Comparing pyridoxine with dopaminergic agonists (cabergoline and bromocriptine): Unveiling the strategy for lactation inhibition - A systematic review of clinical trials.

This systematic review aims to evaluate the efficacy and safety of Pyridoxine compared to Dopaminergic agonists (cabergoline and bromocriptine) in post-partum lactation inhibition. Cochrane Central, PubMed/MEDLINE, Cochrane Central, ScienceDirect, ClinicalTrials.gov, Web of Science, CINAHL and Google Scholar, covering the period from inception to November 2023. Additionally, the bibliographies of included articles and previous meta-analyses were screened for any relevant articles. The systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. The outcomes of interest encompassed inhibition of lactation, breast pain/tenderness, breast engorgement, milk secretion, fever, mastitis, prolactin level and adverse events related to pyridoxine, cabergoline and bromocriptine. Methodological quality assessment was conducted using the Cochrane risk of bias assessment tool for rigorous evaluation. Three clinical trials assessed the effectiveness of pyridoxine and dopaminergic agents (cabergoline and bromocriptine) for lactation inhibition. It was assessed by using different assessment methods such as a scale for milk secretion, serum prolactin levels, and questionnaires for assessing breast engorgement, breast pain, and milk leakage. On the global assessment of the therapeutic efficacy of dopaminergic agents, it was found that there was significant inhibition of lactation as compared to pyridoxine (p < 0.001). In conclusion, this systematic review contributes significant insights into lactation inhibition interventions. Dopaminergic agonists, specifically cabergoline and bromocriptine, stand out as more effective and tolerable choices compared to Pyridoxine. These findings provide a foundation for informed clinical decisions and underscore the need for careful consideration of lactation inhibition strategies in diverse clinical contexts.

Sarcoid-like reaction and hypothyroidism induced by PD-1 inhibitor treatment in metastatic renal cell carcinoma: a case report and literature review.

BACKGROUND: Pembrolizumab is among the approved treatments for a variety of cancer types, including clear cell renal cell carcinoma (ccRCC). It has contributed to enhancing the prognosis of renal cell carcinoma. However, it is essential to be aware of the numerous potential immune-related side effects associated with its use. CASE PRESENTATION: A 69-year-old patient with a history of metastatic renal cell carcinoma has been undergoing treatment with Pembrolizumab, an immune checkpoint inhibitor. The medication has led to the development of a sarcoid-like reaction, initially misinterpreted as cancer recurrence and progression. Additionally, the patient has experienced new-onset hypothyroidism, which has been attributed to the immunotherapy. CONCLUSION: Clinicians, including oncologists, endocrinologists, and radiologists, should maintain a high level of suspicions and awareness regarding the potential adverse events associated with newly introduced immunotherapies like pembrolizumab. This knowledge is crucial for the accurate diagnosis and appropriate management of patients receiving these treatments.

Waugh syndrome: A rare coexistence of intussusception and intestinal malrotation: Case report and literature review.

INTRODUCTION: Waugh's syndrome, characterized by the concurrent presence of acute intussusception and gut malrotation, is a rare clinical entity. The relationship between these conditions is not well-explored, and the true incidence may be underreported. CASE PRESENTATION: A 4 month old male infant, with an uneventful medical history, presented to the pediatric emergency department due to irritability and rectal bleeding lasting one day. The infant had a history of bilious vomiting and dark bloody rectal discharge. Physical examination revealed a hypoactive, dehydrated child with a palpable mass in the left lower abdomen. Abdominal ultrasound indicated Colo-colonic intussusception, and attempts at hydrostatic reduction were unsuccessful. Subsequent CT scan revealed malrotation with ileo-Colo-rectal intussusception. The patient underwent a two-step operation, involving manual reduction and Ladd's procedure, with a successful recovery and no post-surgical complications. CLINICAL DISCUSSION: Reviewing the cases, we explore the unique features of Waugh's syndrome, its diverse age presentation, and the challenges in timely diagnosis. Diagnostic modalities, including abdominal ultrasound and contrast studies, are discussed, emphasizing the importance of recognizing malrotation in conjunction with intussusception for appropriate management. CONCLUSION: Our experience highlights the potential underrecognition of Waugh's syndrome and emphasizes the need for a high index of suspicion. The rarity of laparoscopic interventions in documented cases is noted, emphasizing the prevailing reliance on open surgical approaches. A call for prospective studies is made to determine the actual incidence of intussusception in intestinal malrotation cases and to enhance understanding for optimal patient management.

