Aortic dissection, a life-threatening condition, is characterized by a tear in the inner layer of the aorta, allowing blood to surge between the layers, forcing them apart. Type B Aortic Dissection, explicitly impacting the descending aorta, can present with various complications that magnify its severity [1]. A notable concern is the formation of a haemothorax, where blood accumulates in the pleural space, severely compromising respiratory function [2]. Additionally, a false lumen, a secondary channel formed due to the dissection, can result in sluggish blood flow and potential leaks. Levy (2023) [3]. If not addressed, these leaks can escalate into endoleaks post-endovascular interventions, further complicating the clinical scenario. While surgical and endovascular interventions offer potential solutions, the intricate nature of aortic dissection requires a meticulous approach to prevent and manage associated complications. Such complications' severity and potential fatality underscore the critical importance of early diagnosis, intervention, and multidisciplinary management.
A 70-year-old male with a history of bilateral surgically treated inguinal hernias, presents with a one-day history of abdominal pain, nausea and vomiting, abdominal distension and obstipation. On examination, the patient was found in good general condition, had a pulse rate of 90 bpm, a blood pressure of 120/60 mmHg, and a temperature of 37°C.
Boerhaave's syndrome is a rare spontaneous oesophageal perforation. It is classically caused by forceful emesis and retching. We report a 16-month-old boy who presented to the emergency department because of externalized blood from his mouth after his meal. Initial examination was unremarkable. His hemoglobin was at 10 g/dL. Hours later, he developed sudden massive upper gastrointestinal bleeding leading to hemorrhagic shock and cardiac arrest. Post-mortem examination revealed an aorto-oesophageal fistula complicating an oesophageal rupture with mediastinitis. This case highlights an exceptional and fatal presentation of oesophageal perforation in early childhood and emphasizes the need for early recognition of Boerhaave's syndrome.
Ectopic adrenocorticotropic hormone (ACTH) secretion is an uncommon but potentially life-threatening paraneoplastic syndrome; most often associated with pulmonary neuroendocrine tumours. Gastrointestinal malignancies represent a rare source and may be diagnostically challenging, particularly in the absence of classical phenotypic features of Cushing’s syndrome. We report the case of a 68-year-old woman with metastatic small bowel adenocarcinoma who presented with severe, persistent hypokalaemia, hypocalcaemia and hypomagnesaemia identified incidentally during routine pre-chemotherapy assessment. Despite aggressive intravenous replacement and repeated hospital admissions, electrolyte abnormalities remained refractory. The disproportionate severity of metabolic derangement and evidence of renal potassium wasting prompted endocrine evaluation, which revealed marked ACTH-dependent hypercortisolism with failure of dexamethasone suppression. Pituitary imaging was normal. Histopathological re-review of tumour tissue demonstrated neuroendocrine differentiation, supporting a diagnosis of ectopic ACTH secretion. Initiation of medical adrenal blockade with metyrapone, alongside physiological glucocorticoid replacement, resulted in rapid biochemical stabilization and clinical improvement. This case highlights the importance of recognising ectopic ACTH secretion as a cause of refractory dyselectrolytaemia in oncology patients and underscores the need for early endocrine involvement when standard explanations fail.
Background: Platypnea-orthodeoxia syndrome (POS) is a rare medical condition characterized by platypnea (a symptom of dyspnea that worsens when upright, but improves upon reclining) and orthodeoxia (measurable hypoxia that worsens when upright, but improves upon reclining). This syndrome poses diagnostic challenges due to its subtle symptomatology and requires a high index of clinical suspicion. Case report: We report a 90-year-old male with persistent hypoxemia, suggestive of POS. Transesophageal echocardiography revealed a large PFO with right-to-left shunting. The PFO was closed percutaneously using the GORE CARDIOFORM septal occluder. Remarkably, the patient demonstrated significant improvement in oxygenation after the procedure. Conclusion: POS, while rare, is clinically significant due to its association with diseases that represent considerable morbidity and mortality. Timely recognition and intervention are crucial for diagnosing the underlying cause, reducing symptoms, and preventing complications. Increased awareness among healthcare practitioners of the presenting signs and symptoms of POS is crucial for timely management and improved patient outcomes.
