Uganda; 2Department of Obstetrics and Gynaecology, Jinja Regional Referral Hospital, Jinja, Eastern Region, UgandaCorrespondence: Bwire Innocent, Email innocent.bwire@gmail.comBackground: Bicornuate uterus is a rare congenital uterine anomaly that occurs due to incomplete fusion of the mullerian ducts during fetal development, resulting in a single cervix and two uterine horns with partial to complete separation with or without communication between the cavities. Pregnancy in a rudimentary non-communicating uterine horn of a bicornuate uterus is an even rare occurrence, usually due to transperitoneal migration of sperms or zygote, and it is often associated with fetal demise and uterine rupture. We report a case of a bicornuate uterus unicollis with a third-trimester fetal demise in a non-communicating rudimentary uterine horn with focus on diagnosis, investigations and management in a low resource setting.Case Presentation: The patient was a 24-year-old Ugandan, gravida 2 para 0+1 at 29 weeks of gestation who presented with abdominal pain for 3 days. She had a history of dyspareunia, dysmenorrhea, and a first-trimester miscarriage four years ago. Laparotomy for an abdominal ectopic pregnancy revealed a bicornuate uterus with a gravid non-communicating rudimentary uterine horn containing a dead fetus. Resection of the right non-communicating uterine horn was done with preservation of the right ovary.Conclusion: Despite the rarity and difficulty in the diagnosis of uterine anomalies in low-resource settings, it is important for clinicians, especially obstetricians and gynecologists, to be aware of a bicornuate uterus with a non-communicating rudimentary horn pregnancy that can lead to fetal demise and uterine rupture. Early antenatal diagnosis by ultrasonography is crucial in prevention of future obstetric complications in low resource settings.Keywords: case report, uterus bicornuate non-communicant rudimentary horn, rudimentary uterine horn pregnancy, fetal demise, laparotomy, Uganda
Salah Eldin Abdel Hag Abdel Haleem1– 31Department of Pharmacology, Faculty of Medicine, Al-Baha University, Al-Baha, Kingdom of Saudi Arabia; 2Department of Pharmacology, Faculty of Medicine, University of Bahri, Khartoum, Sudan; 3Center for Addiction Sciences, Universiti Malaya, Federal Territory, Kuala Lumpur, MalaysiaCorrespondence: Salah Eldin Abdel Hag Abdel Haleem, Email salahaque@yahoo.comAbstract: The accidental ingestion of automotive lubrication grease presents a distinct clinical challenge due to its high-viscosity semi-solid matrix and thickener profile. They are chemically complex, characterized by long, open carbon chains, a metallic salt group, and potentially toxic polycyclic aromatic hydrocarbons (PAHs). Given its common domestic availability, automotive grease represents a source of potential accidental poisoning. This report details the case of a 5-year-old girl who ingested automotive lubrication grease and subsequently developed acute gastroenteritis. Her symptoms included abdominal pain, excessive bowel movements, excessive salivation, and belching. At presentation, she was fully conscious but displayed irritability and stress. Initial investigations proved inconclusive, failing to yield a definitive diagnosis. Patient stabilization was successfully achieved through oral water intake for irrigation and intravenous fluid administration. Significant improvement was observed following the administration of ondansetron and prednisolone. A complete remission occurred once the ingested substance was passed in the stools. This is a rare and significant clinical presentation of pediatric ingestion of automotive grease with successful conservative management. The case emphasizes the importance of timely intervention and meticulous follow-up in managing unusual toxic exposures in emergency settings.Keywords: pediatric toxicology, hydrocarbon ingestion, petroleum distillate, supportive treatment, emergency medicine
Hussein Salad Yusuf,1 Mohamed Said Adan,1 Abdirisak Ali Abukar,1 Raqiib Abdirahman Mubarik,1 Abdiaziz Siad Mohamed,1 Zakariye Yusuf Mohamed,1 Mustaf Abdi Ulusow,1 Sharmarke Hassan Ali,2 Liban Ade Huseein,3 Mohamed Osman Dahir,4 Ismail Mohamoud Abdullahi51Department of Neurosurgery, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia; 2Department of Thoracic Surgery, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia; 3Department of Infectious Diseases, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia; 4Department of Radiology, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia; 5Department of Pathology, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Hussein Salad Yusuf, Email husseinsaladyusuf@gmail.comBackground: Spinal mucormycosis is a rare but potentially fatal fungal infection that is often observed in immunocompromised patients, particularly in those with poorly controlled diabetes or other systemic conditions. Early diagnosis and treatment are crucial for improving patient outcomes.Case Presentation: A 55-year-old male with poorly controlled diabetes mellitus presented with throat pain, chest tightness, and dyspnea. Over the course of one year, the patient experienced repeated hospitalizations for pneumonia and pleural effusion, and subsequently developed a spinal abscess following a traditional cupping procedure. Imaging revealed severe spinal cord compression and abscess formation, extending from the thoracic spine. Initial treatment with antibiotics did not yield a significant improvement, and further imaging suggested possible tuberculosis. However, histopathological examination after thoracic spinal laminectomy confirmed the presence of mucormycosis.Management: The patient was initially started on empiric intravenous fluconazole, which was discontinued upon confirmation of mucormycosis. Definitive therapy with intravenous liposomal amphotericin B was then initiated, along with broad-spectrum intravenous antibiotics for possible secondary bacterial infection. Thoracic spinal laminectomy was performed; however, despite treatment, no recovery from paraplegia was observed, and the patient was discharged after several months of care.Discussion: Mucormycosis can present insidiously, mimicking bacterial or tuberculous infections, making early diagnosis difficult. In this case, delayed identification and treatment of the fungal infection allowed it to spread, leading to severe complications. The importance of maintaining a high index of suspicion for fungal infections in immunocompromised individuals is emphasized, particularly when standard therapies fail.Conclusion: Spinal mucormycosis is a rare but serious condition that requires prompt diagnosis and aggressive management. This case underscores the need for early recognition and a multidisciplinary approach for managing infections involving both medical and surgical interventions. Timely initiation of antifungal therapy is critical for improving patient outcomes and reduce mortality.Keywords: mucormycosis, traditional cupping procedure, diabetes mellitus, spinal involvement, paraplegia, surgical treatment, case report
Background:Pediatric varicocele is most often recognized during adolescence; presentation at a younger age or with atypical features should prompt consideration of secondary causes. Nutcracker syndrome (NCS) is the symptomatic clinical consequence of left renal vein (LRV) compression and may produce collateral gonadal venous reflux. Case Presentation:A 10-year-old boy presented with a 6-month history of painless left scrotal swelling. Examination demonstrated a soft "bag of worms" mass that became more prominent with standing and the Valsalva maneuver. Urinalysis showed no hematuria or proteinuria. Scrotal Doppler ultrasonography demonstrated left pampiniform plexus veins measuring up to 3.31 mm with reflux. Because of the patient's young age, abdominal Doppler evaluation was extended to the renal venous circulation and demonstrated focal LRV compression between the aorta and superior mesenteric artery with marked prestenotic dilatation. The aortomesenteric angle was 8.58°, the hilar-to-compressed LRV diameter ratio was approximately 10.9:1 (5.34 mm/0.49 mm), and peak systolic velocity at the compressed segment was approximately 91.2 cm/s. The combined clinical and Doppler findings supported anterior NCS with associated left-sided varicocele. Conclusion:This report does not claim a novel NCS-varicocele association. Its educational value lies in demonstrating a practical Doppler pathway from an apparently isolated scrotal finding to an upstream vascular cause in a young child with normal urinalysis. Morphologic and hemodynamic ultrasound findings should be interpreted together with the clinical presentation.
Liban Hussein Ahmed,1,2 Tadese Kebede Nadew,3 Esmail Husein Mohamud,4,5 Ifrah Hassan Nur,3 Abdirafi Said Elmi,2,3 Abdullahi Ali Muse,4 Mohamed Osman Alim41Intensive Care Unit Department, Jazeera Specialist Hospital, Mogadishu, Somalia; 2Faculty of Medicine, Jazeera University, Mogadishu, Somalia; 3Department of Neurosurgery, Jazeera Specialist Hospital, Mogadishu, Somalia; 4Internal Medicine and Gastroenterology Department, Jazeera Specialist Hospital, Mogadishu, Somalia; 5Faculty of Medicine, Somali National University, Mogadishu, SomaliaCorrespondence: Liban Hussein Ahmed, Intensive Care Unit Department, Jazeera Specialist Hospital, Mogadishu, Somalia, Email liban1909@gmail.comIntroduction: Penetrating gunshot injuries to the head are among the most severe forms of traumatic brain injury and are associated with high morbidity and mortality. This case report describes a 40-year-old female who presented to the emergency department 2 hours after sustaining a penetrating cranio-cerebral gunshot injury. The patient experienced loss of consciousness at the time of injury. On admission, with a Glasgow Coma Scale score of 10/15 and no focal neurological deficits. Vital signs were stable.Non-contrast head CT of the brain revealed a retained bullet in the parietal lobe without evidence of intracranial hemorrhage, mass effect, or midline shift, although image interpretation was limited by metallic artifact. The patient underwent an emergency craniotomy for removal of the retained intracranial bullet. Extreme caution was exercised to preserve the superior sagittal sinus and avoid vascular injury during the procedure. The surgery was completed without complications, and the patient was subsequently monitored in the intensive care unit). Follow-up CT imaging confirmed complete bullet removal and preservation of the superior sagittal sinus. Clinically, the patient showed neurological improvement, with her GCS increasing to 15/15.Conclusion: This case highlights the importance of early clinical stabilization, rapid neuroimaging, and timely neurosurgical intervention in improving outcomes following penetrating cranial gunshot injuries. Favorable neurological recovery can be achieved through surgical planning and timely intervention, even when a retained intracranial bullet is located in close proximity to critical neurovascular structures.Keywords: penetrating traumatic brain injury, retained intracranial bullet, superior sagittal sinus injury, craniotomy
