Operation of a giant occipital encephalocele in an infant: A surgical case report

INTRODUCTION AND IMPORTANCE

Encephalocele is a rare medical condition where certain parts of the central nervous system protrude through a skull defect, resulting in a deformity where the head size is smaller than the protrusion. This condition is relatively uncommon, and only a few cases have been reported worldwide.

CASE PRESENTATION

We present a case of a 13-day-old neonate with a giant occipital encephalocele who underwent a successful surgical intervention in a resource-limited setting.

CLINICAL DISCUSSION

The diagnosis of encephaloceles is frequently by clinical examination, although sonography could be helpful before birth. It is crucial that this patient receives immediate surgical intervention. In cases where hydrocephalus and ventriculomegaly are absent, we predict a better prognosis. The prone position is preferred in these operations, and Anesthesia is a real challenge.

CONCLUSIONS

Congenital giant occipital encephaloceles can be identified clinically shortly after birth. They cause a substantial surgical challenge due to their massive size. Surgical repair must be performed as early as possible.

Complementary and alternative medicine use among cancer patients in Iran: A systematic review

Background

Cancer patients frequently turn to complementary and alternative medicine (CAM) to mitigate the adverse effects of conventional cancer treatments, alleviate stress, manage comorbidities, and address the cancer itself. This systematic review aims to investigate descriptive studies conducted in Iran, focusing on the prevalence and methods of CAM use among cancer patients.

Methods

A thorough search of PubMed, Scopus, Google Scholar, Web of Science, Magiran, and the Scientific Information Database (SID) was conducted in both English and Persian from inception to July 2023. Inclusion criteria targeted studies exploring the frequency and patterns of CAM utilization among Iranian patients across diverse cancer types.

Results

A total of 604 articles were found in the preliminary search, and 14 were included in this review. Among the 3,990 participants in the included studies, a weighted average of 51.83% (range 4.6%-100%) had used at least one CAM method. The most commonly used CAM methods were prayer (41.8%), medicinal herbs (30.1%), traditional and folk treatments (27.2%), bloodletting (17.3%), and hydrotherapy (13%). Patients reported using CAM for various reasons, including their beliefs, desire to cure the disease, reduce stress, positive past experiences, and improve physical condition. On average, 39% of patients informed their physicians about their CAM use.

Conclusion

The findings underscore the relatively prevalent adoption of CAM by Iranian cancer patients. Given the low rate of disclosure to physicians, there is a compelling need for healthcare system vigilance and monitoring to ensure comprehensive patient care.

Acute Necrotizing Encephalopathy in Adult Patients With COVID-19: A Systematic Review of Case Reports and Case Series

BACKGROUND AND PURPOSE

Acute necrotizing encephalopathy (ANE) is a rare neurological disorder that is often associated with viral infections. Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a few COVID-19-associated ANE cases have been reported. Since very little is known about ANE, the present study aimed to determine the clinical, biochemical, and radiological characteristics of affected patients.

METHODS

A search was conducted on PubMed, Scopus, Embase, and Web of Science databases for articles published up to August 30, 2022 using relevant keywords. Case reports and series in the English language that reported ANE in adult patients with COVID-19 confirmed by reverse transcription polymerase chain reaction were included in this study. Data on the demographic, clinical, laboratory, and radiological characteristics of patients were extracted and analyzed using the SPSS software (version 26).

RESULTS

The study included 30 patients (18 males) with COVID-19 and ANE who were aged 49.87±18.68 years (mean±standard deviation). Fever was the most-prevalent symptom at presentation (66.7%). Elevated C-reactive protein was observed in the laboratory assessments of 13 patients. Computed tomography and magnetic resonance imaging were the most-common radiological modalities used for brain assessments. The most commonly prescribed medications were methylprednisolone (30%) and remdesivir (26.7%). Sixteen patients died prior to discharge.

CONCLUSIONS

The diagnosis of COVID-19-associated ANE requires a thorough knowledge of the disease. Since the clinical presentations of ANE are neither sensitive nor specific, further laboratory and brain radiological evaluations will be needed to confirm the diagnosis. The suspicion of ANE should be raised among patients with COVID-19 who present with progressive neurological symptoms.

A pediatric case series of catastrophic gastrointestinal complications of posttransplant lymphoproliferative disease with increasing incidence, high association with coronavirus disease 2019, higher mortality, and a plea for early endoscopy to prevent late fatal outcome

BACKGROUND

Posttransplant lymphoproliferative disorder is one of the most severe complications after transplantation, caused by uncontrolled proliferation of Epstein-Barr virus-positive B-cells in the setting of chronic immunosuppression. As one of the biggest transplant centers worldwide, we observed a potential increase in the number of patients with posttransplant lymphoproliferative disorder presenting with gastrointestinal symptoms in 1 year, during the coronavirus disease 2019 pandemic. There is limited information about dysregulation of the immune system following coronavirus disease 2019 infection, which may lead to Epstein-Barr virus reactivation in Epstein-Barr virus-positive B-cells and development of posttransplant lymphoproliferative disorder. Furthermore, there is no consensus in literature on a modality that can help in early diagnosis of posttransplant lymphoproliferative disorder with nonspecific gastrointestinal presentations before late and fatal complications occur.