Perceptions of telemedicine among healthcare professionals in rural tertiary care hospitals of rural Sindh, Pakistan: a qualitative study.

Background: Telemedicine has proven to be a boon in the field of medical sciences, as it provides a platform for all health-care personnel to assist patients remotely through digital technology advancements. It brings hope to the lower middle-income regions of the world. Thus, the study was conducted to explore the perceptions regarding telemedicine among healthcare professionals (HCP) in rural Sindh, Pakistan. Methodology: Overall, 19 in-depth interviews were conducted and this comprised of HCP working in the Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences (PAQSJIMS) and Peoples University of Medical and Health Sciences for Women (PUMHSW) being involved in providing online consultations and practicing telemedicine. The interviews were conducted and audio recorded in Sindhi and Urdu and were later transcribed in to English, coded for themes and sub-themes, and were analyzed using content analysis. Results: The opportunities perceived with the use of telemedicine services were reducing nosocomial infections, facilitating the healthcare in remote areas, handling telemedicine tools, application of telemedicine services on the ground and reducing stress. However, inadequate awareness regarding telemedicine, difficulty in physical examination, the need for training, lack of compliance, and concerns regarding accuracy in diagnosis and treatment were identified as the perceived barriers to the use of telemedicine services. Conclusion: HCP had perception toward telemedicine as have numerous opportunities favoring implementation as well as various barriers are needed to overcome to promote the usage of telemedicine. Increased awareness, training programs, and technological advancements are key to overcome these challenges.

A single center experience with a rare clinical entity of idiopathic granulomatous mastitis: Case series and review of the literature.

INTRODUCTION AND IMPORTANCE: Idiopathic granulomatous mastitis (IGM), also called autoimmune mastitis or granulomatous lobular mastitis is a benign, rare disease of the breast lobules. It is characterized by chronic non-caseating granulomatous sterile inflammation of the breast lobules. It is a disease of middle-aged women. CASE SERIES PRESENTATION: Herein we report six cases of IGM the General Surgery Department at Palestinian Medical Complex (PMC) with a good response to treatment and significant improvement. The patients were followed-up for an average of 4-month period. DISCUSSION: Pathophysiology is uncertain. It has a wide differential diagnosis and malignancy should be ruled out. Its diagnosis is highly challenging and is only made by biopsy. Treatment options include medical and surgical therapy. Patients are usually started with a low dose prednisolone, other options include immunosuppressive agents, antibiotics, NSAIDs, colchicine and minimally invasive surgery. IGM has a high recurrence rate up to 40 % and long term follow up is advised. CONCLUSION: IGM is a rare breast pathology that evolves in an unpredictable manner over time. Clinical and radiological aspects vary and pose a diagnostic challenge, particularly in breast cancer. The pathological examination is still the most important component of certain diagnoses. The clinically correlated treatment is still debatable.

Infantile B-cell acute lymphoblastic leukaemia with the highest recorded count of white blood cells in the literature: case report and literature review.

Introduction: Infantile leukaemia is an uncommon haematological cancer that manifests within the first year of life. This malignancy is highly aggressive and possesses distinctive immunophenotypic, cytogenetic, and molecular attributes. It can originate from either myeloid or lymphoid cells. It often exhibits a higher incidence among females. Case presentation: A 1-month-old male infant, initially seemingly healthy, presented with irritability and feeding difficulties. Born without complications, routine neonatal assessments appeared normal, and physical examination revealed no abnormalities. However, laboratory tests indicated an extremely high white blood cell count, low platelets, and elevated haemoglobin. Further examinations showed a white blood cell count of 1450 × 106/l with a blood film revealing significant leukocytosis dominated by blast cells. Abdominal ultrasound confirmed hepatosplenomegaly which was not present during pregnancy. Subsequent bone marrow analysis and flow cytometry established a diagnosis of B-cell acute lymphoblastic leukaemia (B-ALL). Clinical discussion: It is rare for infantile ALL to manifest within the first month after birth. In most cases, the diagnosis is established before birth. When characteristic signs such as hepatosplenomegaly, leukaemia cutis, or infiltrative involvement of the extramedullary and central nervous systems are present, postnatal diagnoses are relatively straightforward. However, there are instances where children present with non-specific and ambiguous symptoms that resemble other medical conditions. Conclusion: This case underscores the importance of paediatricians being vigilant and attuned to the subtle indicators that differentiate common illnesses from serious conditions such as infantile ALL.

