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DR.MOHAMMED IRFAN SHEIKH

in Case Study

Verrucous Tongue Lesion

Verrucous Tongue Lesion

A 67-year-old woman presented with a 2-month history of tongue pain, dysphagia, and dysarthria. She was a nonsmoker and did not drink alcohol, but she had diabetes, hypertension, and atherosclerotic cardiovascular disease. On examination, an exophytic mass with a whitish surface and multiple papillary projections was seen, involving the right half of the tongue. The tongue showed limited mobility and was indurated and tender to palpation. No enlargement of the cervical lymph nodes was detectable. Histopathological examination confirmed the clinical diagnosis of verrucous carcinoma, but in situ hybridization was negative for p16 as a surrogate marker of human papillomavirus infection. Verrucous carcinoma is a well-differentiated variant of squamous-cell carcinoma that is locally destructive, although it grows slowly and rarely metastasizes. Human papillomavirus infection and smoking are the main recognized etiologic factors. The patient was given methotrexate to reduce the size of the tumor before surgical excision. The patient had a favorable response, and there was no recurrence at 6 months of follow-up.

#HUMANPAPILLOMAVIRUS

Moniccca

in General

Brain surgery removal of metastatic tumor high power surgical microscope

Video clip from craniotomy to remove a metastatic tumor viewed from a high power magnification surgical microscope.

#SURGICAL_FOOTAGE

#FARHAD_LIMONADI

#BRAIN_TUMOR_REMOVAL

#ELECTRONIC_POSTURE_AID

#METASTASIS_(DISEASE_OR_MEDICAL_CONDITION)

#BRAIN_(ANATOMICAL_STRUCTURE)

Andy Wells

in General

Infrahyoid flap harvest

Infrahyoid flap harvest for floor of mouth reconstruction

Kuldeep Vairagi

in Discussion | 19 hours ago

Q. main extracellular cation? A. Potassium B. Chlorine C. Sodium D. Mg

#NURSINGOFFICER

#MEDICALSTUDENT

Gleiguem Bezeid

in General

Diagnostic ???

I want the medical history of the patient pleeeeeease

Kuldeep Vairagi

in Discussion | 21 hours ago

Q. Longest vein in body? 1. Pulmonary vein 2. Umbilical vein 3. Great sephenous vein 4. IVC

#NURSINGOFFICER

#MEDICALSTUDENT

#NURSINGSTUDENT

DR.MOHAMMED IRFAN SHEIKH

in Case Study

Enlarged Pinna

An 82-year-old man presented with a 1-year history of swelling of his left ear, with associated difficulty hearing. He had applied topical glucocorticoids for 4 months without response. On examination, the ear was enlarged, indurated, and erythematous (Panel A), with no associated lymphadenopathy. Biopsy revealed chronic inflammatory infiltration in the dermis, with confluent epithelioid granulomas and a lymphocytic background. High magnification showed abundant intracytoplasmic amastigotes in dermal macrophages (Panel B). Leishmania infantum was identified by means of culture and polymerase-chain-reaction assay. No visceral enlargement was noted on ultrasonography of the abdomen. The patient was treated with amphotericin B, with complete resolution of the lesion after 2 months (Panel C) and recovery of hearing loss.

Fatemeh Kourki

in Articles

Prenatal Fluoride Exposure and IQ in Kids: Is There a Link?

Prenatal Fluoride Exposure and IQ in Kids: Is There a Link?

Pregnant women's fluoride intake was associated with a reduction in their children's IQ at ages 3 to 5 years, in an observational study published online today in JAMA Pediatrics. Various outside experts have attested to the quality of the study's methodology and statistical analysis — which included sensitivity analyses and controlled for a multitude of potential confounders — but critics and other experts still point to important limitations that encourage caution in how the results are interpreted until additional research replicates the findings.

Loujain Hekmat Ahmad

in General

CerebroVascular Accident

CerebroVascular Accident

Ischemic stroke ( CVA ) is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.

