Conservative Management of a Distal Humerus Spiral Fracture Sustained During Arm Wrestling: A Case Report and Literature Review.

Arm wrestling is a popular recreational activity that involves intense and repetitive muscular contractions of the upper extremity. Arm wrestling can result in various musculoskeletal injuries, including bone fractures. Humeral shaft fractures, particularly spiral fractures, are the most common fractures resulting from arm wrestling. Here, we present a case of a 25-year-old male patient who sustained a distal humerus spiral fracture during an arm-wrestling competition. The patient was managed conservatively with external reduction, cast stabilization, and physiotherapy with good outcomes. Despite initial angulation and rotation, the fracture healed well, and the patient regained full function of his arm within eight weeks. This case highlights the biomechanical aspects and risk factors of this type of fracture during arm wrestling and the value of protective measures such as proper technique, training, and protective equipment. It also highlights the potential for conservative management in such cases.

Pseudo-Pneumothorax Due to Skin Folds in a Patient With Pneumonia.

Pseudo-pneumothorax refers to several conditions that can mimic pneumothorax on chest radiography, leading to diagnostic uncertainty and unnecessary interventions. These include skin folds, bed sheet folds, clothes, scapular borders, pleural cysts, and elevated hemidiaphragm. We report a case of a 64-year-old patient with pneumonia whose chest radiograph revealed, in addition to the typical pneumonia findings, what appeared similar to bilateral pleural lines raising the suspicion of bilateral pneumothorax, but this finding was not supported clinically. Careful reexamination and further imaging ruled out the possibility of pneumothorax and concluded that this was the result of artifacts produced by skin folds. The patient was admitted and received intravenous antibiotics and was discharged three days later in stable condition. Our case highlights the importance of careful examination of imaging findings before unnecessarily proceeding to tube thoracostomy, especially when the clinical suspicion of pneumothorax is low.

Growing a peritoneal dialysis program in Palestine from zero to 178 patients in 5 years: a single-center experience.

INTRODUCTION: Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in 5 years at An-Najah National University Hospital in Palestine, presenting some challenges and ways to overcome them. METHODS: This was a single-center retrospective study of patients treated with PD from November 2016 to December 2021. Demographic and clinical data were obtained for each patient. In addition, PD discontinuation, peritonitis, and mortality rates were calculated and presented as the primary patient outcomes. RESULTS: A total of 158 patients were eligible for the study. The mean age was 51.8 ± 16.4 years, and 53.8% of patients were male. Diabetic nephropathy was the most common cause of kidney failure. 63 episodes of peritonitis were diagnosed in 48 patients (30.4%) for a rate of 1 episode/ 38.2 patient-months (0.31 episodes/ patient-years). 20 patients had their PD treatment discontinued, mainly due to psychosocial reasons and infectious and mechanical complications. Death was the fate of 27 patients, with cardiovascular disease and COVID-19 being the two main causes. CONCLUSION: The outcomes of this experience proved favorable and showed that PD could serve as a viable option for kidney failure patients in Palestine. Moreover, this study can serve as an example for other places where circumstances are challenging to take the initiative of starting their PD programs.

Bilateral pneumothorax in a parturient undergoing cesarean section under general anesthesia.

Pneumothorax is quite unusual to occur during or following cesarean section, as only six cases have been reported so far, and only one of them was bilateral. Here, we report a 19-year-old, previously healthy, non-smoking primigravida who underwent a cesarean section under general anesthesia, and whose oxygen saturation level quickly dropped to 81% following endotracheal intubation. Although an initial chest radiograph did not demonstrate pneumothorax, a CT scan performed on the following day showed the patient had developed bilateral pneumothorax. Chest tubes were inserted on both sides, and the patient was discharged on the sixth postoperative day in stable condition. This case underlines the need to include pneumothorax in the differential diagnosis when managing a patient with acute respiratory distress during cesarean section or in the immediate post-operative period.

Wandering spleen torsion in a patient with polysplenia syndrome.

Polysplenia Syndrome is a rare condition that refers to the presence of 2 or more spleens in association with other thoracoabdominal abnormalities. Here, we report a case of a 13-year-old girl who presented with acute lower abdominal pain and was diagnosed with polysplenia syndrome after obtaining a CT scan of her chest, abdomen and pelvis. Diagnostic imaging also revealed the presence of a wandering spleen hanging in the lower abdomen and upper pelvic cavity and showing signs of infarction. The patient underwent splenectomy afterward and splenic torsion was confirmed intraoperatively. To the best of our knowledge, this was the first reported case of wandering spleen torsion in a patient with polysplenia syndrome. Physicians should keep in mind the possibility of a wandering spleen torsion presenting in various locations when dealing with polysplenia syndrome patients complaining of abdominal pain.

The vulnerability of maintenance dialysis patients with COVID-19: mortality and risk factors from a developing country.

Patients on maintenance dialysis therapy are especially vulnerable to COVID-19 and its complications. This study aimed to assess the incidence, epidemiological characteristics, and mortality rate of COVID-19 among maintenance dialysis patients. This retrospective observational chart review study included 548 patients from all dialysis units in the West Bank of Palestine who acquired COVID-19 between 5 March 2020, and 11 August 2021. We collected data on patients' demographics, clinical features, and outcomes. A multivariable logistic regression model was used to assess independent risk factors for COVID-19-related mortality. The incidence of COVID-19 among maintenance dialysis patients was 35.3%, as 548 out of 1554 patients have tested positive during the study period. Patients on haemodialysis were three times riskier to get infected than those on peritoneal dialysis (37% vs 11.3%). Half (50.2%) of infected patients required hospitalisation, and 24.5% were admitted to an intensive care unit, while the mortality rate stood at 26.8%. Old age, male sex, central venous catheter use, comorbid diabetes, smoking, and having an RH negative blood group type were determined to be significantly associated with increased risk of mortality. In conclusion, the incidence of COVID-19 among Palestinian maintenance dialysis patients was notably high, especially among haemodialysis patients. High rates of hospitalisation, ICU admission, intubation and death were observed, and predictive factors for COVID-19-related mortality were identified. Therefore, the implementation of strict infection control measures and promotion of home dialysis are warranted to reduce the infection rate.KEY MESSAGESThe incidence of COVID-19 among Palestinian maintenance dialysis patients was notably high; more than one-third of the total dialysis population acquired COVID-19, with haemodialysis patients being three times more likely to get infected compared to their peritoneal dialysis counterparts.The mortality rate among maintenance dialysis patients was 26.8%, more than 25 times higher than that of the general population. The risk of mortality was significantly increased with age, male sex, smoking, diabetes, and having central venous catheter as vascular access for haemodialysis.Strict infection control measures, as well as the promotion of home dialysis, are necessary to reduce the risk of infection.