Search

Introduction: It is crucial to be aware of post-COVID-19 non-pulmonary complications. Avascular necrosis (AVN) is one of these complications. It should be noted that the risk of AVN persists in individuals who have recovered from the COVID-19 infection. The current study aims to report several cases of AVN after being infected with SARS-CoV-2., Materials and Methods: This is a single-centre retrospective case series conducted over a 2-year period (January 2021-December 2022) involving individuals who developed AVN after being infected with COVID-19., Result: The study included a total of 17 patients. The mean age of patients was 38.65±6.1 years. Twelve of them were male (70.6%) and five were female (29.4%), with a ratio of 3:1. The mean BMI of the patients was 28.3±2.4 kg/m 2 . Eleven (64.7%) patients reported administering steroid injections throughout the infection course. The mean interval between COVID-19 infection and presentation to the clinic was 6.53 months. The majority of patients (82.3%) complained of bilateral hip pain. Limping was observed in 47% of the cases. MRI showed AVN in all cases. Bilateral core decompression was performed in five cases (29.4%), total hip replacement in three cases (17.6%), and conservative treatment in nine cases (53%)., Conclusion: The ongoing pandemic may have many long-term sequelae. There is a risk of developing AVN after COVID-19., Competing Interests: The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Carcinoma of breast is a heterogeneous disease. Using their light microscopic appearance, the invasive forms are usually divided into three main types: infiltrating lobular carcinomas, infiltrating ductal carcinomas, and other infiltrating carcinomas. This paper aims to discuss and report a case of bilateral invasive ductal carcinoma of the breast., Case Report: A 48-year-old female presented with bilateral breast masses of 5-month duration. On examination. she had bilateral palpable breast masses, which were hard, mobile, and irregular. On the right side, there was skin tethering and palpable axillary lymph nodes. Ultrasound examination showed a heterogeneous, irregular, ill-defined, mass-like lesion, seen in the upper outer quadrant of the right breast along with a hypoechoic. irregular mass 12*13mm in the upper outer quadrant of the left breast. FNA showed bilateral invasive ductal carcinoma. Right axillary lymph nodes were positive for adenocarcinoma. She received 4 sessions of NACT which was followed by right-side mastectomy with axillary lymph node dissection and left-side mastectomy with sentinel lymph node biopsy., Discussion: Bilateral breast carcinomas are very rare. They form 2-5% of all breast malignancies. About 2-11% of breast cancer patients develop cancer in the opposite breast in their lifetime with an incidence rate varying from 4 to 8 per 1000 people per year., Conclusion: Bilateral carcinoma of the breast is very rare. Microscopically, the findings usually reveal infiltrative ductal carcinoma. The treatment of choice is bilateral modified radical mastectomy., (© 2022 The Authors.)

Introduction; Pulmonary fibrosis is a frequently reported COVID-19 sequela in which the exact prevalence and risk factors are yet to be established. This meta-analysis aims to investigate the prevalence of post-COVID-19 pulmonary fibrosis (PCPF) and the potential risk factors. Methods; CINAHL, PubMed/MEDLINE, Cochrane Library, Web of Science, and EMBASE databases were searched to identify English language studies published up to December 3, 2021. Results; The systematic search initially revealed a total of 618 articles - of which only 13 studies reporting 2018 patients were included in this study. Among the patients, 1047 (51.9%) were male and 971 (48.1%) were female. The mean age was 54.5 years (15-94). The prevalence of PCPF was 44.9%. The mean age was 59 years in fibrotic patients and 48.5 years in non-fibrotic patients. Chronic obstructive pulmonary disease was the only comorbidity associated with PCPF. Fibrotic patients more commonly suffered from persistent symptoms of dyspnea, cough, chest pain, fatigue, and myalgia (p-value < 0.05). Factors related to COVID-19 severity that were associated with PCPF development included computed tomography score of ≥18, ICU admission, invasive/non-invasive mechanical ventilation, longer hospitalization period, and steroid, antibiotic and immunoglobulin treatments (p-value < 0.05). Parenchymal bands (284/341), ground-glass opacities (552/753), interlobular septal thickening (220/381), and consolidation (197/319) were the most common lung abnormalities found in fibrotic patients. Conclusion, About 44.9% of COVID-19 survivors appear to have developed pulmonary fibrosis. Factors related to COVID-19 severity were significantly associated with PCPF development., (© 2022 The Authors.)

