Modulating the electronic structure of catalysts is widely recognized as an effective strategy to enhance electrocatalytic performance. This study synthesized a nanosheet array composed of Cr-Co2P confined within a P, N co-doped carbon matrix (Cr-Co2P@PNC) through a facile synchronous carbonization-phosphorization method, then anchored it onto a P-doped carbonized wood framework (PCW) to construct a composite catalyst. Benefiting from the synergistic coupling between the Cr-Co2P@PNC nanosheet array architecture and the wood-derived carbon matrix, the Cr-Co2P@PNC/PCW demonstrates remarkable catalytic activity and long-term durability for the oxygen evolution reaction (OER), achieving an overpotential of 283 mV at 50 mA cm-2 with stable operation exceeding 100 hours. Experimental characterization and theoretical calculations confirm that the coupling of wood-derived interconnected hierarchical porous structures with the nanosheet array facilitates extensive contact between active sites and electrolyte, enhancing mass transport during reactions. Cr doping modulates the electronic structure, alleviating strong adsorption at Co sites and reducing the energy barrier of the OER rate-determining step. The P, N co-doped carbon matrix promotes electron transfer and optimizes reaction kinetics. This work demonstrates an optimization strategy for OER composite catalysts while providing new perspectives for exploring renewable wood-derived catalyst designs.

Percutaneous Coronary Intervention to Spontaneous Coronary Artery Dissection with Coexistent Takotsubo Cardiomyopathy: a case reportAhmed Elsherif 1, Pouya Ebrahimi1, Dr Sophia Khattak1,2, Sudhakar George1, Sohail Q. Khan1,2Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, B15 2TH, Birmingham, UKInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom

Left Gluteal and Perianal Eumycetoma Lesion Extending into the Left Greater Sciatic Foramen, pelvic cavity to the External Anal Sphincter

A document by Zahra Sadin . Click on the document to view its contents.

Background Beta-lactam antibiotics remain the most commonly reported cause of drug allergy in children. Skin testing often shows limited sensitivity and logistical challenges, particularly for non-immediate reactions, leading to the adoption of risk-stratified diagnostic algorithms. This retrospective study evaluated the safety and diagnostic performance of a risk-stratified approach in children with suspected beta-lactam hypersensitivity, focusing on low-risk non-immediate phenotypes. Methods Medical records of 180 children (aged 3–18 years) evaluated for suspected beta-lactam allergy were reviewed. Patients were stratified based on reaction timing and clinical phenotype. Moderate-to-high-risk cases (history of anaphylaxis or immediate reactions) underwent skin testing followed by drug provocation test (DPT) if skin tests were negative. Low-risk cases (mild maculopapular exanthema [MPE] or benign delayed-onset urticaria occurring >6 hours after dosing and lasting >24 hours) underwent direct oral DPT without prior skin testing. Results Beta-lactam hypersensitivity was confirmed in 15.6% (28/180) of patients, with higher confirmation rates in immediate reactions (21.1%) compared to non-immediate reactions (3.5%). Among 57 low-risk non-immediate patients who underwent direct DPT, only 2 (3.5%) experienced mild, self-resolving cutaneous reactions; no systemic or severe reactions were observed. No positive reactions occurred in patients with delayed-onset urticaria (>6 hours post-dose). Conclusion Risk stratification based on detailed clinical history provides a safe and effective strategy for evaluating suspected beta-lactam hypersensitivity in children. Direct oral DPT without preceding skin testing is safe and efficient for low-risk non-immediate phenotypes, including mild MPE and benign delayed-onset urticaria, and should be more widely implemented to facilitate timely delabeling.