Unique clinical entity: Infective endocarditis with ruptured MCA mycotic aneurysm presented as fever of unknown origin: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Fever of unknown origin (FUO) in children poses a complex challenge for doctors. It involves a broad spectrum of potential diagnoses, with infectious diseases being the predominant culprits, followed by connective tissue disorders and malignancies. CASE PRESENTATION: A 4-year-old boy with a prior diagnosis of a congenital bicuspid aortic valve was admitted to our hospital after experiencing two months of intermittent high-grade fever, severe nighttime headaches, and episodes of nausea and vomiting. His condition deteriorated rapidly with a drop in hemoglobin, elevated inflammatory markers, and the discovery of a large intracerebral hematoma. Further evaluation revealed infective endocarditis and a ruptured cerebral mycotic aneurysm associated with the bicuspid aortic valve infection. The aneurysm was successfully treated through cerebral endovascular catheterization, and the patient received six weeks of intravenous antibiotics. Cardiac surgery for valve repair was planned for a later date. CLINICAL DISCUSSION: Among the infectious causes, infective endocarditis (IE) is a notable contributor, accounting for 1-5 % of all FUO cases. IE can lead to severe complications, with a small fraction of patients experiencing neurological issues such as stroke, encephalopathy, or the development of cerebral mycotic aneurysms. CONCLUSION: The presented case serves as a stark reminder that FUO can be caused by serious underlying conditions, such as infective endocarditis. The rapid progression from fever and neurological symptoms to a ruptured cerebral mycotic aneurysm highlights the potentially life-threatening nature of these cases.

Odds of HIV among incarcerated drug users: a systematic review and meta-analysis of Asian countries.

Background: HIV makes up a large portion of infectious diseases globally. People injecting drugs in prisons are at high risk for contracting HIV infection. Prisons house ~10.2 million people globally, making them a high-risk setting for HIV transmission. This systematic review summarizes the available data on the odds of developing HIV infection among imprisoned people who inject drugs (PWIDs) in Asian regions. Methods: The authors electronically assessed published studies from January, 2000 to December, 2022, including studies that investigated the odds of HIV in imprisoned PWIDs. We extensively searched PubMed, ERIC, and Cochrane Central and Google Scholar with no constraints in language or time. All the observational studies evaluating the chances of HIV in Asian prisoners with an exposure group of PWIDs and a control group of non-injecting-drug users were included in our analysis. Results: The databases search yielded 254 potential studies, 10 observational studies of which having a total of 17 333 participants were included. A low or moderate risk of bias was reported in all the studies except one case-control. The pooled analysis showed a significant association between PWIDs and the chances of contracting HIV infection (Odds ratio=6.40; 95% CI=3.89-10.52; P<0.00001; I2=53%). Conclusion: This study found a vital correlation between injecting-drug usage during imprisonment and HIV transmission speed. The results of this meta-analysis support the need to prevent HIV and conducting treatment programs in high-risk settings like prisons.

Congenital erythropoietic porphyria presenting with recurrent epistaxis: a case report.

BACKGROUND: Congenital erythropoietic porphyria (CEP), also known as pink tooth or Gunther disease, is a rare hereditary disorder caused by an enzyme mutation in the heme biosynthesis pathway, which leads to the accumulation of immature and non-physiological protoporphyrin rings in various tissues. CEP is characterized by sun-exposed bullous skin lesions, hemolytic anemia, red/brown urine, and teeth staining. CASE PRESENTATION: We present a unique case of a 10-year-old Asian boy with CEP who presented with recurrent epistaxis, an unusual presentation for this condition. Based on clinical presentation and laboratory findings, including elevated urine uroporphyrin and coproporphyrin I and III levels, microcytic anemia, a higher red cell distribution width (RDW), and a lower platelet count, a thorough assessment and detailed workup resulted in a diagnosis of CEP. The patient underwent a successful splenectomy and recovered without any complications. CONCLUSION: This case report aims to raise awareness among healthcare professionals about the uncommon and atypical presentation of CEP and its management options.