Introduction: Coronavirus disease 2019 (COVID-19) has evolved as a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). With the rise of cases worldwide, plenty of potential COVID-19 complications have emerged, including increased susceptibility to subsequent bacterial and fungal infections. This study aims to report four cases of COVID-19 associated with pulmonary mucormycosis., Method: This is a multi-center case series study. Diagnosis of COVID-19 was confirmed by reverse transcriptase-polymerase chain reaction., Result: A total of 4 patients infected with SARS-CoV2 were involved in this study. The majority of the cases were female, aged >42 years old. All patients developed severe symptoms. All of the patients had received steroids, half of them had co-morbidities. The most common computerized tomography (CT) scan findings were pulmonary cavitation and empyema. All of the cases were treated with a combination of surgery and antifungal treatment., Conclusion: As the number of COVID-19 cases rises, enhanced surveillance for co-infections with unusual pathogens should be continued. Clinicians should raise awareness of these deadly infections, which can further aggravate severe COVID-19., Competing Interests: There is no conflict to be declared., (© 2022 The Authors.)

Introduction: Despite numerous studies regarding neurological manifestations and complications of COVID-19, only a few cases of neurological consequences following complete recovery from SARS-CoV-2 infection have been described., Objectives: The current study aims to present a quantitative meta-analysis of published studies regarding the post-infectious neurological complications of COVID-19., Data Sources: The Web of Science, PubMed, MEDLINE on OVID, and Google scholar were searched for English-language researches published after January 1, 2020., Result: The review of the literature revealed 60 cases - of which 40 (66.7%) cases were male, and 18 (30%) were female. The average age was 44.95 years. Overall, 17 (28.3%) patients had comorbid conditions. Twenty-four (40%) patients were hospitalized during an active COVID-19 infection. The average interval from the COVID-19 infection to the onset of neurological sequelae was 33.2 days. Guillain-Barre syndrome was the most commonly reported neurological condition (15, 25%)., Conclusion: Despite recovery from acute infection, the pandemic highlights the significance of ongoing, comprehensive follow-up of all COVID-19 patients - even those initially were believed to be asymptomatic., (© 2022 The Authors.)

Introduction: Thin-section chest computed tomography is an important diagnostic test and utilized to determine the severity of lung involvement in COVID-19 pneumonia. The goal of this study is to examine the relationship between CT severity and the oxygen saturation level of individuals with COVID-19., Method: This is a single-center retrospective study of COVID-19 patients that were admitted at a COVID-19 hospital. Patients confirming COVID-19 with PCR testing, patients undergoing lung CT-scan and measures of capillary oxygen saturation using pulse oximetry at the time of admission were all included., Result: The total number of the cases were 105. The age was classified into four age groups, with the majority of them falling into the fourth to sixth decade of life (42, 40%). Diabetes was the most common comorbidity disease (29, 27.6%). Pulse oximetry showed hypoxemia in 87 (82.9%) cases. The most common CT finding was ground glass opacities (GGO) (45, 42.9%). The data showed a significant positive correlation between oxygen saturation and CT severity in patients infected with covid-19., Conclusion: These findings support the importance of using pulse oximetry to monitor COVID-19 patients in order to evaluate or even estimate their clinical situations., Competing Interests: There is no conflict to be declared.l, (© 2022 The Authors.)

Introduction: The osteoclast-like giant cell is a benign tumor that presents as either an isolated benign tumor or one with a carcinomatous component. This study aims to report a rare case of osteoclast-like giant cell tumor (GCT) of the parotid gland., Case Report: A 67-year-old female presented with a painless left pre-auricular swelling of 2-month duration which increased in size gradually over that period. On examination, there was a firm, mobile mass with well-defined borders in the left parotid gland. Fine needle aspiration cytology showed a giant cell-rich lesion that was highly cellular and contained a large number of osteoclast-like multinucleated giant cells, with clusters of spindle and epithelioid cells. Total parotidectomy was performed. After the operation, the patient was sent for radiotherapy., Discussion: The histogenesis and exact nature of this tumor are unknown although numerous ideas have been put forward. The most common clinical manifestation is a painless slow-growing tumor in the parotid area. Primary osteoclast-like GCT of the salivary gland might show concomitant benign or malignant neoplasms. There is also a "pure form" of the tumor that has no accompanying neoplasm., Conclusion: GCT of the parotid gland is a rare tumor. The histogenesis and nature of parotid gland GCT are not completely understood. The treatment of choice is total excision followed by radiotherapy., Competing Interests: None to be declared., (© 2022 The Authors.)

