Clinical features and laboratory findings first case of B. 1.617.2 (delta) variant concern (VOC) in Iraq.

Since the initial report of the severe acute respiratory syndrome (SARS CoV-2) in Wuhan, China, in 2019, the virus has constantly mutated, resulting in the appearance of novel variants. In December 2020, the B.1.617.2 (delta) variant concern (VOC) was first reported in India, and rapidly spread around the globe, is now the main brand in the United Kingdom, and it has grown dramatically. Here we present the clinical features and laboratory findings of the first case of B. 1.617.2 (delta) variant concern (VOC) in Iraq. A 6-year-old female child presented with severe abdominal pain, headache, severe vomiting, and diarrhea, runny nose, alerted mental status, loss of appetite, and fever. The patient was diagnosed with COVID-19 delta variant B.1.617.2 by RT-PCR. The patient was treated by administration of glucose saline 4% for 3 days, ceftriaxone vial 1 mg every 12 h for 6 days, and an acetaminophen bottle on a need to prevent fever followed by a Flagyl bottle every 24 h for 3 days. Vaccination and prevention the spread of the virus and against it are important preventive approaches for delta variant. Sore throat, runny nose, headache, and vomiting, diarrhea are the major clinical features of the delta variant. This was followed by an elevation of the leukocyte WBC, and blood platelets. To reduce the impact of new delta variant B.1.617.2 infection; handwashing, wearing a double mask, avoiding crowded and closed settings, social distancing, lockdown, and ensuring good ventilation are major significant options against this variant.

Thrombosed external jugular vein aneurysm mimics to a branchial cyst: A novel case from Iraq and review of the literature.

INTRODUCTION AND IMPORTANCE: Venous aneurysms are rare diseases, and according to their locations, history will change. They will be diagnosed based on the clinical history and imaging modalities. The exact incidence of external jugular vein aneurysm remains controversial. In the neck, venous aneurysm has been reported most commonly in the internal jugular vein. Frequently the venous aneurysm has a fusiform shape, and the saccular type is extremely rare. CASE PRESENTATION: Here we present a case of the external jugular vein aneurysm which was misdiagnosed as a branchial cyst presented with gradual swelling in the left supraclavicular region. The patient was diagnosed intraoperatively, and by histopathological examination. The patient successfully underwent surgery of Proximal and distal control of the external jugular vein without resection of the clavicle were performed, and trans-fixation of the external jugular vein was done without any complications. CLINICAL DISCUSSION: Idiopathic, spontaneous venous aneurysm of the external jugular vein thrombosis is extremely rare clinical findings. Computerized tomography was the gold standard test for the diagnosis of venous thrombosis, but nowadays neck ultrasound is the diagnostic test of choice. However, the mass was like a branchial cyst by ultrasound. CONCLUSION: External jugular vein aneurysm is rare, when it was a saccular type and thrombosed without any causes it will be extremely rare. When idiopathic thrombosis of external jugular vein aneurysm was confirmed by imaging modalities, then it was symptomatic, enlarged, ruptured or disfigured, the surgical excision will be mandatory without anticoagulant drugs preoperatively or postoperatively.

Subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patient: Presenting unusual case report.

INTRODUCTION AND IMPORTANCE: In non-intubated COVID-19 patients, subcutaneous emphysema and spontaneous pneumomediastinum (SPM) remain rarely, with incidence rates of 3.0 and 1.2 per 100,000, respectively; nevertheless, the occurrence of these conditions in COVID-19 patients is unclear. Up to date only few cases have been reported. The mechanism of pneumomediastinum in non-intubated COVID-19 patients remains unclear. CASE PRESENTATION: Here we present a 63-year-old male with subcutaneous emphysema, and spontaneous pneumomediastinum with a 1-day history of chest pain and productive cough, without chills and dyspnea. The patient was diagnosed by nasopharyngeal RT-PCR, Chest CT, and laboratory findings. The patient successfully treated by given double (mask and nasal) oxygen therapy, antibacterial (moxifloxacin tablet 400 mg) every 24 h for 7 days, followed by antiviral (lopinavir tablet 400 mg) twice daily for 6 days and corticosteroid treatments as well as steroid therapy (methylprednisolone 40 mg) daily for 8 days. Subcutaneous emphysema treated by supraclavicular slit-like incision (3 cm) bilaterally and milking of skin from face, neck, shoulders and chest done for three days for subcutaneous emphysema but regarding the pneumomediastinum we did only follow up of the patient. CLINICAL DISCUSSION: Spontaneous pneumomediastinum and subcutaneous emphysema are rare clinical finding in non-intubation of COVID-19 patients but frequently common in patients with coronavirus acute respiratory distress syndrome (COV-ARDS), or intubated COVID-19. In the present paper, subcutaneous emphysema and spontaneous pneumomediastinum occurred at the same time, with no past history of pulmonary diseases, and smoking of the patient. The only reason of this patient was high-pressure repetitive cough. CONCLUSION: The authors declared that COVID-19 infection leading to subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patients. Our case revealed that oxygen therapy, bed rest, analgesic, and supraclavicular slit-like incision best option for treat subcutaneous emphysema (SE) and spontaneous pneumomediastinum (SPM).

Bilateral inframammary pilonidal sinus: A case report with literature review.

INTRODUCTION: Pilonidal sinus (PNS) is a chronic inflammatory perianal disorder that rarely occurs outside sacrococcygeal region. The aim of this study is to report an extremely rare case of bilateral inframammary PNS with brief literature review. CASE REPORT: A 25-year-old female presented with a discharging sinuses in both inframammary region for two years. Examination showed multiple discharging sinuses with several centimeters of induration and tenderness. Under general anesthesia, complete excision of the sinuses with primary closure done. Histopathological examinations showed chronic foreign body granuloma surrounding hair shaft pictures consistent with PNS. DISCUSSION: Inframammary PNS has never been reported in the literature. As with intermammary PNS, in this case also it is associated with obesity and large breasts with tight brassieres. Diagnosis is usually clinical. In contrast to sacrococcygeal PNS, operation under general anesthesia is main treatment modality. CONCLUSION: Pilonidal sinus of inframammary region is an extremely rare condition. High index of suspicion is required for diagnosis. Excision with primary closure is the definitive therapy.

Primary chest wall Hydatid cyst: Review of literature with report of a new case.

INTRODUCTION: Hydatid cyst is a parasitic disease caused by Echinococci. The most commonly affected organ is liver, followed by lungs. Hydatid disease of the chest wall is extremely rare. The aim of this study is to report a case of chest wall Hydatid cyst with literature review. A 20-year-old pregnant lady presented with left hypochondrial and lower chest painful swelling. There was 10 × 15 centimeters, tender mass with features suggestive of abscess. The patient refused every sort of radiological examination. Under general anesthesia, oblique incision was done, on opening, clear fluid came out, with deep incision pus-like fluid and many daughter cysts drained. Complete evacuation of the cyst was done with closure of the residual cavity. The patient refused chemoprophylaxis because of her pregnancy. CONCLUSION: primary chest wall Hydatid cyst is a very rare disease in endemic areas. Mass and pain are the most common presentation. Excision under general anesthesia is main modality of treatment.

Porocarcinoma: A systematic review of literature with a single case report.

INTRODUCTION: Eccrine porocarcinoma is a very rare type of skin cancer. It is an aggressive dermatological malignancy. We presented a 62-year-old male with long history of a mass in left forearm complicated by distant metastasis and death. A rapid review of literature has been presented. CONCLUSION: Eccrine porocarcinoma is a rare but aggressive type of skin disease. It may arise de novo or complicate a benign skin lesion. Wide local resection is recommended.