The new wave of Congo virus in Pakistan: emerging threat.

Congo virus, or Crimean-Congo hemorrhagic fever (CCHF), is a tick-borne disease caused by a single-stranded RNA virus (genus nairovirus, Bunyaviridae family). It spreads through infected ticks' bites or contact with viremic individuals or livestock. Factors supporting its spread include hot, humid climates, limited pesticide use, poor animal control, inadequate irrigation during monsoons, and vector control deficiencies. Nosocomial transmission in under-resourced hospitals poses a threat to healthcare workers. Decades of CCHF cases persist in Pakistan due to these factors, with six deaths reported by June 2023. To combat the epidemic, Pakistan should raise awareness, improve irrigation, establish surveillance systems, and implement livestock quarantine and vaccination.

Genotype Mutations in Palestinian Children with Familial Mediterranean Fever: Clinical Profile, and Response to Colchicine Treatment: A Retrospective Cohort Study.

Background: Familial Mediterranean fever is a hereditary autoinflammatory disease affecting mainly Arabs, Turks, Armenians, and Jews with genotype-phenotype heterogeneity, presenting as recurrent episodes of fever along with polyserositis and rash. To date, more than 370 mutations in the MEFV gene have been recognized to cause the disease. Methods: We conducted a retrospective cohort study involving 124 patients in Hebron, Palestine, diagnosed with FMF at the Al-Ahli, and Palestinian Red Crescent Society (PRCS) Hospitals. Results: The median age of diagnosis was five years, presenting as abdominal pain (76.6%), fever (67.7%), joint pain and arthritis. Regarding MEFV gene mutations, we had 62 patients (50%) with heterozygous genotypes, 40 patients (32.3%) with homozygous phenotypes, 21 patients (16.9%) with compound heterozygous genotypes, and one was a missing state. Regarding variant frequencies, M694V was the most common one (43.4%), followed by E148Q (15.6%), V726A (5.7%), A744S (4.1%), and R202Q (4.1%). Positive family history was detected in 59 patients (54.6%), and there was no significant difference in zygosity regarding characteristics, consanguinity, and family history. Conclusions: We affirm in this study of 124 children with FMF, abdominal pain, followed by fever, joint pain and arthritis were the main manifestations. Further, M694V, E148Q, V726A, A744S, and R202Q were the most frequent mutations, and carrying the M649V mutations is associated with a predisposition to other comorbidities. We believe that this study gives a pervasive overview of FMF in Palestinian patients. Looking forward, future studies on a larger number of patients could precisely highlight the genotype-phenotype association among FMF patients.

The clinical significance of laparoscopy in the differentiation of inclusion cysts from ovarian masses: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Peritoneal inclusion cysts (PICs) are infrequently encountered cysts within the abdominal and pelvic regions, typically observed in perimenopausal women. They frequently pose a diagnostic challenge as they can be clinically misinterpreted as ovarian-related lesions, owing to their resembling clinical presentations and radiological features. CASE PRESENTATION: A 30-year-old female patient without significant medical or surgical history sought medical attention for mild left lower abdominal discomfort lasting two days. Initial evaluation ruled out pregnancy, and further tests showed no abnormalities in her blood work. Pelvic ultrasound revealed a 4.5 cm cystic mass in her left ovary while her right ovary and uterus appeared normal. A laparoscopic ovarian cystectomy was planned. During the procedure, it was discovered that the mass was not connected to the left ovary but was, in fact, a peritoneal inclusion cyst. CLINICAL DISCUSSION: previous intraperitoneal surgeries performed within a timeframe ranging from 6 months to 20 years, intraperitoneal inflammation, pelvic inflammatory disease, peritoneal tuberculosis, leiomyoma, tubo-ovarian abscess, among others. However, the absence of these predisposing factors does not minimize the possibility of PICs. CONCLUSION: This case highlights the diagnostic challenges and the value of laparoscopy in accurately identifying and differentiating such cystic cases.