Introduction: Subcutaneous emphysema caused by a surgical operation is known as surgical emphysema, and if the cause is unknown, it is known as spontaneous subcutaneous emphysema. The current study aims to report a rare case of recurrent spontaneous SE of unknown origin., Case Report: A 27-year-old male patient presented with swelling of the chest, neck, and face that had started 20 days prior. There was crepitation on palpation. Pulmonary function tests were normal. Laryngoscopy showed a normal larynx. Bronchoscopy showed a normal bronchial tree except for some redness in the trachea and left main bronchus. Computed tomography of the chest with contrast showed subcutaneous emphysema in the anterior chest and lower neck.The patient reported a similar condition 3 years prior resulting in swelling of the upper left chest with an associated pneumothorax that was treated with tube thoracostomy. Workup including VATS was done to find the underlying cause but no cause was found., Discussion: The pathogenesis is the same as in the most cases. Air that is driven into the interstitial tissues around the pulmonary vasculature gradually moves back toward the lung's hilum, resulting in pneumomediastinum. The air gradually spreads to the soft tissues of the neck, face, chest, and limbs, resulting in widespread subcutaneous emphysema., Conclusion: Spontaneous subcutaneous emphysema without known origin is a rare condition that may resolve by conservative treatment., Competing Interests: None to be declared., (© 2022 The Authors.)

Introduction: Pericardial effusion (PE) related to COVID-19 has rarely been observed, with most reported cases being non-hemorrhagic. This study aims to present a rare case of post-COVID-19 hemorrhagic PE., Case Report: A 44-year-old male presented with shortness of breath upon exertion, palpitation, and left-sided chest tightness. He was a recently recovered from COVID-19. He was conscious, oriented, tachypneic, and tachycardic. Chest examination revealed a mixture of fine and coarse crackles along with muffled heart sounds. He had elevated D-dimer, C-reactive protein, prothrombin time, and aPTT. Computed tomography pulmonary angiogram showed acute pulmonary thromboembolism involving the posterior segmental lobar branch of the left lower lobe with concomitant pulmonary infarction. Echocardiography showed severe PE without diastolic collapse. Pericardial drainage was performed and by the 2nd day, there was no more effusion. On the 7th day, the patient developed severe complications which led to cardiac arrest., Discussion: PE is a collection of fluid in the pericardium. It has been rarely observed in relation to COVID-19, both during and after the viral infection. If PE is suspected, Echocardiography can be used to confirm its diagnosis. There is no standard management for these cases and only non-hemorrhagic patients with mild to moderate effusion can be treated using conservative measures., Conclusion: Hemorrhagic PE can be a rare but possible post-COVID-19 sequel, and echocardiography can be used to confirm its diagnosis. Drainage is necessary to resolve the effusion., Competing Interests: There is no conflict to be declared., (© 2022 The Authors.)

Introduction: Primary non-Hodgkin's breast lymphoma is a very rare entity. The present study aims to report a case of primary diffuse B-cell non-Hodgkin's breast lymphoma., Case Presentation: A 55-year-old female presented with a right breast mass for a duration of 4 months. There was no history of cancer in her family. She has had umbilical hernial repair two years before this presentation. Examination revealed the presence of a suspicious mass in the right breast and multiple axillary lymph nodes. Ultrasound showed a rounded vascular mass (46*40mm) and pathological axillary lymph nodes, U5. Mammography showed a round, dense mass with an indistinct posterior margin and a few round axillary lymph nodes, M4. A Core needle biopsy was done which showed an invasive mammary carcinoma; the result of the FNA of the axillary lymph nodes was benign lymphoid tissue. Histopathological examination confirmed the presence of a tumor, sized 6.4cm, non-Hodgkin's lymphoma. Modified radical mastectomy was performed. The histopathological examination confirmed non-Hodgkin's lymphoma., Clinical Discussion: There are two main groups of primary breast lymphoma. The bilateral diffuse-type affects the younger puerperal women associated with pregnancy or recent childbirth that may involve the CNS, ovaries, and gastrointestinal tract without lymph node involvement. The second type, the unilateral type, which appears in elderly women without extra mammary involvement., Conclusion: Primary breast non-Hodgkin's lymphoma is a rare disease. It mimics breast cancer, and hence, may lead to misdiagnosis. The common modalities of treatment include chemotherapy, radiotherapy, and surgery., Competing Interests: There is no conflict to be declared., (© 2022 The Authors.)