Richter’s hernia is a rare subtype of femoral hernia in which only the antimesenteric portion of the bowel wall becomes incarcerated, potentially leading to ischemia and perforation without complete luminal obstruction. We present the case of a 90-year-old woman with hypertension who developed abdominal distension, pain, and intolerance to food. On admission, she was found to have signs of bowel obstruction and a right inguinal incarcerated hernia. Surgical exploration revealed a right-sided Richter’s femoral hernia with a 2 cm perforation in the small intestine, located 40 cm from the ileocecal valve. Resection and end-to-end anastomosis were performed, and the hernia defect was repaired with a polypropylene mesh. The postoperative course was initially favorable, but the patient subsequently developed community-acquired pneumonia and died 10 days later due to respiratory complications. This case highlights the importance of early recognition and individualized surgical management of Richter’s hernia, especially in elderly patients with increased risk of morbidity and mortality.
The prognosis of cancer is highly dependent on its stage at diagnosis, with early diagnosis strongly correlating with better treatment outcomes. The incidence of discovering cancer during pregnancy has steadily increased over the years, with 1/2000 cases reported in the 1960s to 1/1000 cases currently reported.1 However, these diagnoses are primarily driven by patients experiencing symptoms that prompt their healthcare team to investigate the possibility of cancer. Incidental findings of cancer during a Cesarean section (C-section) are extremely rare. In this case report, a 25-year-old G1P0 patient underwent a C-section at 41.1 weeks due to prolonged rupture of membranes and failure to progress. During the C-section, multiple nodules were found incidentally on the patient’s uterus, bladder, abdominal wall, and omentum. The ovaries and fallopian tubes were also examined but no gross abnormalities were reported. A uterine nodule biopsy was sent to pathology and, combined with the results of a CT of the abdomen and pelvis, resulted in a diagnosis of low grade serous ovarian carcinoma. The patient’s care was transferred to a gynecologic oncologist, where she completed six cycles of depo-Lupron and anastrozole chemotherapy in addition to an omentectomy and a total abdominal hysterectomy with bilateral salpingo-oopherectomy. While rare, it is important to be aware of the occurrence of incidental cancers found at the time of cesarean section. OB/GYN’s must biopsy any abnormal intraoperative findings during a Xesarean section, as the results may lead to a life-saving diagnosis.
We describe a 64-year-old woman with hypertension and gastroesophageal reflux disease who presented with fever, chills, and abdominal discomfort. Evaluation revealed an obstructive right-sided ureteral stone with sepsis due to Escherichia coli bacteremia. Urological intervention with cystoscopy and ureteral stent placement was performed. The case was further complicated by hypercalcemia secondary to primary hyperparathyroidism, likely contributing to recurrent nephrolithiasis, and sepsis-associated thrombocytopenia. A nuclear medicine parathyroid scan demonstrated a right-lobe-adjacent mass consistent with adenoma. This case highlights the intersection of obstructive uropathy, infection, and metabolic abnormalities, underscoring the importance of comprehensive diagnostic evaluation and multidisciplinary management in patients presenting with complicated urinary tract infections.
Thalassemia is among the most common inherited hemoglobin disorders worldwide, caused by mutations that impair the production of alpha or beta globin chains, resulting in chronic hemolytic anemia and significant morbidity. Advances in supportive care, such as regular blood transfusions and iron chelation therapy, have dramatically improved survival, yet iron overload, cardiac failure, endocrine dysfunction, and infections remain major complications. This review summarizes the current understanding of the genetic basis, pathophysiology, diagnosis, and evolving treatment options of thalassemia.