Life-saving intervention following spontaneous rupture of splenic vein in a young patient: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: The spontaneous rupture of the splenic vein is indeed a rare occurrence, and it carries a high risk of mortality. To date, only a very limited number of documented cases of splenic vein rupture attributed to hepatic cirrhosis have been reported. CASE PRESENTATION: A 17-year-old male patient was urgently referred to our hospital due to sudden severe abdominal pain. Upon admission, the patient displayed critical signs, including abdominal tenderness and shock. Lab results revealed low red blood cell count and elevated creatinine levels. A CT scan uncovered a substantial abdominal fluid accumulation and a ruptured splenic vein alongside a dilated superior mesenteric vein. Emergency exploratory surgery revealed extensive intraperitoneal bleeding due to the splenic vein rupture, leading to a total splenectomy and vein ligation. Surprisingly, histological findings confirmed liver cirrhosis, although the patient had shown no liver-related symptoms prior to surgery. Over six months of careful monitoring, the patient displayed significant improvement in health with no complications or readmissions. CLINICAL DISCUSSION: The rupture of the splenic vein is an uncommon condition that should be taken into consideration when evaluating the potential causes of intra-abdominal hemorrhage, particularly in cirrhotic patients and pregnant women. The appropriate treatment typically involves controlling the hemorrhage and performing the ligation of the splenic vein, often necessitating an urgent splenectomy. CONCLUSION: This case underscores the critical importance of considering uncommon sources of sudden intraperitoneal hemorrhage, such as splenic vein rupture. It also emphasizes the vital role of prompt surgical intervention in such cases.

Rare occurrence of hemoglobin Lepore variant in a Palestinian patient: a case report and brief literature review.

Introduction: In hemoglobinopathies, a basic lesion alters the rate of globin synthesis or the structure of the globin in healthy hemoglobin (Hb). Genetic instructions are used to synthesize the polypeptide chains that make up globin chains. The kind and extent of the structural aberration of the Hb molecule are closely related to the clinical features. Hematologically, the heterozygous form of the Lepore syndrome has a pattern resembling minor thalassemia, and electrophoretically, it is characterized by aberrant Hb Lepore fractions at a rate of 5-15% and a decreased percentage of HbA and mildly increased HbF. Clinically speaking, Hb Lepore heterozygotes patients are asymptomatic and resemble the clinical picture of patients with mild thalassemia. Case Presentation: A 28-year-old female came to our attention for assessment of generalized weakness and fatigue for a 4-month duration. Laboratory evaluation, including complete blood count, showed mild microcytic hypochromic anemia with parameters resembling the thalassemia trait. Iron profile studies were normal. Abdominal ultrasound showed mild splenomegaly. Hb electrophoresis was performed and showed an abnormal high-performance liquid chromatography pattern with an abnormal Hb band, mild elevated HbF, and mild reduction in HbA. The interpretation of the Hb electrophoresis curve suggested heterozygosity for beta chain variant Hb Lepore. Discussion and Conclusion: Hb Lepore is one of the structural Hb variants with a characteristic fusion gene between the delta and beta chains. Hematologically, the heterozygous form of the Lepore syndrome has a pattern resembling the thalassemia trait. In Palestine, the prevalence of Hb Lepore, either homozygous or homozygous state, is unknown.

Metastasis of incidentally diagnosed renal cell carcinoma to the sacrum 7 years after partial nephrectomy: Case report and literature review.

INTRODUCTION: After undergoing partial nephrectomy for renal cell carcinoma (RCC), approximately 20-40 % of patients may develop either distant metastatic disease or locally recurring disease. Delayed occurrence of metastasis is an important aspect to consider in the management and monitoring of patients with renal cell carcinoma. CASE PRESENTATION: A 69-years-old male who had been followed up for liver hemangioma, an incidental enhancing right renal mass was discovered which then revealed to be renal cell carcinoma on computed tomography scan. The patient underwent a partial nephrectomy in 2016without any reported complications, complaints, adverse event and/or re-admissions. Seven years following the surgery, the patient began experiencing left hip pain, leading him to seek medical advice which is then confirmed to be a cancerous metastasis of the renal origin. CLINICAL DISCUSSION: Advocating for extended surveillance protocols is important to ensure that patients receive optimal care and that any disease progression is identified promptly. Early detection and intervention may lead to better treatment outcomes and improved patient survival. Therefore, continued vigilance and close monitoring of patients with RCC, even after long periods of disease-free survival, are essential components of comprehensive cancer care. CONCLUSION: This case highlights the challenges in predicting and detecting the occurrence of metastases in renal cell carcinoma despite regular surveillance and follow-up examinations. The delayed appearance of the metastatic lesion underscores the importance of continued vigilance and thorough monitoring even in cases where initial imaging and blood tests appear unremarkable in patients with renal cell carcinoma.