Introduction: Accessory breast (AB) is extra and ectopic breast tissue. Fibroadenoma (FA) in AB is a rare finding. This study aims to present a case of FA in axillary AB mimicking carcinoma of unknown primary (CUP)., Case Report: A 38-year-old female presented with a mass in her right axilla. She had a mass in her right breast for 5 years. She previously had a left breast lumpectomy for a benign condition. The lump in her axilla was palpable and hard. Ultrasound showed an oval lymph node in the level I axilla (12*6mm) with blurred and unclear fatty hilum, suspicious for malignancy. Magnetic resonance imaging revealed an oval lesion (12*7mm) in the level I axilla with no fatty hilum and with heterogeneous enhancements, suggesting abnormal nodes. Fine needle aspiration of the axillary mass suspected CUP. But core biopsy resembled FA. Both masses in the right axilla and breast were surgically excised. Histopathology confirmed FA in both masses., Discussion: Although pathologies in AB are uncommon, it is still susceptible to the same malignant and benign transformations that are found in normal breasts. The axilla is the most frequent location for FA in AB and often affects young women. Imaging techniques can be inconclusive and only histopathology can conclude a definitive diagnosis., Conclusion: FA in axillary AB is a rare condition that causes a diagnostic dilemma as it can be mistaken for other benign or malignant pathologies., Competing Interests: None to be declared., (© 2021 The Authors.)

Introduction: Paget's disease of the breast is a rare cutaneous eczema-like condition that occurs in the nipple-areolar complex of the breast. The current study aims to report a rare case of Paget's disease of the breast associated with invasive ductal carcinoma in a male breast., Case Report: A 54-year-old male presented with ulceration of the left nipple-areolar complex that has been progressing over the last 6 months. On examination; there was a palpable axillary lymph node. On ultrasound, a small hypoechoic heterogenous mass was seen beneath the areola (8*4 mm) with surrounding vascularity, and a few axillary lymph nodes with normal morphology and cortical thickness. The mammography revealed some points of calcification arranged in clusters. The patient underwent left side mastectomy and sentinel lymph node biopsy. The result of histopathological examination showed left side unifocal invasive ductal carcinoma., Discussion: There are two main theories that explain the histogenesis of Paget's disease of the breast with and without underlying malignancy: epidermotropic theory, which suggests an epidermal infiltration of the nipple with Paget cells, and transformative theory, which proposes a malignant transformation of normal glandular cells of the epidermis., Conclusion: The clinical presentation of Paget's disease of the breast is characteristic and should always warn the surgeon of the possibility of underlying malignancy., (© 2021 The Authors.)

Introduction and Importance: For many years, thoracotomy has been considered as the standard approach for thoracic injuries. The aim of the current paper is to report a successful use of video assisted thoracoscopic surgery (VATS) as the first line approach for the removal of a bullet retained deep in the lung parenchymal tissue., Case Presentation: A 46-year-old male presented with a vague pain in the chest at the site of a penetrating bullet injury 26 years prior. Chest and native chest Computed Tomography scan (CT scan) showed a 22 mm foreign body inside the substance of the left lower lobe in the anterior segment. Decision was made to remove the foreign body using VATS. The surgery was performed through an uni-port. The left lower lobe was explored and the foreign body was found within the anterior segment. It was removed and the defect was sutured using Vicryl 2/0., Clinical Discussion: Although VATS has been established to be an accurate evaluating technique for direct evaluation of the chest wall, lung parenchyma, mediastinum and diaphragm, along with its effectiveness in successfully treating a variety of conditions, its use in thoracic trauma is still not well defined., Conclusion: This report supports the use of VATS as an effective and minimally invasive approach in the removal of foreign bodies in lung parenchyma., Competing Interests: None to be declared., (© 2021 The Authors.)

Introduction: Subcutaneous emphysema is an extremely rare complication after lobectomy. The current study aims to report a case of lung cancer developing extensive subcutaneous emphysema after lobectomy., Case Presentation: A 73-year-old man presented with dyspnea and cough for one month duration associated with wheeze and sputum. He was a chronic heavy smoker (100 pack/year). Work up revealed squamous cell carcinoma. Although he had poor pulmonary function tests, he underwent left upper lobectomy. On the fifth postoperative day, he was discharged from the hospital as there was no air leak and the lung remained expanded 15 hours after clamping of the thoracostomy tube. Two days later, the patient developed generalized subcutaneous emphysema. The patient was re-admitted to the hospital and a thoracostomy tube was inserted. The lung expanded upon insertion while the subcutaneous emphysema remained the same and even slightly increased over night. A 3 cm incision was made at the left infra-clavicular area and a negative pressure applied to it. The subcutaneous emphysema completely subsided a few hours after this intervention., Discussion: Because of the benign course, the majority of cases of subcutaneous emphysema (mild to moderate) only need nonoperative management alongside treatment of the predisposing factors. These patients may need nothing other than bed rest, good analgesia, supplemental oxygen, and reassurance., Conclusion: Subcutaneous emphysema after lobectomy prolongs hospital stay. It mainly occurs in cases with poor pulmonary function tests, steroid use, and those with extensive adhesion., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2021 The Authors.)