Introduction:Migration of intrauterine devices (IUDs) into the bladder is an uncommon complication; however, multiple cases have been documented in which the IUD perforates the uterine wall and migrates partially or completely into the bladder. This condition may cause chronic urinary symptoms, recurrent urinary tract infections, bladder stone formation, benign bladder hyperplasia, and even vesicouterine or rectovesical fistulas (1-6).The incidence of uterine perforation and migration associated with IUDs is estimated to range from 1.9 to 3.6 per 1,000 insertions; nevertheless, specifically intravesical migration is much rarer (3,4). Clinical presentation is usually nonspecific and includes dysuria, urinary urgency, pelvic pain, hematuria, or recurrent urinary tract infections. Diagnosis requires a high index of clinical suspicion and careful integration of gynecological history, particularly in patients with persistent urinary symptoms and history of IUD use, as migration may occur immediately after insertion or even several years later (1,2,4,7). Appropriate identification relies on imaging studies such as ultrasound, plain radiography, and computed tomography; however, definitive diagnostic confirmation is established by cystoscopy (4,5,7).Treatment depends on the location and degree of migration. Endoscopic removal via cystoscopy is considered the procedure of choice in most cases, although laparoscopic or open approaches may be required in complex situations (1-3,5,6).Intravesical migration of IUDs is well documented in the medical literature and should be suspected in patients with atypical urinary symptoms and absence of the device from the uterine cavity (1-7). The present case highlights the importance of considering bladder lithiasis secondary to IUD migration as a differential diagnosis in women with recurrent urinary tract infections and no evidence of the device in the uterus, as well as the effectiveness of open cystolithotomy, which in this case resolved the complication without adverse events.Case HistoryA 33 year old female patient from Calakmul, Campeche with a 12 year history of systemic arterial hypertension. Gynecologic and obstetric history included three pregnancies, one vaginal, and two cesarean sections secondary to preeclampsia.In 2012, the patient underwent her first cesarean section due to preeclampsia without complications. In 2016, a copper intrauterine device (IUD) was inserted, after which the patient developed symptoms consistent with recurrent urinary tract infections. In 2019, she became pregnant and delivery was completed by cesarean section, during which the IUD was not removed; during the same procedure, bilateral ligation was performed due to satisfied parity.Differential diagnosis, investigation and treatmentIn 2024, hysteroscopic removal of the IUD was attempted; however, the device could not be located. For this reason, a computed tomography scan was performed, revealing a T shaped structure with central hyperdense line measuring 3071 Hounsfield units and peripheral calcifications approximately 5 mm in size measuring 800 Hounsfield units, located in the right posterior bladder wall, with no apparent uterine or adnexal abnormalities (Figure 1).Based on these findings, the patient was referred to the Regional High-Speciality Hospital of the Yucatan Peninsula (IMSS-Bienestar) for confirmatory diagnosis and treatment. Diagnostic cystoscopy was performed, confirming the intravesical location of a calcified IUD. During the same procedure, an open cystolithotomy was performed, which proceeded without complications, allowing removal of a 5 cm bladder stone (Figure 2). Notably, cystoscopy revealed no scars, lesions, or fistulas that could explain migration of the IUD into the bladder, as presented in Figure 3.Conclusion and resultsPostoperative evolution was satisfactory. A complementary assessment by the Obstetrics and Gynecology Department demonstrated no evidence of reproductive organ damage associated with the intravesical migration of the intrauterine device. Given the complication related to prior IUD use, the patient received counseling regarding contraceptive