Very rare metastatic phenomena of biliary tract cancer to the cerebellum: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: The occurrence of brain metastasis due to cholangiocarcinoma is an exceedingly uncommon phenomenon, documented in only a few numbers of published cases. Recent studies indicated an incidence rate of just 0.15 % for brain metastases in connection with this condition, which was also linked to a reduced survival rate. CASE PRESENTATION: A 58-year-old woman with a history of hepatobiliary cholangiocarcinoma presented with a recent onset of unsteady walking, dizziness, vomiting, and worsening occipital headaches. Her medical history included successful chemotherapy treatment for her cholangiocarcinoma. Neurological examination revealed right-sided cerebellar deficits, and imaging indicated a sizable lesion in the right cerebellar hemisphere with surrounding vasogenic edema. A PET scan revealed a liver lesion but no other significant abnormalities. The recommended approach was surgical excision of the cerebellar lesion to relieve symptoms, halt deterioration, and obtain a tissue sample for analysis. After comprehensive discussions with the patient and her family, they opted for the surgical procedure. CLINICAL DISCUSSION: The major contributors to brain metastases include lung cancers, breast cancers, testicular cancers, melanomas, and renal tumors. In contrast, brain metastases originating from gastrointestinal cancers are less frequent, accounting for fewer than 4 % of cases, with notable impact on 1 % of colorectal cancers, 0.62 % of gastric cancers, and 0.33 % of pancreatic cancers. However, brain metastases are extremely rare. CONCLUSION: This study underscores the significance of anticipating and identifying brain metastases in biliary tract cancers, even in the face of their low incidence and the limited amount of available literature on the subject.

Huge mesenteric inflammatory myofibroblastic tumor as a rare cause of intussusception with recurrence after 10 months: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Inflammatory myofibroblastic tumor (IMT) is an infrequent, generally non-cancerous mesenchymal growth. IMT can affect individuals across various age groups, with a higher prevalence in children and adolescents. While it can emerge in any bodily region, it has a tendency to develop more often in the lungs and mesentery. IMT occurrence in the small bowel is exceptionally uncommon. It's a rare cause of intussusception and has unpredictable recurrence rate. CASE PRESENTATION: This report highlights a unique clinical presentation involving a mesenteric IMT, which presented as small intestine intussusception in a 2-year-old child. Additionally, the patient was found to have an asymptomatic mass in the right upper quadrant, later identified as a recurrent IMT 10 months after surgical intervention for intussusception caused by the same tumor. CLINICAL DISCUSSION: IMTs originate from mesenchymal tissues and encompass a blend of fibroinflammatory conditions. They exhibit a diverse combination of inflammatory and spindle cells. Diagnosing IMTs prior to surgery is intricate, as they can mimic malignant growths. Histopathology following surgery is usually needed for confirmation. Complete removal with a clear margin is the favored treatment approach. CONCLUSION: Intestinal IMT is an infrequent and often overlooked condition, but it should be taken into account when diagnosing small bowel intussusception. The best chance of preventing recurrence in cases of intestinal IMT is through complete surgical removal with a negative margin. Nonetheless, the most effective approach for managing local recurrence and metastasis is still uncertain and necessitates ongoing long-term observation.

Brain abscess as a complication of nasopharyngeal COVID-19 swab testing: Two case reports and a literature review.