CASE PRESENTATION

Our case series includes five Iranian (Persian) patients, three female (2, 2.5, and 5 years old) and two male (2 and 2.5 years old), who developed gastrointestinal posttransplant lymphoproliferative disorder after liver transplantation. All of our patients were on a similar immunosuppressant regimen and had similar Epstein-Barr virus serologic status (seronegative at time of transplantation but seropositive at time of posttransplant lymphoproliferative disorder diagnosis). Four patients had either a positive coronavirus disease 2019 polymerase chain reaction test or exposure within the family. Although all of our patients presented with nonspecific gastrointestinal symptoms, four patients developed late posttransplant lymphoproliferative disorder complications such as bowel perforation and obstruction. All five patients with gastrointestinal posttransplant lymphoproliferative disorder received chemotherapy, but only two survived and currently are continuing the therapy. In one of the surviving patients, prompt endoscopic investigation resulted in early diagnosis of posttransplant lymphoproliferative disorder and a better outcome.

CONCLUSION

Since 80% of our patients had exposure to coronavirus, a potential relationship might be suggested between the two. Furthermore, as we witnessed in one case, urgent endoscopic investigation in immunocompromised patients presenting with gastrointestinal symptoms can improve the clinical outcomes and therefore should be considered for early diagnosis of posttransplant lymphoproliferative disorder.

Chylous ascites as a rare complication of abdominal trauma in a 7-year-old girl: A case report

Key Clinical Message

Abdominal trauma can be one of the causes of chylous ascites in pediatric cases, along with tuberculosis and malignancy. However, a definitive diagnosis is more reasonable to be done by excluding other causes.

Abstract

Chylous ascites (CA) is a rare type of ascites. Though it has high mortality and morbidity rates, which usually happen due to the rupture of lymph vessels into the peritoneal cavity. Congenital abnormalities, including lymphatic hypoplasia or dysplasia, are the most causes in pediatrics. CA following trauma in children is very rare, and to the best of our knowledge, there are very few reports in this regard. Here, we report a 7-year-old girl who was referred to our center with CA after a car accident.

A Giant Frontal Sinus Mucocele in an Opium Addict Patient: A Case Report

Mucocele is a benign soft tissue mass that could occur in all accessory glands. Mucocele can also occur in paranasal sinuses. It is mostly placed in the frontal sinus and barely grows larger than 1.5 centimeters(cm). Based on the affected site, it could cause facial pain and headache. Analgesics like opioids could relieve and potentially make patients ignore the headache and cause giant frontal mucocele. This article discusses a patient with giant frontal sinus mucocele (7×8×8 cm) and opium addiction that presented with severe and intolerable pain. A 32 yr old man came to Rajaee Trauma Hospital, Shiraz, Iran with a severe headache and a large swelling of the face frontal region that developed gradually. In physical examination, the mass was non-tender, non-pulsatile, and free from the overlying normal skin. Computed tomography (CT) scan and magnetic resonance imaging (MRI) demonstrated a frontal sinus mucocele. The operation was planned, and the patient was discharged after two days. Subsequently, the 6-month follow-up of the patient was normal. Two different hypotheses are declared in this article. First, the potential role of opium addiction as a risk factor for giant mucoceles was noted, then the analgesic non-responsiveness of sinus mucoceles was described. The latter hypothesis is more likely. So, we should consider that if the patient had an analgesic-resistant headache, one differential diagnosis could be sinus mucocele. Moreover, the pos sible psychological effect of addiction on discounting face beauty was acknowledged.

Aplastic anemia: a new complication in the recent mysterious hepatitis outbreak among children worldwide: two case reports

Background

Recently, an unknown hepatitis outbreak among children has concerned many individuals worldwide. These cases are frequently reported, mainly from Europe and other countries. In this study, we present two similar patients, who, to the best of our knowledge, are the first cases reported in the Middle East (Shiraz, Fars Province, Iran). Unlike in similar cases reported up until 30 April 2022, our patients’ hepatitis eventually resulted in aplastic anemia.

Case presentation

In this study, we present cases of two Iranian boys aged 13 and 8 years with hepatitis of unknown origin who developed aplastic anemia in the course of hospitalization.

Conclusions

Hepatitis-associated aplastic anemia is a well-known immune-mediated form of aplastic anemia that we detected in our patients and treated with immunosuppressive therapy. One patient established a satisfactory response to the treatment, but unfortunately, the other was declared brain dead.

Polypectomy-induced encephalocele manifested as meningitis and CSF rhinorrhea in a pregnant woman: a case report

Encephalocele is a protrusion of the intracranial contents through a cranium defect. Encephalocele is divided into primary (congenital) and secondary (acquired) classes. From an epidemiological point of view, primary encephalocele is much more prevalent than secondary cases. Furthermore, among the secondary causes of this condition, iatrogenic encephalocele is recognized as a rare phenomenon. In this case report, we introduce a case of secondary encephalocele in a 30-year-old pregnant female who came to our emergency center at 5 weeks of gestation with a vague headache in her forehead and a runny nose. she reported a history of nasal polypectomy 9 months ago and a 10-day hospitalization for meningitis 5 months prior to admission. MRI of the patient's brain showed evidence of cerebral parenchymal herniation to the right nasal cavity, which was suggestive of encephalocele. She was scheduled for endoscopic transnasal reconstruction, and during the operation, a significant right-sided posterior ethmoidal roof defect with CSF leak and encephalocele was revealed. Eventually, the skull defect was successfully repaired with a vascularized flap, and the patient was discharged in good general condition.