Rejected

The Food and Drug Administration has approved crizotinib (Xalkori) to treat adult and pediatric patients ages one year and older who have recurrent or refractory inflammatory anaplastic lymphoma kinase (ALK)-positive myofibroblastic tumors.The most common adverse effects in adults are vision disorders, nausea, and edema. The most common adverse effects in pediatric patients are vomiting, nausea, diarrhea, abdominal pain, rash, vision disorder, upper respiratory tract infection, cough, pyrexia, musculoskeletal pain, fatigue, edema, constipation, and headache.

Urachal cancer is a rare but aggressive malignancy. A urachal mass concerning for adenocarcinoma was identified in a 32-year-old G2P1 female on 12-week ultrasound and confirmed on pelvic MRI. Due to progressive growth of the mass and refractory abdominal pain, a multi-disciplinary meeting was held, after which the patient chose to undergo an exploratory laparotomy. A tubo-ovarian abscess was identified involving the intestine, right ovary, fallopian tube, and communicating with a patent, necrotic urachus. This is the first reported case of a tubo-ovarian abscess masquerading as a urachal malignancy, which can present similarly with abdominal pain and irritative urinary symptoms.

Postoperative pain caused by laparoscopic cholecystectomy can be controlled by different methods. The study aimed to observe the efficacy of laparoscopic transversus abdominis plane (TAP) block in laparoscopic cholecystectomy and to analyze the cost-effectiveness of the procedure in comparison to the non-TAP method.

Weaning of mechanical ventilation while maintaining appropriate pain control and preventing delirium is one of the most challenging aspects of burn care. Dexmedetomidine, an α-adrenergic receptor agonist used for sedation may improve intensive care unit (ICU) patients' arousal status and enhance patient comfort.

Background Open adrenalectomy is an invasive surgical procedure that is commonly performed for adrenal gland neoplasms in developing countries. Due to its complexity, the patients are predisposed to a number of complications and dismal outcomes. The objective of our study is to assess different characteristics of patients undergoing open adrenalectomy, including their histology, postoperative complications, and outcomes. Methods This retrospective cross-sectional study included 107 patients undergoing open adrenalectomy for primary adrenal gland neoplasms. Patients with bilateral involvement, metastatic disease, or unresectable tumors were excluded. Patients were evaluated for different features that included demographic data, tumor properties, postoperative outcomes, and complications. Results Out of 107 patients, 45 (42.1%) were females. The mean age of the patients was 47.53 ± 8.45 years. Abdominal pain and severe headaches were the most common presenting complaints. A total of 96 (89.7%) tumors were benign, while 11 (10.3%) were malignant. Upon the histopathological examination of the resected specimen, adrenal adenoma was present in 49 (45.8%) cases, while adrenal pheochromocytoma was present in 41 (38.3%) cases. A total of 51 patients developed different postoperative complications including surgical site infections (22.4%), atelectasis (11.2%), deep venous thrombosis (7.5%), and retroperitoneal hematoma (5.6%). In-hospital mortality occurred in three (2.8%) patients. Conclusion Surgical site infections, atelectasis, deep venous thrombosis, and retroperitoneal hematoma were frequent postoperative complications after open adrenalectomy. These complications increase morbidity and mortality, especially in developing countries. Improved surgical techniques, intraoperative hemostasis, and multidisciplinary approach can yield favorable postoperative outcomes.

Amyloidosis is characterized by depositing insoluble fibrillar proteins that misfold into beta-pleated sheets. This phenomenon occurs on a systemic or local level and may interfere with the function of various organs, including the heart, kidneys, and liver. Among those presenting with amyloidosis, hepatic, gastrointestinal, renal, cardiac, vitreous, and immunological involvement may occur. These manifestations are linked to several clinical presentations, varying from abdominal pain and hepatomegaly to restrictive cardiomyopathy and chronic renal failure. The two most common types of amyloid proteins are amyloid light chain (AL) and serum amyloid A (AA) proteins. AL produced by immunoglobulin light chains kappa and lambda (κ, λ) circulate systemically and accumulate in organs. At the same time, serum AA proteins are acute-phase reactants seen in infectious, chronic inflammatory states. In an immune-mediated infection such as COVID-19, serum AA levels may be a predictive factor of disease severity and a valuable biomarker to monitor the clinical course of COVID-19 patients. This report highlights a case in which infection with COVID-19 provoked an effective immune response that may have contributed to the accelerated progression of systemic amyloidosis with hepatic involvement. The study further investigates the involvement of AL and AA proteins in COVID-19 infections, including their role in synergistically exacerbating an already grueling clinical course.

Dengue fever (DF) is the most common arthropod-borne viral illness with significant public health implications that can cause severe clinical symptoms and possibly death. We sought to determine the epidemiological and clinical characteristics of patients presented with DF to the Royal Hospital in a recent outbreak in Oman.

This study aimed to investigate whether the use of levonorgestrel intrauterine devices (LNG-IUD) in the perspective of traditional Chinese medicine (TCM) can improve the body constitution deviations and quality of life (QoL) in patients with chronic pelvic pain (CPP) and heavy menstrual bleeding (HMB).

In this study, we present a case of Behcet's colitis that caused acute inflammation in the gallbladder and mimicked the clinical picture of an acute abdomen: severe right-sided abdominal pain, nausea, fever, and tenderness in the right hypochondrium, right flank, right loin, and right iliac fossa (RIF), with severely elevated white blood cell (WBC) count. The picture of acute acalculous cholecystitis and acute abdomen was resolved after three days of antibiotic therapy. Then, the pain mainly was localized in the right flank and loin, with mild pain in the right iliac fossa, with positive Rovsing's and psoas signs. The pain in the right flank, loin, and RIF dramatically subsided after initiating a low dose of steroid injections. The colonoscopy, which was performed after the marked improvement of the patient's general condition, showed large, deep ulcers with severe colitis in the proximal transverse colon and the ascending colon. There was no cobblestone appearance. The histopathology of the colonoscopic biopsy showed surface ulceration with marked inflammatory infiltrates, mainly neutrophils, and no granulomas were found. The acid-fast bacillus (AFB) test was reported negative. Detailed history-taking, repeated clinical examinations, laboratory studies, and careful interpretation of ultrasound (US) and contrast-enhanced computed tomography (CECT) findings may prevent unnecessary surgical interventions in such fragile patients and lead to a better prognosis. A diagnosis of Behcet's colitis was made, taking into consideration the patient's past medical history, mucocutaneous lesions, and US, CECT, colonoscopic, and histopathology findings. Although there are no specific investigations and tests for Behcet's colitis, sparing of the rectosigmoid area, the absence of cobblestone appearance, the presence of deep, large round ulcers, patchy localization of the lesions, the absence of granulomas, and negative AFB are helpful for confidently excluding other specific colitis such as Crohn's disease, ulcerative colitis, intestinal tuberculosis (TB), diverticulitis, and ischemic colitis. In our view, in the differential diagnosis of the non-surgical cause of acute abdomen, Behcet's colitis must be considered among other rare causes, such as inferior myocardial infarction, diabetic ketoacidosis, sickle cell disease, familial Mediterranean fever, and acute intermittent porphyria, especially for the population of Mediterranean coast and Middle East countries.

We aimed to characterize the ocular phenotype of patients with ROSAH (Retinal dystrophy, Optic nerve edema, Splenomegaly, Anhidrosis, and Headache) syndrome and their response to therapy.