Introduction:Cervical polyps are common benign lesions, typically found in women of reproductive age. While often asymptomatic, they may lead to abnormal uterine bleeding and secondary complications such as anemia. Diagnosis is usually confirmed through transvaginal ultrasound or hysteroscopy; however, these methods pose challenges in virgin women, necessitating alternative diagnostic and therapeutic approaches. This case underscores several clinically relevant considerations. First, cervical polyps, though uncommon in young nulliparous women, should be considered in cases of refractory abnormal bleeding. Second, in settings where hysteroscopic resection is unavailable, transabdominal polypectomy offers a safe and effective solution for preserving anatomical integrity. The patient's presentation with severe metrorrhagia and anemia was particularly notable, as cervical polyps in this demographic typically manifest with milder symptoms. Case Presentation:We report the case of a 22-year-old virgin Syrian woman with a six-year history of heavy menstrual bleeding and intermenstrual bleeding, unresponsive to medical management. Upon admission, she presented with severe anemia (hemoglobin: 7.5 g/dL), requiring blood transfusion. Pelvic magnetic resonance imaging (MRI) identified a large cervical polyp, later confirmed as a benign adenomatous lesion on histopathology. Given the patient's virginity and restricted vaginal access, an abdominal polypectomy was performed leading to complete resolution of symptoms. Conclusion:Cervical polyps, though rare in adolescents and young nulliparous women, warrant consideration in cases of unexplained gynecologic bleeding. A thorough diagnostic workup, including advanced imaging when necessary, is essential for accurate identification. While vaginal polypectomy remains the standard treatment, transabdominal resection represents a viable alternative for patients where vaginal access is limited. This case highlights the importance of individualized management in optimizing patient outcomes.
Background:Pleomorphic adenoma is the most common benign salivary gland tumor of the head and neck, predominantly affecting the parotid gland. Although minor salivary gland tumors are less common, the palate is a notable site, while involvement of the hard palate remains relatively rare. Complete surgical excision is the mainstay of treatment, with postoperative wound care or reconstruction tailored to the resulting defect. Although postoperative infection following oral surgery is uncommon, the risk increases with extensive tissue manipulation, flap elevation, bone exposure, or use of foreign materials and surgical packing. Infection associated with intraoral packing after excision of a palatal pleomorphic adenoma is exceptionally rare and may present challenges in postoperative management, highlighting the need for early recognition and a structured, evidence-informed approach to treatment. Case Presentation:We describe a case of a 29-year-old Ankole male who presented with a painless swelling in the oral cavity that had slowly increased in size over three years. Clinical and radiological evaluations suggested a benign tumor arising from the palatal salivary glands. Surgical excision was performed, and absorbable intraoral packing was placed in the surgical wound. The histopathological examination provided the diagnosis of pleomorphic adenoma. On the fifth day after surgery, the patient developed clinical signs of surgical site infection. The packing was removed, wound care was continued, and antimicrobial treatment was administered. His condition improved progressively, and complete wound healing was achieved after three weeks of daily dressing. Conclusion:This report presents an uncommon postoperative complication following excision of pleomorphic adenoma of a minor salivary gland of the hard palate. Infection of intraoral packing complicated the early postoperative course, but removal of the infected material, antibiotics, and regular local wound care led to satisfactory recovery. The case underlines the importance of close postoperative follow-up.
Introduction:Between conservative treatments and total knee arthroplasty, adequate interventional pain management options for osteoarthritis of the knee (OAK) are limited. BXT-786 is a novel nerve-selective biomaterial intended to provide prolonged analgesia when delivered around the nerve branches that innervate the knee joint for use in patients with symptomatic OAK. Methods:We conducted a nonrandomized, single-cohort, open-label pilot feasibility study at a single site in Australia (ANZCTR.org ID: ACTRN12624000250538p) between April and December 2024. The primary objective of the current study was to evaluate the safety and tolerability of BXT-786 version 3.0 in four patients with symptomatic OAK. The secondary objective was to evaluate the preliminary analgesic performance of BXT-786 in managing knee pain associated with OAK. Results:BXT-786 treatment showed a reduction in knee pain that was observed approximately 4 to 9 days post-procedure. Compared to the baseline, the subjects saw a 79.7% decrease in average numerical rating scale pain scores at 6 months. Anecdotal information indicated that most subjects experienced pain relief, which enabled increased mobility, improved use of the affected knee, and greater engagement in daily life activities. BXT-786 treatment did not affect motor functions or result in device-related serious adverse events. Conclusion:This study demonstrates feasibility of BXT-786 version 3.0 in four patients with symptomatic OAK. The observed preliminary clinical benefit of nerve-selective treatment also supports further investigation as a potential non-systemic, non-pharmacologic, and minimally invasive intervention option for long-term pain relief.