history and future reproductive planning, confirming that no additional contraceptive intervention was required due to her previous bilateral tubal ligation. Ongoing multidisciplinary follow-up by Urology and Obstetrics and Gynecology was planned.From the patient’s perspective, she reported that she did not perceive the absence of the intrauterine device, as she had missed routine gynecological follow-up visits. She also indicated that urinary symptoms were common among female members of her family, which led her to consider her recurrent urinary complaints as normal and not indicative of increased severity. This perception contributed to a delay in seeking specialized care. After diagnosis and treatment, the patient reported an improved understanding of her condition and the importance of regular medical follow-up, even in the absence of alarming symptoms.DiscussionThe IUD is one of the most widely used contraceptive methods due to its multiple benefits and low incidence of adverse effects. Nevertheless, among its complications, the most serious is migrations to pelvic or abdominal organs, with the bladder being the least frequently affected site (8-10).Risk factors associated with IUD migration include immediate postpartum insertion, uterine structural abnormalities (such as uterine retroversion or scars secondary to previous sections), and the action of uterine contractions, which may promote displacement of the device from the uterine wall to adjacent organs (2). Although the exact mechanism of migration is not fully understood, two main hypotheses have been proposed: the first involves an acute traumatic perforation occurring immediately after insertion, and the second involves delayed inflammatory perforation resulting from progressive erosion and necrosis of the uterine wall, which may occur during the puerperium or even years after insertion (8,10).Once inside the bladder, the IUD acts as a nidus for crystallization and bladder stone formation by promoting the precipitation of mineral salts on its surface. This increases the risk of recurrent urinary tract infections and lower urinary tract symptoms, such as urinary frequency, dysuria, suprapubic pain, and hematuria (8). In the present case, the patient developed recurrent urinary tract infections, a finding consistent with reports in the literature; however, it has also been documented that some patients may remain asymptomatic for years (9,11).Although most migrated IUDs cause urinary tract infections and can be identified on plain radiography, complementary imaging studies are recommended for a more accurate evaluation. Among these, computed tomography is particularly useful prior to extraction, as it allows precise localization, assessment of device integrity, and detection of potential complications (4,7,12). In the reported case, both computed tomography and cystoscopy were essential for establishing the definitive diagnosis and planning the therapeutic approach, thereby minimizing the risk of complications.Management of migrated IUD remains controversial; however, removal is recommended as soon as possible in symptomatic patients, in accordance with the recommendations of the World Health Organization and the International Planned Parenthood Federations´s International Medical Advisory Panel (12). Although endoscopic cystolithotripsy is considered the treatment of choice due to its minimally invasive nature, therapeutic decision should be based on stone characteristics (size, hardness, number), location, presence of predisposing lesions, the patient’s clinical condition, and resource availability (8,9). In our case, the large size of the bladder stone justified an open cystolithotomy, which was performed without complications and followed by an adequate postoperative course.Although IUD migration is an uncommon complication after implantation, clinicians should be aware of this potential risk. A systematic review which included 165 cases of IUD perforation reported partial or complete bladder perforation in 39 cases, and cystoscopy was the removal technique in 23 of these patients. These findings highlight the importance of