Background: Hepatolithiasis, characterized by the presence of intrahepatic bile duct stones, is a relatively rare but significant condition that can lead to recurrent cholangitis, liver abscesses, biliary cirrhosis, and even cholangiocarcinoma. The condition poses diagnostic and therapeutic challenges due to its complex presentation and the intricate anatomy of the biliary tree.

Alopecia areata incognita, also known as diffuse alopecia areata, is an uncommon subtype of alopecia areata primarily observed in young females. Alopecia Areata Incognita is characterized by sudden and intense hair loss, differing from the distinctive bald patches commonly associated with Alopecia Areata. Importantly, AAI generally carries a more favorable prognosis compared to alopecia areata totalis, universalis, and ophiasic areata?1?.

Background: Coronavirus is exceedingly contagious, and an effective treatment has yet to be identified. However, its transmission can be halted or slowed by employing preventative measures and remaining informed about the disease and its mode of transmission. Objectives: This study investigates the knowledge, attitudes, and behaviors of Riyadh schoolchildren regarding COVID-19.

Tigecycline, the inaugural glycylcycline antibiotic in clinical use, is experiencing rising global utilization owing to its effectiveness against multidrug-resistant (MDR) bacteria. Although gastrointestinal side effects like nausea and vomiting are more prevalent, it is important to recognize that tigecycline can also lead to liver injury. The manufacturer has issued a warning regarding tigecyclines potential to elevate total bilirubin (TB) and transaminase levels. [1] We present the case of a 74-year-old female with a history of multiple comorbidities who developed severe hepatotoxicity following tigecycline therapy for a complicated intra-abdominal infection. The patient shows an abnormal liver function test with hyperbilirubinemia. Later on she developed jaundice. This case underscores the importance of considering TILI in patients receiving tigecycline, particularly those with preexisting liver disease or receiving other potentially hepatotoxic medications.

Intussusception, a rare cause of intestinal obstruction in adults, accounts for only 1% of obstruction cases and 5% of all intussusceptions. Its global incidence is 1-3 cases per million per year. Early identification is challenging, which can lead to significant morbidity and mortality. In adults, intussusception is often associated with benign or malignant lesions, with primary adenocarcinoma being the principal cause. Preoperative diagnosis can be complex, and computed tomography (CT) is considered the preferred imaging modality. Most cases require surgical intervention, and the decision on whether to reduce before resection depends on the type and location of the lesion. Both laparoscopic and open surgeries are valid options, depending on clinical conditions and the surgical teams experience. We present the case of a patient in their fourth decade of life with a 15-day history, who presented to the emergency room with symptoms of intestinal obstruction secondary to intussusception. An emergency laparotomy was performed, revealing intussusception from the ascending colon to the transverse colon with a neoplastic-looking lesion in the cecum. A right radical hemicolectomy with intestinal diversion was performed. Histopathological examination revealed a moderately differentiated grade 2 adenocarcinoma.

Background: Interleukin-33 (Il-33) is involved in the pathogenesis of atopic asthma by activating Th2 cells. Immunoglobulin E (IgE) attached to mast cells and degranulation which cause bronchoconstriction, mucus secretion and vasodilation in asthma. The pathomechanism of asthma in pregnancy not clearly understood. The main of this study to evaluate the level of IL-33 and IgE in asthma pregnancy.

Clefts of the lip and/or palate (CL/P) represent the most prevalent congenital anomalies in the oropharyngeal region, originating from defects in craniofacial fusion processes between the 5th and 12th weeks of embryonic development. The incidence of CL/P varies significantly across geographical regions, ethnic groups, and genders, with males exhibiting a higher prevalence of cleft lip and females more frequently affected by isolated cleft palate. Genetic studies have identified sex-specific variants that contribute to these differences, notably the MSX1 gene in males and GTF2A1L and LTBP1 genes in females. Environmental factors, including maternal smoking, alcohol consumption, and nutritional deficiencies, along with hormonal influences such as estrogen, play critical roles in the etiology of CL/P. Epigenetic mechanisms, particularly DNA methylation, also contribute to the phenotypic variability. Understanding the genetic and molecular mechanisms underlying CL/P is essential for early diagnosis and personalized treatment strategies. Prenatal genetic screening and counseling can mitigate risks and improve outcomes. Future research should prioritize large-scale genomic studies to elucidate the complex interactions between genetic and environmental factors in CL/P development, aiming for targeted and personalized therapeutic interventions.

