Rejected

History In 2017, a 72-year-old woman was seen in the gastroenterology department with a 2-month history of mild and intermittent abdominal pain without other accompanying symptoms. Her medical history was unremarkable, except for a previous visit due to facial photodermatitis 3 years earlier. Diazepam for a sleeping disorder was the only chronic medication recorded. Results of physical examination, blood count, and basic metabolic panels including assessment of renal and liver function were normal; only the ferritin level was slightly elevated (265 ng/mL [595 pmol/L]; normal range, 10-120 ng/mL [22-269 pmol/L]). Abdominal US was performed, followed by multiphasic contrast-enhanced CT and liver MRI due to the findings of the first study. A diagnosis was not established in that moment, and acetaminophen was prescribed for pain relief. As the symptoms continued, laboratory tests and imaging studies were repeated 2 years later, with similar findings and no notable changes (Figs 1-5).

We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID.

There is an increasing cesarean section (CS) rate in Egypt. Multiple methods are used to manage pain after CS.

Metastasis to adrenal glands from primary pulmonary carcinoma is quite a common occurrence. In most cases, the diagnosis is made based on an imaging evaluation done because of chronic non-specific pulmonary symptoms. Further evaluation to determine the type of carcinoma is done using histopathological evaluation of the primary lung lesion. Here, we have described a case of a 60-year-old man who presented with chest pain and was incidentally detected with a lower lung mass and a bulky left adrenal gland in the upper abdominal cuts on a CT of the thorax. As the evaluation of the fine needle aspiration (FNA) sample from lung lesion couldn't be successfully performed, sampling from the left adrenal gland was attempted under the guidance of conventional endoscopic ultrasound using an endobronchial ultrasound probe (EUS-B). When the technique failed to localise the left adrenal gland, a modification was made and the gland was localised using the spleen as a marker. This case further presented a challenge, when due to the unfolding of rugae, the FNA needle wasn't able to reach up to the left adrenal gland. Further adjustment was made and the maximum depth of the gland from the margin was measured and the needle was fully freed. Multiple jabs were made and sampling was successfully done. Cellblock confirmed the presence of adenocarcinoma of pulmonary origin, positive for thyroid transcription factor 1 (TTF-1). The patient remained stable and did not present with any early or late post-procedural complications. The patient was started on appropriate chemotherapy for the disease. He has received three cycles of carboplatin and pemetrexed till now and is doing well.

Blunt trauma to the kidney is usually minor and self-limiting. In some cases, the patient may present with intractable hematuria or persistent flank pain and discomfort, which necessitates aggressive management. It is very rare and unusual to find a renal arterio-venous malformation following blunt trauma. This unusual presentation should be kept in mind when a patient presents with hematuria and history of blunt abdominal trauma. We report the case of a young male who suffered blunt abdominal trauma two years back, and continued to have on-and-off hematuria. After extensive work up, a diagnosis of renal arterio-venous malformation was made. His case was managed promptly with renal angio-embolization. Key Words: Blunt trauma, Arterio-venous malformation (AVM), Angio-embolisation, kidney.

Hypertriglyceridemia is known to be the third most common etiology of acute pancreatitis. Triglyceride levels above 1,000 mg/dL are associated with an increased risk of acute pancreatitis. We present the case of a 22-year-old female, a known case of hypertriglyceridemia, who developed sudden onset severe epigastric abdominal pain. A marked elevation in triglyceride levels of >3,000 mg/dL, serum lipase levels of 722 U/L, and serum amylase levels of 161 U/L, in the absence of other risk factors of acute pancreatitis, suggested hypertriglyceridemia-induced acute pancreatitis. Computed tomography (CT) of the abdomen and pelvis with contrast confirmed acute pancreatitis with hepatic steatosis. She was initially placed nil per os (NPO) and intravenous (IV) fluids with normal saline were administered. However, she was subsequently transferred to the intensive care unit as she developed acute respiratory distress syndrome. She was started on IV insulin with 5% dextrose in normal saline and a hydromorphone hydrochloride patient-controlled analgesia (PCA) pump was used for pain control. The patient's condition improved gradually. At the time of discharge, the triglyceride (311 mg/dL) and lipase levels (81 U/L) of the patient were within the normal range. The prognosis of hypertriglyceridemia-induced acute pancreatitis is considered to be worse than non-hypertriglyceridemic acute pancreatitis. Patients with hypertriglyceridemia-induced acute pancreatitis need swift diagnosis and treatment to avoid serious complications.