INTRODUCTION AND IMPORTANCE: The nasopharyngeal swab, which has experienced a marked increase in utilization during the COVID-19 pandemic and is considered the gold standard for COVID-19 testing due to its high diagnostic accuracy and sensitivity, The procedure is generally safe and well-tolerated, with pain, discomfort, and the urge to cough or sneeze being the most common complications. Though it is occasionally associated with serious complications. CASE PRESENTATION: we report two cases of brain abscess as a complication of nasopharyngeal COVID-19 testing. The first case was of a 47-year-old male diabetic patient with a positive medical history for immune thrombocytopenic purpura (ITP) who developed a frontal brain abscess one week after the swabbing procedure and was treated with systemic antibiotics followed by a successful functional endoscopic sinus surgery. The second case involved a hypertensive female patient in her 40s who also developed a frontal brain abscess on the same side as painful nasal COVID-19 testing. Systemic antibiotics were used to treat the patient. CLINICAL DISCUSSION: Serious adverse events from nasopharyngeal COVID-19 testing were reported to occur rarely, with incidences ranging from 0.0012 to 0.026 %. Retained swabs, epistaxis, and CSF leakage were commonly reported complications, which were frequently associated with high-risk factors such as septal deviations, pre-existing basal skull defects, and sinus surgeries. However, brain abscess complications are considered one of the extremely rare complications, with only a few cases reported in the literature. CONCLUSION: Appropriate approaches that depend on adequate anatomical knowledge are necessary for practitioners to perform nasopharyngeal COVID-19 testing.

Radiological identification of neuromyelitis optica in a patient presented with unexplained weight loss and generalized weakness: a case report and literature review.

Central nervous system (CNS) inflammatory demyelinating disease known as neuromyelitis optica spectrum disorder (NMOSD) is characterized by recurrent inflammatory events that primarily affect the optic nerves and spinal cord; it may also affect the hypothalamus, area postrema, and periaqueductal gray matter. The NMOSD-specific aquaporin-4 antibody (AQP4-IgG) is available. Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) have recently been discovered in a group of patients who do not have AQP4-IgG. Case presentation: A 29-year-old female presented to the hospital with the complaint of blurry vision in her right eye and left eye ptosis for 2 days. Two months ago, the patient had a history of generalized fatigue with continuous documented fever with an average of 38.5°C, which was relieved by acetaminophen and ibuprofen. She also complained of continuous hiccups that increased at night and interfered with her sleep pattern and breathing; they lasted for 3 weeks and disappeared suddenly. She had also developed episodes of vomiting and could not tolerate food intake due to which she lost 6 kg within 3 weeks. She was later diagnosed with neuromyelitis optica (NMO) using radiological neuroimaging. Clinical discussion: Early and correct diagnosis, followed by urgent treatment for acute exacerbations and the prevention of further relapses, are essential for treating NMO spectrum illnesses since they entail significant morbidity and, occasionally, fatality. Conclusion: The patient mentioned here represents a typical example of NMO disease. This case emphasizes the presence of this disease in our environment and the importance of accurately diagnosing this ailment, even in a context with minimal resources, to prevent disability.

Rare clinical entity of cystic meningioma in an elderly patient: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Meningiomas, the most prevalent extra-axial neoplasm, are frequent tumors of the central nervous system that make up around 15 % of all intracranial malignancies. Although atypical and malignant meningiomas do exist, benign meningiomas make up the majority of cases. On both computed tomography and magnetic resonance imaging, a well-circumscribed, homogeneously enhancing, extra-axial mass is a typical imaging feature. An associated cyst is a rare imaging characteristic that may make it challenging to differentiate the tumor from a primary intra-axial glial neoplasm. Peritumoral edema can also lead to false positive results. CASE PRESENTATION: A 64-year-old female patient presented to the emergency department of our hospital due to difficulty of the speech with a 3-week duration associated with unilateral headache, gait unsteadiness, and urinary incomitance. Neuroimaging of the brain by magnetic resonance imaging (MRI) with and without gadolinium contrast revealed an extra-axial cystic lesion located in the left fronto-temporal area, measuring about 4 cm × 4 cm × 4 cm. The patient underwent a craniotomy for removal of the lesion and the resected tissue was sent to pathology. Histopathological assessment revealed a pure cystic meningioma. CLINICAL DISCUSSION: Cystic meningioma's preoperative diagnosis is not often easy to make. Compared to CT screening, brain MRI with gadolinium offers a higher diagnostic yield. To confirm the category and subtype of the tumor, a histopathological assessment of the tumor cells should always be performed. CONCLUSION: Although its rare, cystic meningioma should be considered in the differential diagnosis of cystic brain lesions.