Background: A main risk factor for cardiovascular illnesses is high cholesterol, which causes 3.6 million deaths yearly by WHO, 2022. Reducing the risk of heart attacks and strokes depends on lowering cholesterol. Recent research indicates that pineapples bromelain enzyme might help reduce cholesterol levels. This review examines bromelains potential application in cholesterol management and its effect on cholesterol metabolism.

Jaw fractures are a major cause of functional disability and social and cosmetic morbidity. Despite the high incidence of subcondylar fractures, their treatment remains controversial. In recent years and hand in hand with a refinement of surgical techniques and osteosynthesis, the focus has shifted to surgery. An optimal approach is one that allows the surgeon to perform an anatomical reduction under direct vision to avoid damage to facial nerve branches due to manipulation of the fragments or the approach per se and ultimately, that the scar is aesthetically acceptable. The aim of this paper is to offer a direct and safe approach, through the study of the technique in cadavers. A safe approach was found in most cases through incisions 13 mm from the preauricular line, as well as incisions with a length of 20 mm.

Introduction: Atherosclerosis begins when the injured artery wall creates chemical signals that cause certain types of leukocytes (monocytes and T cells) to adhere to the artery wall. These cells move towards the artery wall. There, they are transformed into foam cells that collect cholesterol and other fatty materials and trigger the growth of smooth muscle cells in the artery wall. Colchicine or colchicine is a highly poisonous alkaloid, originally extracted from the plant Colchicum autumnale. It has been used in the treatment of various diseases, but on an increasingly smaller scale due to its high toxicity.

Heart failure with preserved ejection fraction (HFpEF) represents a significant and growing subset of heart failure cases, characterized by clinical signs and symptoms of heart failure despite a normal or near-normal left ventricular ejection fraction (LVEF). Unlike heart failure with reduced ejection fraction (HFrEF), the pathophysiological mechanisms underlying HFpEF are multifactorial and complex, involving intricate interactions between comorbidities, myocardial structural and functional abnormalities, and systemic inflammatory responses. This review delves into the intricate pathophysiology of HFpEF, exploring the roles of myocardial fibrosis, ventricular-arterial coupling, endothelial dysfunction, and extracardiac factors such as obesity, diabetes, and hypertension. Understanding these mechanisms is crucial for the development of targeted therapeutic strategies aimed at improving patient outcomes in HFpEF.

Left Main Coronary Artery Disease (LMCAD) is a critical condition that poses significant risks due to its potential to compromise a large myocardial territory. Patients with LMCAD who are deemed high surgical risks present a unique challenge, as the standard surgical approach, coronary artery bypass grafting (CABG), may be contraindicated or associated with high morbidity and mortality. This article reviews contemporary interventional strategies for managing LMCAD in high-risk surgical patients, with a focus on percutaneous coronary intervention (PCI) and the use of drug-eluting stents (DES). We evaluate clinical outcomes, procedural success rates, and long-term prognosis, comparing these with traditional surgical approaches. Additionally, we discuss patient selection criteria, risk stratification, and the role of multidisciplinary heart teams in optimizing treatment strategies. By synthesizing the latest evidence and clinical guidelines, we aim to provide a comprehensive overview of the interventional management of LMCAD in this vulnerable patient population.