recognizing the bladder as a relevant site of IUD migration, and suggest that urinary tract symptoms should raise clinical suspicion in women with risk factors and history of IUD implantation (13).Considering the factors that may favor IUD displacement, it is essential to implement preventive measures to reduce placement failures, such as incorrect insertion or migration to adjacent organs. These include proper training of healthcare personnel, appropriate education regarding potential complications and the importance of periodic surveillance is also crucial, as IUD migration may present either early or several years after insertion. These strategies have been shown to improve the attitudes toward IUD provision and to achieve high rates of successful insertions with low complications rates in developed countries (14).Intravesical migration of an IUD, although rare, should be suspected in women with persistent urinary symptoms, recurrent urinary tract infections, and a history of IUD use, particularly when the device is not visualized within the uterine cavity. Timely diagnosis through imaging studies and cystoscopy is essential to prevent major complications. Treatment should be individualized according to the clinical and surgical characteristics of each case; in this context, both endoscopic removal and open cystolithotomy represent safe and effective alternatives.ReferencesChristodoulides AP, Karaolides T. Intravesical migration of an intrauterine device (IUD): case report. Urology. 2020;139:14–17. doi:10.1016/j.urology.2020.02.009.Varlas VN, Meianu AI, Rădoi AI, et al. Intrauterine contraceptive device migrated in the urinary tract: case report and extensive literature review. J Clin Med. 2024;13(14):4233. doi:10.3390/jcm13144233.Agil A, Tjahjodjati T, Atik N, Rachmadi D, Zahrina TT. Iatrogenic trauma of the bladder due to long-term unidentified intrauterine device malposition inside the bladder with rectovesical fistula: a case report. F1000Res. 2023;12:1390. doi:10.12688/f1000research.136351.2.Chai W, Zhang W, Jia G, Cui M, Cui L. Vesical transmigration of an intrauterine contraceptive device: a rare case report and literature review. Medicine (Baltimore). 2017;96(40):e8236. doi:10.1097/MD.0000000000008236.Qu R, Yang L, Dai Y. Cystoscopy to remove an intrauterine contraceptive device embedded in the urinary bladder wall: a case report and literature review. J Int Med Res. 2021;49(5):3000605211015032. doi:10.1177/03000605211015032.Zhang P, Wang T, Yang L. Extensive intravesical benign hyperplasia induced by an extravesical migrated intrauterine device: a case report. Medicine (Baltimore). 2019;98(20):e15671. doi:10.1097/MD.0000000000015671.Li Q, Qi D, Bi T, Guo X, Chen H. Uterine perforation caused by migration of intrauterine devices: a case report. Front Med (Lausanne). 2024;11:1455207. doi:10.3389/fmed.2024.1455207.Malki EG, Sbeih D, Bael P, Alsarabta H, Alzawahra A. The rolling stone: migration of an intrauterine device leading to bladder stone formation nine years after insertion: a case report. BMC Urol. 2025;25(1):93. doi:10.1186/s12894-025-01780-0.Chen Z, Lv Z, Shi Y. Intrauterine device migration with uterine penetration and bladder involvement complicated by secondary stones three years post-insertion: a case report. Int J Womens Health. 2024;16:1903–1907. doi:10.2147/IJWH.S492865.Tan JH, Lip H, Ong W, Omar S. Intrauterine contraceptive device embedded in bladder wall with calculus formation removed successfully with open surgery. Malays Fam Physician. 2019;14(2):29–31.Arshad Z, Saleem A, Zarak MS, Ahadi A, Umar Q, Afshan R. From contraception to calculus: an unusual case of intrauterine contraceptive device migration to the bladder nine years post-insertion. Cureus. 2024;16(4):e57582. doi:10.7759/cureus.57582.Verstraeten V, Vossaert K, Van den Bosch T. Migration of intrauterine devices. Open Access J Contracept. 2024;15:41–47. doi:10.2147/OAJC.S458156.Ouyang M, Peng K, Botfield JR, McGeechan K. Intrauterine contraceptive device training and outcomes for healthcare providers in developed countries: a systematic review. PLoS One. 2019;14(7):e0219746. doi:10.1371/journal.pone.0219746.