#ISCHEMIC_STROKE

Loujain Hekmat Ahmad

in General

Transient Ischemic Attack

Transient Ischemic Attack

Transient Ischemic Attack ( TIA ) : a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction . 1 Symptoms during 24 hours with typical episodes lasting less than an hour . 2 Brain Injury on MRI.

Mussa

in General

Medicaltalks

in General

This patient stated "I think I cut off my finger.”

This patient stated "I think I cut off my finger.”

Unfortunately, fingertip injuries are exceedingly common in the emergency department (ED). Fingertip amputation is defined by an injury that occurs distal to the tendon insertions on the distal phalanx. Most will involve some kind of repair in the ED, and many will also require definitive operative care by a hand surgeon. Goals of care include pain reduction, preservation of sensation, and bony support for nail growth. While some hand surgeons will attempt re-implantation of an amputated fingertip, success rates remain exceedingly low. However, patients should be reassured that they will likely maintain most functionality of their hand. Injuries involving minor tissue loss (usually less than 1 cm squared) without exposed bone may be allowed to heal by secondary intention. Options for more significant injuries include revision amputation (rongeuring of bone) with primary closure, skin grafting, and flap reconstruction. Most of these injuries will require a digital nerve block for pain control and repair. I’m general, it is possible to restore the function and survival of a replanted part, with the general operative sequence being the vascular shunt first to minimize ischemia time, bone fixation with or without shortening if needed, extensor tendon repair, artery repair, venous anastomoses, flexor tendon repair, and nerve repair. This patient’s fingertip was amputated proximal to the nail bed so the bone was further debrided and the wound was closed with sutures. Fingertip injuries are traumatic events for patients but when properly managed in the emergency department, patients can enjoy a return of nearly full function of their hand.

Dirty Harry

in General

Laryngeal Nerve Palsy or Paralysis (Anatomy, physiology, classification, causes, pathophysiology)

"Laryngeal nerve palsy usually refers to the palsy of the recurrent largyngeal nerve. The recurrent laryngeal nerve is responsible for both abduction (opening) and adduction (closing) of the vocal fold. Therefore recurrent laryngeal nerve palsy is also called vocal cord paralysis and may be the first presentation of severe pathology such as cancer. People often present with hoarseness, coughing and exertional dyspnea. The vagus nerve runs a complex course. The vagus nerve exits the brainstem and descends and supplies and innervates many organs including the heart, lungs and gastrointestinal tract. The right and left vagus nerve descends along the trachea behind the common carotid artery. As the vagus nerve descends down it gives off a few branches; the superior laryngeal nerve which branches into the external and internal laryngeal nerves. The external laryngeal nerve supplies the cricothyroid muscle, the tuning fork of the larynx, responsible for raising pitch.The internal laryngeal nerve is responsible for sensation of the larynx above the vocal cords."

AshleyCooper

in General

Minimally invasive brain surgery (third ventriculostomy) through a keyhole approach.

Surgical footage taken through the neuro-endoscope during a minimally invasive neurosurgery to perform third ventriculostomy for treatment of obstructive hydrocephalus. This procedure obviates the need of having a ventriculoperitoneal shunt which has a high infection and complication rate.

#FARHAD_LIMONADI

#SURGERY_FOOTAGE

#HYDROCEPHALUS_(DISEASE_OR_MEDICAL_CONDITION)