Bile duct injuries (BDI) are serious consequences of surgical treatment of the bile duct, with the majority occurring after cholecystectomy. The prevalence ranges from 0.3 to 0.6%, with 400 BDI recorded annually in the US. Hepaticojejunostomy is the preferred choice for repairing BDI, but factors like biliary peritonitis, localized inflammation, sepsis, and early repair time can affect the outcome. BDIs are more common in women in their forties due to higher cholelithiasis diagnosis. Laparoscopic cholecystectomy is considered the most effective therapy for cholelithiasis, but open cholecystectomy remains a viable choice in hospitals without sufficient laparoscopic technology or training. Roux-en-Y hepaticojejunostomy remains the optimal choice for long-term management. This review focuses on evaluating stenosis and treatment efficacy in patients with bile duct injuries. The efficiency of treatment has decreased, with 2.5% of patients avoiding additional surgeries

Vaginal pessaries are used in gynaecology to treat utero-vaginal prolapse or urinary incontinence (pelvic floor disorders). However, self-administered or provider-administered per vagina insertion of herbal materials and concoctions is a practice prevalent amongst the low socioeconomic class of developing nations with poor access to good comprehensive health care. These oftentimes unhygienic and toxic materials may present with symptoms of immediate and or long-term complications. Asymptomatic cases may be forgotten only to be discovered incidentally. This study reports the case of a 47-year-old nullipara with amenorrhoea and infertility with an incidental finding of long forgotten intracervical herbal packing. The prolonged herbal pessary caused chemical vaginitis, scarring and subsequent cervical stenosis and amenorrhoea.

PNETs, also known as primitive neuroectodermal tumors, are extremely uncommon sarcomas that originate from the neural crest. It has been observed that the yearly incidence of these instances is 2.9 cases per million people between the ages of birth and 20.

Neurocysticercosis (NCC) is a common parasite affecting the central nervous system, causing over 50,000 fatalities annually in Latin America. Treatment varies depending on the location and prognosis is not good. Treatment often involves anti-parasitic medications and shunt implantation. Meningitis, stroke, and hydrocephalus are common complications. Endoscopy is the primary treatment for ventricular forms, but alternative methods like shunt implantation and microsurgery are considered. Anti-cysticercus medications and shunt implantation are recommended for patients with subarachnoid forms and hydrocephalus. Endoscopy is a potential treatment for extra-parenchymal NCC due to its potential to reduce inflammation and improve cerebrospinal fluid (CSF) circulation. However, early extraction may reduce the risk of chronic inflammation. Patients without extracorporeal membranes (ETV) have a higher shunt failure rate, potentially due to tolerance to changes in CSF flow. The Karnofsky index, an estimate used to evaluate functional status, suggests that endoscopy as an initial therapy is a viable option. Patients with a history of shunting or chronic illness may benefit from a comprehensive examination of the ventricular system and basal subarachnoid space. Steroid administration is recommended after treatment to prevent parasitic antigen release and immune response.

Surgical intervention is required for the treatment of hand tendon injuries, which include both open and blunt traumas, and mainly impact the flexor tendons. These injuries are significant and require skillful surgical intervention. Both sorts of injuries are discussed in this article, with a particular emphasis placed on the crucial need of timely detection and adequate treatment. In order to guarantee a correct evaluation, diagnostic technologies such as ultrasonography and magnetic resonance imaging (MRI) play a crucial role. Consistent initial therapy and attentive followup, with an emphasis on collaborative efforts between the surgeon and the patient, are essential to achieving successful outcomes. The comprehensive rehabilitation process is not complete without the incorporation of occupational therapy and physiotherapy into the treatment schedule.

Transsphenoidal surgery (TSS) is a popular method for resecting pituitary tumors, but it has been associated with severe consequences such as perioperative medical issues, endocrine problems, and surgical complications. The pituitary gland, a bilobed endocrine organ, contains eight hormones and is surrounded by the sella turcica, tuberculum sellae, dorsum sellae, and cavernous sinus dura. The glands structure is complex, with the optic chiasm and sphenoid sinus being significant structures. The sphenoid sinus, which grows with age and has variable septal and cavitary architecture, can make the transsphenoidal approach more difficult to perform in cases of bleeding, vision loss, or cranial nerve palsy. Understanding the anatomy of the sphenoid sinus is crucial for a safe sellar approach and tumor removal. The operative microscope introduced in the 1960s has further improved surgical outcomes with low morbidity and mortality rates.

