International Journal of Clinical Research
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Decision-Making and Implications of Sex-Reassignment Surgery in Intersex Individuals in the Arab World: A Case Series
No full textBackground: Knowledge, clinical guidelines, and medicolegal frameworks regarding intersex individuals are inexistent in the Arab world. Some medical professionals view intersexuality as a disorder of sexual development that often needs sex-reassignment surgery to correct while others view intersexuality as a natural variation along the sex spectrum. No study to date addresses the vast gap in the literature.
Methods: We contacted eleven non-governmental and civil society organizations involved in matters of sexuality and gender in the Arab world through email. Eight organizations answered but only one, Helem, had been directly involved in supporting intersex individuals and agreed to an interview. We conducted a semi-structured interview with Helem after consent was taken from intersex individuals or their legal guardians to share their experiences.
Results: We studied three cases of intersex individuals, of which two underwent sex-reassignment surgery at a young age. The surgeries were experimental in nature and had negative health consequences. Decision-making is influenced by physician factors, notably lack of knowledge, and parental factors, like stigma. Sociocultural reasons factor in the decision more than scientific evidence. Physicians, in the cases presented, dealt with intersexuality as a rare pathology requiring urgent surgical intervention. Parents of intersex individuals suffer significant psychosocial stressors.
Conclusion: Medical professionals are ill-equipped to deal with intersex individuals in the Arab world, often performing unethical and abusive practices for which they are not held accountable. Parent education and referral to intersex-knowledgeable physicians seem to deter parents from opting for SRS. Intersexuality is severely understudied and ignored in the medical field. Guidelines and medicolegal frameworks are required to address this issue
Avascular Necrosis of the Femoral Head After Recurrent Traumatic Posterior Hip Dislocation in a 10-Year-Old Girl: A Case Report
Get PDFBackground: Traumatic hip dislocation (THD) is a rare pathology in the pediatric population. The severity of the trauma, mismanagement, or late treatment of such pathology can lead to complications, including avascular necrosis (AVN) of the femoral head. We hereby report a case of recurrent traumatic posterior hip dislocation that eventually lead to AVN of the femoral head in a 10-year-old girl.
Case presentation: A 10-year-old girl presented to the Emergency Department complaining of left hip pain one day following a fall from a standing position. On physical examination, the left hip was held in the position of flexion, adduction, and internal rotation, with complete loss of range of motion of the left hip joint. Radiographic imaging was done and showed: a posterior dislocation of the left hip, enlargement of the growth cartilage of the left femoral epiphysis, and hypertransparency of the anterosuperior corner of the left femoral neck, and increased bone density of the upper left femoral epiphysis, suggesting previous hip dislocations. Open reduction with arthrotomy and posterior capsulorrhaphy was performed 36 hours post-injury, followed by hip immobilization by a spica cast. Two months after surgery, the cast was removed. On examination, the left hip was stable with good mobility, and weight-bearing was authorized. Follow-up was done three months post-injury. The patient had no complaints, but radiographic images showed signs of avascular necrosis (AVN) on the left femoral head.
Conclusion: Our case emphasizes the importance of early diagnosis and management of a THD in pediatrics, to prevent serious complications such as AVN
Musculoskeletal Tuberculosis Involving Ribs, Spine, and Pelvis in a 17-year-old Girl: A Case Report
Get PDFBackground: We present a case of progressive back pain associated with weight loss and low-grade fever in a 17-year-old patient previously diagnosed with spinal tuberculosis (TB) also known as tuberculous spondylitis or Pott’s disease.
Case presentation: Upon the patient's presentation to the clinic, a differential diagnosis including infectious and non-infectious causes such as extra-pulmonary tuberculosis, septic arthritis, malignancy, rheumatologic diseases, and physical abuse was made. Her preliminary workup was suggestive of granulomatous disease. A positive tuberculin skin test (TST), and a polymerase chain reaction (PCR) test of the tissue with mycobacterium tuberculosis deoxyribonucleic acid (MTB DNA), confirmed the diagnosis of musculoskeletal TB.
Conclusion: The patient was treated with anti-TB regimen and Pyridoxine to avoid peripheral neuropathy associated with isoniazid use. Her clinical follow-up showed improvement with a proper response to treatment and no sequelae
Diagnosis of Cornual Pregnancy in the Emergency Room: A Rare Case Report
Get PDFIntroduction: Ectopic or extrauterine pregnancy is a life-threatening medical condition in which a fertilized egg is implanted elsewhere than in the uterine cavity, commonly in the fallopian tubes. However, it can also occur in the peritoneal cavity, ovaries, and cervix. There are several etiological factors contributing to ectopic pregnancies, such as a history of pelvic inflammatory diseases, habitual abortions, and miscarriages, previous ectopic pregnancies, fertility procedures, as well as increased maternal age that has been correlated with a higher risk of carrying an ectopic pregnancy. Often, the first alerting sign in any ectopic pregnancy is a pain in the pelvic region, along with vaginal bleeding usually spotted between the 6th and 11th gestational week. Other symptoms include vomiting, nausea, tachycardia, and in severe cases hypovolemic shock due to internal bleeding induced by the rupture of the tubes. The key to diagnosing an ectopic pregnancy is transvaginal ultrasound, alongside the measurement of beta human chorionic gonadotropin hormone (beta-hCG) concentrations, which are usually found to be low in such cases. The management of ectopic pregnancy is either medical or surgical.