Myocarditis is an inflammatory disease of the heart muscle, with manifestations that include myocardial infarction, arrhythmia, and even sudden death. The primary etiology of myocarditis is a viral infection, with studies demonstrating that infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to myocarditis. This enzyme is involved in many body tissues, including the gastrointestinal system and the cardiac system. This enzyme is responsible for converting angiotensin I to angiotensin II in the renin-angiotensin system of our body. This review aims to characterize the symptomatology and comorbidities of males, females, and pediatric patients who developed the SARS-CoV-2-related myocarditis (SARS-CoV-2RM) or the SARS-CoV-2 vaccine-related myocarditis (SARS-CoV-2VRM). From July 10 to July 20, 2021, a PubMed database search for "SARS CoV-2 Related Myocarditis" was conducted. From July 21 to July 30 2021, the search for "SARS CoV-2 Vaccine Related Myocarditis" was conducted. The search completed was specific for title/abstract fields using keywords "Covid-19" AND "Myocarditis" AND "Vaccine" and specifying "Males" or "Females", respectively. Inclusion criteria included articles discussing comorbidities and symptomatology. Exclusion criteria included autopsy/postmortem reports, letters to the editor, retrospective studies, and observational studies. In the end, 49 articles were found and included in this review. We found that 27 of 40 pediatric patients with SARS-CoV-2RM presented with gastrointestinal symptoms, and 12 of 40 pediatric patients had no comorbidities. In female cases, eight of 12 patients with SARS-CoV-2RM presented with noncardiac symptoms, and only four of 12 had comorbidities such as asthma, diabetes, and obesity. In male patients with SARS-CoV-2RM, 10 of 12 presented with respiratory and/or cardiac symptoms, and seven of 12 had cardiac and/or diabetic comorbidities. Furthermore, 22 of 31 male patients with SARS-CoV-2VRM presented with chest pain with no previous comorbidities; four of six females with SARS-CoV-2VRM presented with chest pain, and three of six females had no comorbidities; and seven of 11 pediatric patients with SARS-CoV-2VRM had no comorbidities, but 11 of 11 pediatric patients presented with chest pain. In conclusion, males, females, and pediatric patients with previous SARS-CoV-2VRM showed mostly chest pain with no comorbidities. Males presenting with SARS-CoV-2RM showed mostly respiratory and cardiac symptoms with cardiac and diabetic comorbidities. Females with SARS-CoV-2RM described various symptoms from flu-like, respiratory, to cardiac and had no previous comorbidities. The bulk of pediatric patients with SARS-CoV-2RM mainly presented with GI symptoms and no past comorbidities. More studies are needed to determine the clinical presentation and risk factors that lead to SARS-CoV-2RM and SARS-CoV-2VRM.

To assess the presentation of allergic fungal rhinosinusitis（AFRS） in children and the role of long-term comprehensive therapy of endoscopic surgery combined with drug therapy. The 3 children with AFRS were routinely examined by nasal endoscopy, CT scan, MRI scan and allergen detection before surgery, and mycological and histomathological examination were performed on the secretions in the sinus and the mucosa of the affected sinuses. All the 3 patients underwent endoscopic surgery, preoperative and postoperative treatment with oral and nasal corticosteroid, nasal irrigation, and individualized anti-allergy therapy and immunotherapy. The patients were followed up for 3 to 12 months. All 3 children had nasal polyps and headache, and 2 children had exophthalmos and facial asymmetry. There were typical CT and MRI findings on imaging. Serum total IgE were all elevated, and 2 cases were positive for fungal SIgE. All 3 children underwent endoscopic surgery. Fungal hyphae and spores were found in 1 child, and other fungi tests were positive in another 2 children. Postoperative facial asymmetry was relieved spontaneously, and mucosal swelling and polypoid changes were observed in 2 children. AFRS is a specific type of chronic rhinosinusitis that is not uncommon in children. Early diagnosis, prompt operation, standardized treatment and long-term follow-up are very important in the diagnosis and treatment of AFRS in children.

A plantar fasciotomy using a microdebrider coblation wand may be an effective treatment for treating chronic plantar fasciitis. The objective of this prospective study was to determine the success rate of performing a plantar fasciotomy using a microdebrider coblation wand to treat plantar fasciitis and determine utility of ultrasonographic imaging to evaluate for recovery after treatment.

Granulomatous mastitis (GM) is a chronic inflammatory disease of the breast that usually occurs in women of reproductive age. However, GM during pregnancy is unusual and only one case of GM in the accessory breast has been reported so far. Here, we report an extremely rare case of GM in the accessory axillary breast of a pregnant woman. A 24-year-old pregnant woman had persistent pain and swelling in the right axilla that did not improve with antibiotic administration. Despite incision and drainage for subcutaneous abscess, the incised skin gradually became ulcerated, exposing the subcutaneous granulomatous tissue. Corynebacterium species were isolated in the bacterial culture of drained pus. Lower back pain, pain in several joints, and erythema nodosum on the lower legs appeared later. Based on the result of bacterial culture and the above disease course, the patient was clinically suspected of having GM. The axillary mass was surgically removed after childbirth, and the excised mass was histopathologically confirmed as GM. Treatment for GM should be considered individually and carefully in accordance with the patients' condition. Unnecessary surgery should be avoided. However, early addition of surgical interventions may yield good outcomes, especially for pregnant women because of limited treatment options.