The case of a 60-year-old woman diagnosed with subungual melanoma who received treatment with ipilimumab for 7 sessions and amputation of the first finger of her left hand and who presented multiple glandular damage is presented. The adverse effects associated with antineoplastic therapy induced by inhibition of the cytotoxic T lymphocyte-associated protein 4 (CTLA-4) checkpoints occur in approximately 0.5-10.5% hypophysitis as the main affectation, adrenalitis, alterations in gonadal hormones and thyroid stimulating hormone 91%, 84% and 83%, respectively. With overall survival of 21.4 months in those who developed hypophysitis compared to 9.7 months in those who did not develop it. Some other disorders with a lower proportion are diabetes mellitus due to insulin deficiency, hyponatremia and diabetic ketoacids. In this case, diabetes mellitus occurred due to insulin deficiency with diabetic ketoacids related to thyrotoxicosis, being a rare presentation. We consider that this case is of interest and useful for the initiation of therapy, as well as for follow-up, through thyroid profile, measurement of cortisol, ACTH, insulin, ovarian profile, prolactin and vasopressin, as well as MRI, in order to rule out prevention or treatment. the adverse effects related and reducing the mortality mentioned in the literature.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition characterized by recurrent painful nodules, abscesses, and sinus tracts predominantly affecting intertriginous regions. The pathophysiology of HS involves a complex interplay of genetic predisposition, immune dysregulation, and environmental factors. Recent advancements have shed light on the role of inflammatory pathways and microbial dysbiosis in disease progression. This review aims to provide a comprehensive overview of the latest insights into the pathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for HS. Emphasis is placed on novel biologic therapies and surgical interventions that have shown promise in improving patient outcomes. By integrating recent findings, we aim to enhance understanding and management of this debilitating condition.

Background: The prevalence of diabetes mellitus (DM) and the burden of its complications have been increasing, particularly in low- and middle-income countries. These complications include blindness, chronic kidney disease, heart attacks, stroke, diabetic foot disease, and hearing loss. Of these complications, hearing loss is a hidden disability; it usually goes undetected for a long time until it is too late. Once the diagnosis is late, the hearing loss is irreversible. This emphasizes the importance of early screening and prevention of hearing loss among diabetic patients. The aim of this study was to evaluate the prevalence, severity, and type of hearing loss among diabetic patients attending the medical outpatient clinic of our institution.

Background: Fourniers Gangrene (FG) is a rapidly progressive infective necrotizing fasciitis primarily affecting the genital region1. It is predominantly associated with various urological, gastrointestinal, and retroperitoneal diseases, some of which may involve malignancies of these regions2. The occurrence of Fourniers gangrene following radiation therapy for an underlying carcinoma is exceedingly rare, and therefore, only sporadic cases have been documented in the literature. Treating Fourniers gangrene in this specific context presents increased complexity compared to cases stemming from other causes, and it is associated with elevated mortality rates3. Consequently, a heightened level of vigilance is necessary in the management of such cases. In this report, we present the case of a 71-year-old male patient diagnosed with rectal carcinoma who developed Fourniers Gangrene subsequent to radiotherapy, and the treatment approach was tailored accordingly.

A diaphragmatic hernia can have a congenital origin, thoracic trauma and iatrogenic invasive procedures where intra-abdominal pressure is increased. One of the most frequent procedures that have been related to the presence of this pathology are pericardial peritoneal windows performed to treat symptomatic pericardial effusions. There are few published cases of intra-abdominal complications such as incarcerated diaphragmatic hernia. We report the case of a patient presenting with large bowel occlusion due to diaphragmatic hernia. The objective is to highlight this rare complication in order to encourage the physician who encounters this situation to consider the diagnostic possibility and one of the therapeutic options for its correction.