Case report: We are reporting the case of a 32-year-old pregnant woman, who presented to the emergency department for diffuse abdominal pain and recurrent episodes of vomiting and diarrhea of one-week duration. The patient was stable on admission, but later on, she showed a rapid shift in her vital signs. Blood tests were obtained, and pelvic ultrasound was done, followed by a Computed Tomography (CT) scan that revealed the presence of a right cornual ectopic pregnancy. A rapid surgical intervention was carried out to save the patient’s life and alleviate the pain.
Conclusion: Ectopic pregnancy is an urgent condition that needs to be treated immediately to avoid its fatal consequences. Several risk factors stand behind it, and a usual history and physical gynecological examinations are insufficient to detect it, hormone screening tests additionally to ultrasounds are highly recommended to decrease the incidence of mortality. A proper follow-up with a specialist could avoid the risk of an ectopic pregnancy as well as its undesirable outcomes
CMV Colitis Mimicking Crohn’s Disease in a Patient with CLL: A Case Report
Get PDFBackground: Cytomegalovirus (CMV) infections are common, especially in immunocompromised patients. These infections are usually asymptomatic but can become symptomatic in immunocompromised individuals, with colitis being the second most common presentation of end-organ disease. CMV colitis can mimic Inflammatory Bowel Disease (IBD) or cause an IBD flare, thus making the diagnosis challenging.
Case Report: We describe the case of a 69-year-old male known to have Chronic Lymphocytic Leukemia (CLL) maintained in remission on venetoclax, a BCL-2 inhibitor. The patient was recently started on mesalamine and steroids after a Crohn’s Disease (CD) diagnosis three weeks before presentation. The patient presented with bloody diarrhea and abdominal pain. His workup included a colonoscopy that showed skip lesions (diffuse ulcerated lesions separated by areas of normal mucosa), a characteristic of CD. Ileal and colonic biopsies were sent for Polymerase Chain Reaction (PCR) of CMV and turned out positive. Therefore, the patient was diagnosed with CD with superimposed CMV colitis. We started the patient on ganciclovir. Three months later, a repeat colonoscopy revealed complete resolution of mucosal ulcerations, practically changing the diagnosis to an isolated CMV colitis mimicking CD.
Conclusion: An isolated CMV colitis can mimic CD, and physicians must consider this entity in their differential diagnosis. This case is additionally remarkable because CLL and the use of a BCL-2 inhibitor usually have a protective role against CMV disease, but this was not the case for our patient
Acute Compartment Syndrome of the Hand in a 14-Month-Old Child: A Case Report
Get PDFBackground: Compartment syndrome is a well-known entity, but it is rare in the pediatric population, and its diagnosis is quite challenging. We report a case of an acute compartment syndrome (ACS) of the hand, developed after a crushing trauma, in a 14-month-old boy.
Case Report: A 14-month-old boy presented to the Emergency Department following a crushing trauma to his right hand. The patient had a progressive swelling of the right hand and agitation. On physical examination, the right hand was tense, swollen, with areas of skin necrosis and blisters, along with increased agitation upon palpation. Laboratory tests revealed elevated white blood cells, creatinine kinase, and erythrocyte sedimentation rate. Radiographic imaging showed deviated diaphyseal fractures in the second, third, fourth, and fifth metacarpals. A diagnosis of ACS of the hand was made. After draining the blisters, multiple fasciotomies were carried out to all 11 compartments of the hand. The metacarpal fractures were managed conservatively with a wrist splint for one month. A clinical and radiological follow-up after 7 months showed a complete functional recovery of the right hand and consolidation of the 2nd, 4th, and 5th metacarpal fractures, while the 3rd metacarpal fracture showed pseudoarthrosis.
Conclusion: Compartment syndrome of the hand in children is a rare condition, and its clinical picture may differ from that in adults, leading to a misdiagnosis or late diagnosis in many cases. Our case emphasizes the importance of a careful clinical evaluation in children post-trauma to diagnose such a condition
A Rare Axillary Cutaneous Squamous Cell Carcinoma: A Case Report and Literature Review
Get PDFBackground: Non-melanoma skin cancer is the most frequent tumor in Brazil and the world. One of its forms, squamous cell carcinoma (SCC) predominantly affects the old white population in areas of high exposure to the sun. Most SCCs are indolent, evolving with a cure rate higher than 90% within five years. Rarely, metastasis occurs mainly in regional lymph nodes, but it can also happen in the lungs, liver, brain, skin, and bones.