Objectives: Fluoroquinolones are frequently prescribed due to their wide range of antibacterial effects, ease of administration, and widespread availability. However, they are also the second most frequent antibiotics associated with drug allergies. Although it is effectiveness, the potential for causing severe allergic reactions may restrict the available treatment options. Mesenchymal stem cells have the potential to be used as therapeutic agents because of their ability to modulate the immune system and reduce inflammation. They have the potential to be candidates for the treatment of drug-induced hypersensitivity as they release bioactive substances that regulate the activity of immune cells. In this study, allogeneic mesenchymal stem cells were utilized as a therapeutic approach to address the patient's hypersensitivity to ciprofloxacin. Case Summary: Following cellular treatment, the patient's eosinophil cationic protein levels returned to a normal range, and there was a significant decrease in ciprofloxacin-specific IgE antibodies from 560 pg/ml to 50 pg/ml. No adverse effects were seen throughout the treatment. Practice Implications: According to our findings, mesenchymal stem cells have the ability to regulate the immune response in cases of drug-induced hypersensitivity. Additional research is necessary to comprehend the impact of cell treatments on the immune system.
The increasing trend in resistance to antimicrobial agents is a major threat to the management of infectious diseases. If nothing is done, we may return to a pre-antibiotic era where a minor infection is potentially fatal. Therefore, it is important to use antibiotics judiciously to prevent serious public health threats. To this day, many policies and guidelines have been laid out to define the ideal selection, the correct dosing, and the appropriate duration of antibiotic therapy. Unfortunately, their adaptation still leaves much to be desired. We suspect that demand for inappropriate or unnecessary use represents a major cause of emerging resistance. The consequence is that broadening the antimicrobial spectrum leads to never-decreasing antibiotic exposure, which differentiates these drugs from other substances and increases the selection pressure that leads to the emergence of antimicrobial resistance and indirectly raises the cost. In the face of these threats, the principle of "maximum therapeutic effect with minimal risk" must drive the antimicrobial strategy. It is essential that evidence-based interventions be integrated by all hospitals, physicians, and other health professionals into daily practice.
Background: You may have heard of the gut microbiome, but the vagina also has a microbiota. The bacterial composition of the vaginal microbiome is thought to be associated with women's health and disease states. The vaginal microbiome is a complex and dynamic micro-ecosystem that fluctuates throughout the menstrual cycle and throughout a woman's life. The vaginal mucosa consists of a stratified, non-keratinised squamous epithelium covered by cervicovaginal secretions. The composition of the vaginal microbiota varies greatly between healthy and diseased individuals, and there are many factors that can influence the balance of microbiota in the vagina. Aim of study: The aim of the study was to review the current literature on the importance of the vaginal microbiota and to discover what factors may influence the composition of the vaginal microbiome. Matherials and methods: A systemic review was conducted using Google Scholar, PubMed and ScienceDirect databases and the search was limited to studies published between 2000 and 2024. The search strategy was based on following terms: microbiome, vaginal bacteria, health and microbiome, vaginal microflora and human vaginal microbiota.
Introduction:This paper discusses a patient who developed severe acute hyponatremia due to consuming an excessive amount of water (19 liters) over 4 hours during a religious ritual called "Ruqayyah."Understanding this case can contribute to raising awareness and preventing similar occurrences in the future. Case presentation:A 29-year-old woman, who had been undergoing psychotherapy for depression for the past month, was brought to the emergency department by emergency medical services after experiencing a newonset generalized tonic-clonic seizure.Patients consumed approximately 19 liters of fluid over a period of 4 hours due to religious beliefs.The diagnosis of water intoxication with severe hyponatremia (Na = 109 mmol/L) was made.Optimum fluid and electrolyte management achieved, and the patient discharged with a good neurological outcome. Conclusion:The presented case offers a compelling narrative that intersects cultural practices, medical emergencies, and the importance of culturally sensitive healthcare delivery.Therefore, healthcare providers must be aware of the potential risks associated with certain rituals and be prepared to address any medical emergencies that may arise.
The patient is a 21-year-old Moroccan, without any notable pathological history. He consulted for a painless swelling of the lateral border of the left big toe, evolving for 2 years. Examination revealed a polypoid and poly-lobed mass, flesh-coloured, measuring 3 cm in long axis, of elastic consistency, mobile in relation to the deep plane (Figure 1). Histological examination showed epidermal acanthosis and hyperkeratosis, associated with dermal fibrosis, confirming an acquired acral fibrokeratoma (Figure 2).