#MINIMALLY_INVASIVE_SURGERY

DR.MOHAMMED IRFAN SHEIKH

in Case Study

Rhinoscleroma

A 63-year-old man presented with a 10-year history of a mass growing in the central region of his face, involving his nose and upper lip. He had lived his entire life in an isolated tropical region of Mexico and had received no previous treatment for this condition. Physical examination revealed a systemically well man with bilateral nostril obliteration, palate infiltration, and loss of upper teeth (Panel A). Histopathological examination revealed foamy macrophages (Mikulicz’s cells; Panel B, yellow arrow; hematoxylin and eosin) with intracytoplasmic bacilli plasma cells with Russell bodies (green arrow). Culture of tissue fragments showed the presence of klebsiella. Panel C shows intracellular Klebsiella rhinoscleromatis (black arrow; Warthin–Starry stain), but no cellular forms are clearly shown; the inset shows the area of interest on a larger scale. Rhinoscleroma is a chronic bacterial infection that is typically caused by the gram-negative bacillus K. rhinoscleromatis. Other conditions that may be associated with central facial destruction include giant-cell carcinoma, natural killer T-cell lymphoma, granulomatosis with polyangiitis, tuberculosis, leprosy, leishmaniasis, blastomycosis, cryptococcosis, and syphilis. The patient was offered treatment with ciprofloxacin but preferred to use traditional Mexican herbal medicine and was lost to follow-up.

#CRYPTOCOCCOSIS

h4m

in Discussion | 4 days ago

ROTH'S SIGN SEEN IN?

DR.MOHAMMED IRFAN SHEIKH

in Case Study

Disseminated Lyme Disease

Disseminated Lyme Disease

An 8-year-old boy presented with a 10-day history of periorbital rash, which had been preceded by knee pain, fever, and headache. During a walk in a forest 3 weeks before presentation, he was bitten on the back of his right knee by two ticks, which were removed 2 days later. On examination at presentation, he was noted to have erythema migrans periorbitally (Panels A and B), on the front of the right knee, on the right axilla, and on his buttocks. Serologic testing was notable for a Borrelia burgdorferi IgG antibody level of 0.58 (normal Lyme-index value, <0.20), a B. burgdorferi sensu lato IgG anti-VlsE level of 75.5 kU per liter (normal level, <16.0), and a B. burgdorferi IgM antibody level of 5.85 (normal Lyme-index value, <0.20). Immunoblot testing for B. garinii IgG and IgM antibodies was positive. Erythema migrans is a common manifestation of early, disseminated Lyme disease. However, it may be varied in its presentation, as seen in this patient. The patient received treatment with amoxicillin for 3 weeks and had a complete recovery.

Fatemeh Kourki

in Articles

New Kids' Guidelines: Drink Milk, Water, Avoid Plant-Based 'Milk'

New Kids' Guidelines: Drink Milk, Water, Avoid Plant-Based 'Milk'

A new campaign, "Healthy Drinks, Healthy Kids," addresses the importance of healthful drink choices for children under age 5, enforcing the standards of drinking breast milk and formula, milk, and water, while limiting juice and avoiding most plant-based/non-dairy "milks." The brainchild of a panel of experts representing four organizations — the Academy of Nutrition and Dietetics, the American Academy of Pediatric Dentistry, the American Academy of Pediatrics, and the American Heart Association — the recommendations advise drinking mostly milk and water, with limited juices and avoidance of most plant-based "milks."

DR.MOHAMMED IRFAN SHEIKH

in Case Study

Orofacial Fistulae Associated with Crohn’s Disease

Orofacial Fistulae Associated with Crohn’s Disease

A 28-year-old man presented with a 2-year history of facial lesions with discharge (Panels A and B) that had developed 6 years after a diagnosis of Crohn’s disease, despite the administration of immunosuppressant and biologic therapies. He had fistulating disease and had previously undergone surgical resections that resulted in an ileostomy and a rectal stump. Magnetic resonance imaging of the orofacial region (Panel C) and radiography performed after the infusion of the sinus tract with radiopaque material revealed three orocutaneous fistulae arising from inflamed oral mucosa associated with dental disease (Panel A). Extraction of the teeth and curettage of the sinus tract revealed granulomatous inflammation with no infective organisms. Crohn’s disease is characterized by chronic intestinal granulomatous inflammation that may affect any part of the gastrointestinal tract, from the mouth to the anus. Granulomatous conditions affecting the orofacial region are rare. Treatment with antibiotics after extraction of the teeth resulted in resolution of the fistulae. At follow-up after 1 year, the patient had no recurrence of orofacial disease and underwent a successful completion proctectomy. He is currently being treated with adalimumab and methotrexate and has had no obvious recurrence of disease.

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