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Septic Arthritis of the Hip in a Premature Neonate Caused by Staphylococcus epidermidis: A Case ReportTaylor E. Arnold, BS; Paige Jones-Brooks, MD; Zackary Shearer, MD; Gwenevere White, MDDepartment of Pediatrics, Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Pan Beri Beri in a young male: A Case Report

IntroductionIntussusception is defined as the invagination of one segment of the gastrointestinal tract and its mesentery (intussusceptum) into the lumen of an adjacent distal segment (intussuscipiens). Intussusception is the most common cause of acute small bowel obstruction in children aged less than three years but comprises only 1-5% of adult bowel obstruction presentations. Additionally, in the adult population, a pathological lead point is often identifiable, whereas a minority of pediatric intussusceptions present with a lead point. Of the 5% adult intussusception, malignancy forms the majority of lead point etiology (65%–70%).1 A lipoma is a rare cause of adult intussusception but has been documented in cases worldwide.2 This report describes a case of a late presentation of an adult intussusception due to a lipoma with classical imaging findings and intraoperative photographs of the lesion. The role of bowel resection in patients with large submucosal lipomas should be considered to prevent future complications.

A case report of acute renal failure due to amlodipine overdose and alcohol consumptionKey words: amlodipine overdose; alcohol consumption; acute kidney injury (AKI); acute tubular necrosis (ATN)

Are you looking at lymphoma or perhaps listening to it? The diagnosis of lymphoma can be challenging, reflecting the often-insidious effects of either the primary mass or secondary spread. The case report in this issue by Talbot et al. (2025) describes an unusual location for a primary lymphoma tumour, in the interventricular septum extending around the aortic valve. Significant cardiac findings were noted on auscultation; qualities of cardiac murmurs were consistent with findings attributable to an uncommonly encountered differential diagnosis of effective aortic stenosis. Though presumably not acute in onset at this location, clinical presentation was only prompted when overt signs of periocular swelling were observed by the owner. Lymphoma accounts for 1.3 to 2.8% of equine neoplasms (Taintor and Schleis 2011) and T-cell rich, large B-cell lymphoma (TCRBCL) is the most common subtype (40-45% of cases) (Durham et al. 2012, Valli et al. 2016). Lymphoma associated with peri-ocular swelling (Murphy et al. 1989, Rendle et al. 2012) has also been reported, in this case the peri-ocular swelling was an early sentinel, preceding detection of the primary cardiac infiltration. The accompanying case report also highlights pertinent nuances when interpreting cardiac findings and provides an important aide-mémoire for presentations and manifestations of TCRBCL.

Case Report of IgG4-Related Autoimmune PancreatitisRui Yu1, Shiyu Zhang2, Yanping Zhao2, Jingdong Xiao1*, Chuijie Wang1, Yufeng Li1, Ziting Mo2, Xihan Zhu11Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Beiling Street 33, Shenyang 110032, China2Liaoning University of Traditional Chinese Medicine, Chongshan East Road 79, Shenyang 110847, ChinaCorresponding author: Jingdong Xiao, xiaojd@126.com

Sacral Herpes Zoster Mimicking Pressure Ulcers and Causing Elsberg Syndrome

Helminth infections remain highly prevalent among grazing equids worldwide, with cyathostomins and the tapeworm Anoplocephala perfoliata representing the most widespread parasites. While most horses tolerate low helminth burdens without overt clinical signs, a minority develop higher burdens that can result in substantial intestinal pathology. Infection with A. perfoliata burdens exceeding 20 worms has been strongly associated with mucosal ulceration, ileocaecal valve dysfunction and various forms of colic. Consequently, mounting evidence of reduced anthelmintic efficacy against A. perfoliata represents a growing concern, particularly in light of the apparent absence of a drug development pipeline for equine anthelmintics. This situation highlights the need for sustainable, evidence-based control strategies that favour diagnostic-led treatments over routine blanket deworming. Traditional coprological methods, although integral to nematode control, lack sensitivity for detecting A. perfoliata due to the parasite’s intermittent egg shedding and typically low faecal egg output. In contrast, serological and salivary immunoassays targeting parasite-specific IgG(T) have been developed, providing a more sensitive means of assessing infection status, with antibody levels shown to correlate with tapeworm infection levels. Incorporation of these tests into helminth control programmes enables targeted treatment of infected horses while minimising unnecessary anthelmintic use in individuals with little or no infection. When combined with robust pasture management practices, including regular faecal removal, maintenance of low stocking densities, rotational grazing with non-equine species and adequate paddock rest periods, diagnostic-led approaches can substantially reduce reliance on anthelmintics. This not only helps preserve drug efficacy through the maintenance of refugia but also supports sustainable long-term control of equine tapeworm infections. However, there remains an urgent need to develop validated methods for assessing anthelmintic efficacy against A. perfoliata, which should be a key priority for future research.

An Unusual Case of Citrobacter Koseri Infection During Pregnancy at 27 Weeks: A Case Report and Literature Review

A document by Reem Fakak. Click on the document to view its contents.

A document by Omar Al Ayoubi. Click on the document to view its contents.