There are currently many treatment options; based on the stratification of the neoplasm as high or low risk, an appropriate approach is defined.
Case presentation: This report presents the case of a patient with high-risk squamous cell carcinoma affecting an area not exposed to solar radiation and without any other previous triggering factor, which is quite uncommon for this type of tumor. The rarity of the case stems from the lack of scientific reports on the occurrence of SCC in the axillary region, without a history of local chronic inflammatory lesions. The Portuguese, English, and Spanish languages were used to search the database of the main scientific platforms Pubmed, Cochrane Library, Scielo, and Lilacs, with no results similar to the case reported.
Conclusion: Despite the fact that the axillary area is not sun-exposed, squamous cell skin cancer manifested as an extensive lesion that required a complex surgical resection with flap repair. Such findings highlight the importance of a thorough physical exam and work-up to diagnose lesions in their early forms which require simple resection procedures and avoid late diagnoses resulting in complex procedures. Such an approach reduces the risk of various complications like wound infection or dehiscence, flap ischemia, or necrosis, among others
Analysis of Surgical Resection of Non-Melanoma Skin Cancer in The Head and Neck of Elderly Population in a Public Hospital of São Paulo
Get PDFIntroduction: Skin cancer is among the most frequent neoplasms worldwide. It is divided into two major groups: non-melanoma skin cancer (NMSC) and melanoma skin cancer (MSC), with NMSC still classified into several subtypes, with the most prevalent being basal cell carcinoma subtype (BCC), followed by squamous cell carcinoma (SCC). Although NMSC does not present high mortality rates, it can involve high morbidity on the functional, aesthetic, and emotional levels. There is a divergence in the literature regarding decision-making in the cases of elderly (patients above 65 years of age) and super elderly patients (starting at 80 years of age).
Objectives: This study aims to:
1. Identify the complications of surgical resection of the NMSC of the face and neck in the elderly population.
2. Demonstrate that surgical resection can be used as a therapeutic option in the elderly population without a significantly higher risk of morbidities.
Method: This is a transversal, retrospective single-center study of quantitative nature. After the approval of the Research Ethics Committees, analysis was performed on the electronic records of 34 patients who underwent surgery at the Carapicuíba General Hospital between August 2017 and November 2019. The descriptive analysis of the results was performed employing absolute and relative frequency of the qualitative variables; mean and standard deviation were used for the quantitative variables. Analysis of group differences was done through the Fisher's Exact, Student's, or Mann-Whitney T-tests, to evaluate the factors associated with the complications of the procedure.
Results: The results showed a mean age of 85.1 years; higher prevalence in females (61.8%); higher prevalence of BCC (76.5%); higher involvement in the nasal (23.5%), periauricular (23.5%), and malar regions (17.7%); hypertension (55.9%), and diabetes mellitus (35.3%) as the main comorbidities; 8 (23.5%) patients had post-surgical complications, and 0 patients had intraoperative complications.
Conclusion: It was concluded that surgical resection was a good therapeutic method for the patients approached in the study. It is suggested that the therapeutic choice should be individualized, with the evaluation of the patient as a whole and taking into account aspects other than age group and comorbidities. Moreover, it is necessary to develop new studies and clinical trials with a more significant sample
Listeria Necrotizing Cellulitis: A Case Report
Get PDFBackground: L. monocytogenes typically affects pregnant women, neonates, or immunocompromised individuals, with a wide clinical spectrum that includes Central Nervous System (CNS) infections, endocarditis, and very rarely, localized infections such as necrotizing fasciitis . Although L. monocytogenes is the main pathogenic species, there are a total of 21 described species including L. grayi. L. grayi is not a well recognized human pathogen, despite a few case reports of infection in organ transplant patients. Listeria-associated soft tissue infections are exceedingly rare and are typically seen in immunocompromised individuals, with the usual culprit being Listeria monocytogenes.
Case Report: We report the case of A 33-year-old previously healthy male, presented to the Emergency Department (ED) with left leg swelling, erythema, and fever. After multiple courses of treatment, we were able to isolate the L.grayi from the intraoperative specimen, confirmed the diagnosis of L.grayi associated cellulitis in a healthy young non-immunocompromised patient.
Conclusion: This is to the best of our knowledge the first case of Listeria Grayi associated soft tissue infection in a previously healthy young man 3 months after recovery from COVID-19 infection
The Importance of Research for the Aspiring Young Scientists
Get PDFFor many years, research served as the primary pillar behind the growth of medical sciences and provided the scientific community with the tools needed to expand their discoveries. According to a recent survey, students are now unable to follow research tracks owing to financial difficulties, obstacles in finding opportunities, or a lack of enthusiasm in research due to insufficient exposure to medical research in their medical schools. This becomes a worrisome fact since medical school curricula are not giving much importance to research in the training of future medical generations. This editorial tackles these challenges and how to face them.