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The orbit has a fine bony structure and represents the most vulnerable structure in the cranium. Therefore, penetrating orbital injuries are often associated with traumatic brain injury. Although transorbital-penetrating intracranial injury is not commonly encountered in emergency medicine practice, this occurrence has the potential to cause severe and fatal brain injury. In this study, we report the case of a 21-year-old male patient presented with an injury to his left orbit, caused by falling while holding a metal bar. A local examination revealed a perforating injury at the entry location of a metallic bar (S-shaped) that penetrated his left orbit. CT imaging showed the appearance of a metallic foreign body that entered anterior superior to the left orbit, passed into the left half of the frontal sinus, and extended into the intracranial area. The metallic bar was removed by craniotomy. The patient fully recovered and was discharged on postoperative 9th day. The penetration of foreign bodies through the orbitofrontal region is rare but potentially life-threatening. An emergent surgical initiative is necessary to save the life of the patient. When managed in a timely and efficient manner, the associated mortality and morbidity can be reduced. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum (PM) is a rare presentation associated with Coronavirus disease 2019 (COVID-19). Here, we report two cases presented with spontaneous PM associated with COVID-19 pneumonia.A 58-year-old female patient was admitted to the Emergency Department (ED) with dyspnea, hoarseness, myalgia, and cough. A chest CT scan revealed subcutaneous emphysema, diffuse PM, bilateral diffuse areas of ground-glass opacity, and consolidations. The patient was transferred to the critical care unit. In critical intensive care, the patient developed multi-organ failure and expired on the 10th day. A 34-year-old male patient admitted to the ED with dyspnea and cough. A chest CT scan revealed diffuse PM, bilateral diffuse areas of ground-glass opacity, and consolidations. The patient was transferred to the critical care unit. His progress was uneventful and he was discharged after 12 days. Patients suspected of PM should be examined closely during the differential diagnosis of chest pain, dyspnea, subcutaneous emphysema, and various lung- and heart-induced states. Patients diagnosed with spontaneous PM should be hospitalized for observation because the condition can be associated with complications, including death. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, an increase in the use of herbal supplements, natural products, and traditional medicines has been observed. These herbs and herbal products have been associated with complications, such as liver injury, causing high mortality and morbidity. Case Report: A 51-year-old female presented to the emergency department with a 2-week history of abdominal pain, vomiting, and nascent jaundice. In the detailed history of the patient, the daily consumption of Laurus nobilis tea was reported for 1 month at home. On physical examination, she was icteric and ill-looking. Mild right upper quadrant discomfort with tenderness was noted, but no rash or hepatosplenomegaly was observed. The laboratory tests results were as follows: serum AST/ALT ratio 1.2 (908/744 U/L), gamma-glutamyl transferase 63 U/L, ALP 124 U/L, bilirubin (total/direct) 27.0/14.0 mg/dL, and lactate dehydrogenase 420 U/L. Prothrombin time international normalized ratio was 2.77. The gastroenterology department considered fulminant hepatitis in the patient and recommended liver transplantation. The patient died while preparations for the transplant were ongoing. Conclusion: Many herbal products are known to be hepatotoxic. Laurus nobilis is a commonly consumed herbal product, and the potential of this herb to cause hepatotoxicity should be considered. [ABSTRACT FROM AUTHOR]

Introduction: Drug-induced liver injury is a common cause of liver dysfunction. Phenyramidol causes a neuronal blocking effect and is used as a moderately potent non-narcotic analgesic that can be accompanied by muscle relaxant activity. In this article, a clinically asymptomatic case of hepatotoxicity is described following the intake of phenyramidol HCl tablets in a suicide attempt. Case Report: A 52-year-old female patient was admitted to the emergency department 24 hours after allegedly attempting suicide by ingesting 16 tablets of 400 mg phenyramidol HCI. She displayed no clinical symptoms. An abdominal examination was normal. The results of her first blood test showed: ALT at 58 U/L and AST at 55 U/L. After 24 hours, ALT and AST were measured at 594 U/L and 820 U/L, respectively. The patient, whose liver function tests regressed following symptomatic treatment administered in the gastroenterology department, was discharged 5 days later. Conclusion: Drug toxicities can be difficult to diagnose but becomes easier if an agent can be identified that is suspected of causing liver injury. Accordingly, phenyramidol should be considered as a drug that causes hepatotoxicity. [ABSTRACT FROM AUTHOR]

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