Rejected

Segmental testicular infarction(STI) is a rare unknown condition. Clinical presentation is non-specific and management is unconsensual. We report clinical and surgical management of a segmental testicular infarction. A 18-years old adult presented to emergency with acute right testicular pain. The only triggering factor was a stressful situation. Examination revealed a slightly swollen, non-ascending testicle with no inflammatory signs. We suspected spermatic -cord torsion(SCT), we decided to explore it surgically. Exploration showed a well-demarcated infarcted inferior pole of right testicle. Partial orchiectomy was performed. STI is a rare entity often clinically confused with SCT. Diagnosis is based on intraoperative findings.

Traumatic shoulder dislocations in elderly patients can result in significant shoulder pathology. Rotator cuff tears and recurrent instability are common complications follow a dislocation event, while axillary nerve injury is less common. While there have been rare cases of recurrent shoulder instability with concomitant axillary nerve injury, there have been no prior cases, in which concurrent fracture fragmentation resulted in the initial gross instability.

Analgesia Nociception Index (ANI) and Surgical Pleth Index (SPI) are measures of nociception-antinociception balance during general anaesthesia. The validity of these two monitors during autonomic changes brought about by intraoperative blood loss and noradrenaline infusion has not been studied earlier. The primary objective of the study was to determine the effect of bleeding on ANI and SPI. The secondary objective was to observe the effect of noradrenaline infusion on ANI and SPI and the correlation between ANI and SPI.

Atopic dermatitis is a condition characterized by xerotic and pruritic skin. While the onset of the disease is usually in childhood, it may persist into adulthood. First-line treatments include adequate moisturization, avoidance of irritants, and the application of topical corticosteroids. Dupilumab is a biologic therapy, approved for moderate-to-severe atopic dermatitis, that dampens the pruritus sensation by inhibiting the downstream effects of the T helper cell type 2 pathway by binding to the interleukin-4 receptor α subunit. The monoclonal antibody is typically well-tolerated. We present a novel case of the development of generalized granuloma annulare after treatment with dupilumab. A 71-year-old male with a history of hypertension, hyperlipidemia, chronic kidney disease, gout, and bipolar disorder presented to clinic with biopsy-proven severe atopic dermatitis. First-line treatments had been exhausted, and the patient was not an ideal candidate for traditional systemic options secondary to his poor renal function. Therapy with dupilumab was initiated and continued for two years until the patient developed biopsy-proven generalized granuloma annulare. At this time, dupilumab was discontinued and the pharmaceutical company was made aware of this side effect.

Porokeratosis describes a heterogenic group of keratinization disorders in which lesions are papules and plaques that demonstrate central atrophy surrounded by a hyperkeratotic margin. Clinical variants include not only porokeratosis of Mibelli, but also disseminated superficial, disseminated actinic superficial, linear, punctate, and palmaris et plantaris disseminata. Porokeratosis has a risk of malignant transformation. A woman with disseminated superficial actinic porokeratosis (DSAP) whose lesions presented as pruritic plaques and papules is described. The diagnosis was suspected clinically, supported by dermoscopy findings, and confirmed histologically. The condition-associated pruritus was managed symptomatically; her skin lesions will be monitored clinically. Clinical manifestations, dermatoscopic features, pathology findings, and treatment options for DSAP are summarized.

Glossopharyngeal neuralgia (GPN) is a painful condition characterized by stabbing pain throughout the glossopharyngeal nerve distribution. Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, we have learned that COVID-19 may induce neurological symptoms and complications. This case report presents a 54-year-old patient diagnosed with GPN, potentially secondary to COVID-19. The pain resolved spontaneously in three months without the need for medication. We discuss our diagnostic approach for this patient and propose a possible theory about the relation between cranial neuralgias and COVID-19.

Sjogren's syndrome (SS) is a chronic exocrinopathy caused by lymphocytic infiltration and is associated with numerous manifestations and morbidities. We discuss a case of a 60-year-old female who presented to the Acute Medical Assessment Unit complaining of progressive shortness of breath for one month, not associated with chest pain or lower limb swelling. She also reported joint pain involving both wrists and proximal interphalangeal (PIP) joints, oral dryness, hair loss, and numerous tongue ulcerations. Blood workup revealed triple-negative SS, negative rheumatoid factor, anti-SSA and anti-SSB, a high erythrocyte sedimentation rate (ESR), and antinuclear antibody (ANA) titer of 640. A diagnosis of SS was made. Nevertheless, her CT chest showed massive left-sided pneumothorax; subsequently, a chest tube was urgently inserted. The chest tube was removed two days later with complete resolution on chest X-ray (CXR). However, one week later, she presented with a recurrent pneumothorax that persisted and required surgical intervention that led to complete recovery afterward. Pneumothorax is an extremely rare but potentially unfavorable complication related to SS, with only two cases reported in the literature so far and usually associated with underlying lung pathology.

Lower back pain caused by anatomical lumbosacral transitional vertebra is known as Bertolotti's syndrome. We present the case of a 65-year-old male with persistent chronic lower back pain with radiological evidence of an anatomical lumbosacral pseudo-joint bilaterally. The patient underwent conservative treatment with lidocaine and steroids that helped to improve and manage his symptoms. Our patient is an elderly one, and it is quite uncommon for the first appearance of Bertolotti's syndrome. Therefore, Bertolotti's syndrome is a rare cause of lower back pain, and clinicians should consider it in the differential diagnosis.

Benign prostatic hyperplasia (BPH) is a chronic male disease characterized by the enlarged prostate. Celtis chosenianaNakai (C. choseniana) is medicinally used to alleviate pain, gastric disease, and lung abscess. In this study, the effect of C. choseniana extract on BPH was investigated using testosterone-induced rats. Sprague Dawley rats were divided into five groups: control, BPH (testosterone 5 mg·kg), Fina (finasteride 2 mg·kg), and C. choseniana (50 and 100 mg·kg). After four weeks of TP treatment with finasteride or C. choseniana, prostate weights and DHT levels were measured. In addition, the prostates were histopathologically examined and measured for protein kinase B (Akt)/nuclear factor-κB (NF-κB)/AR signaling, proliferation, apoptosis, and autophagy. Prostate weight and epithelial thickness were reduced in the C. choseniana groups compared with that in the BPH group. The extract of C. choseniana acted as a 5α reductase inhibitor, reducing DHT levels in the prostate. Furthermore, the extract of C. choseniana blocked the activation of p-Akt, nuclear NF-κB activation and reduced the expression of AR and PSA compared with BPH. Moreover, the expression of Bax, PARP-1, and p53 increased, while the expression of bcl-2 decreased. The present study demonstrated that C. choseniana extract alleviated testosterone-induced BPH by suppressing 5α reductase and Akt/NF-κB activation, reducing AR signaling and inducing apoptosis and autophagy in the prostate. These results suggested that C. choseniana probably contain potential herbal agents to alleviate BPH.

The BioNTech-Pfizer vaccine is the only vaccine offered to children among all available vaccines. However, limited evidence is available about the clinical outcomes of COVID-19 vaccines, especially among children and adolescents. This review offers a comprehensive and up-to-date overview of the BioNTech-Pfizer vaccine's current information on children and adolescents.