Basal cell carcinomas (BCCs), a kind of skin cancer, can result in substantial harm to a specific area. They are the most common type of cancer in Western countries. There is a possibility of experiencing this condition at some point in ones life, with a maximum occurrence rate of 39%. UV exposure is the most common risk factor. The majority of these tumors are seen in the craniofacial area. While basal cell carcinomas (BCCs) are frequently non-cancerous, their high prevalence means that treating them substantially increases the burden on the healthcare system, which is already overwhelmed. It is crucial to possess a comprehensive understanding of the many prospective options available to you. Several factors, including the patients age, comorbidities, the location and subtype of the lesion, among others, might influence the decisions made about treatment. The treatment options for basal cell carcinomas (BCCs) on the face may vary significantly compared to those for BCCs occurring in other areas, primarily because achieving a positive esthetic outcome and complete cure are of utmost importance. Obtaining high-quality randomized controlled trials that compare various treatment modalities is challenging. Although conventional excision has traditionally been the favored treatment method, there are currently several other options available. These include radiation, cryosurgery, curettage and cautery, Mohs micrographic surgery, topical imiquimod, photodynamic therapy, and topical 5-fluorouracil. We review and assess the data and literature that supports the existing array of treatment choices for face basal cell carcinoma (BCC).

Mercury is a less recognized cause of heavy metal poisoning(1). Typically, mercury exposure occurs through the consumption of methylmercury in seafood, inhalation of elemental mercury vapors, or accidental or intentional injection for various purposes(2). Elemental mercury injection is rare, with only about 72 cases reported in the literature between 1923 and 1995. Direct subcutaneous injection or extravasation of mercury injected into blood vessels can produce local granulomas and abscesses(3). Generally, cutaneous deposits of elemental mercury cause limited systemic effects, but infiltration into different layers of subcutaneous cellular tissue, fasciae, and muscle can represent a complication at the time of resection(4-5).

Surgical site infection is a common cause of hospital-acquired infections. The Centers for Disease Control introduced the phrase "Surgical Site Infection" to specifically refer to postoperative infections, which can be further categorized as either "Wound infections" or "organ or space infections". The organization also established the criteria that delineate this particular form of illness. Identifying the disease at an early stage and promptly initiating evidence-based therapy may provide a challenge. Early detection, standardized treatment after the first protocol, immediate management of the infection site, and the implementation of additional medications can significantly enhance the outlook for these patients.

Treacher Collins syndrome (TCS) is a rare genetic disorder characterized by craniofacial deformities, resulting from mutations in the TCOF1, POLR1C, or POLR1D genes. These deformities often involve the zygomatic complex, mandible, palate, and external ears, significantly impacting aesthetics and function. This review elucidates the complex pathophysiology, clinical manifestations, and comprehensive surgical management of TCS within the realm of plastic surgery. We emphasize the importance of a multidisciplinary approach, involving otolaryngologists, maxillofacial surgeons, and speech therapists, to optimize functional and cosmetic outcomes. Through detailed analysis of current surgical techniques, including distraction osteogenesis, orthognathic surgery, and ear reconstruction, this article aims to provide a framework for individualized patient care, focusing on improving quality of life and psychosocial integration for patients with Treacher Collins syndrome.

Pulmonary hypertension is a disease of low prevalence that can affect women of childbearing age; however, it is the cardiovascular disease with the highest maternal mortality, up to 56%. Timely counseling and optimization of care during pregnancy and the peripartum period have reduced maternal mortality. We present the case of a 41-year-old female patient with a history of unspecified heart disease of 10 years of evolution without medical treatment and congenital hypoplasia of the right thoracic limb. She came to the emergency department with pregnancy of 22.3 weeks of gestation, dyspnea of medium efforts, peribuccal cyanosis and pulmonary murmur, so a transthoracic echocardiogram was performed at rest that reported moderate tricuspid insufficiency/mild aortic insufficiency/moderate pulmonary insufficiency with high probability of pulmonary hypertension, so it was suggested to interrupt the pregnancy via abdominal, which was denied by the patient and a referral to third level of care was made. Patient was readmitted at 34 weeks of gestation with dyspnea on small efforts and labor in latent phase, so an emergency cesarean section was performed, with anesthetic management with fractionated peridural block, leaving the room with spontaneous ventilation, without vasopressor support to ICU, which later presented a torpid evolution until death.