IntroductionHydrocephalus is a neurological condition marked by abnormal cerebrospinal fluid (CSF) accumulation, causing ventricular enlargement and potential brain damage [1,2]. It results from CSF overproduction, flow obstruction, or impaired absorption, presenting with headaches, nausea, visual disturbances, and cognitive decline, which is diagnosed via CT or MRI [3]. Ventriculoperitoneal (VP) shunts, which divert CSF to the peritoneum, treat various forms of hydrocephalus, including congenital, tumor-related, and normal pressure hydrocephalus [4]. However, VP shunts carry 2-20% complication risks like infection, hemorrhage, and obstruction [4]. A rare but serious complication of VP shunt is trapped fourth ventricle (TFV), where CSF accumulates due to aqueductal and foraminal blockages [5,6], which may be discovered incidentally during imaging studies [7]. This typically occurs post-multiple shunt surgeries, potentially causing brainstem compression and neurological deficits [8,9]. Symptomatic TFV requires surgical intervention [10]. The choice of surgical approach remains subject to institutional resources and expertise, with endoscopic techniques emerging as the preferred modality in well-equipped centers [11]. Early recognition of TFV and intervention are critical to prevent irreversible neurological deficits. We present a case of TFV in a pediatric patient with a history of post-traumatic hydrocephalus, initially misdiagnosed as a space-occupying lesion.

Title: Atypical Presentation of Chikungunya Virus Infection: Severe Generalized Pruritus Preceding Delayed-Onset Polyarthralgia – A Case ReportAuthors:Muhammad Faizan Ali1, Muhammad Hamza2, Hassan Mehdi1, Rahul Falodia3 , Fareena Ambreen4, Muhammad Luqman Khan2, Rida Shakeel5Abdul Eizad Asif6 Fazeela Bibi7 Said Hamid Sadat8Affiliations:Department of Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan, faizi.qamar778@gmail.com; hassanrajput40@gmail.comDepartment of Medicine, Saidu Medical College, Swat, Pakistan, muhammadhamza222000@gmail.com, mkhanluqman@gmail.comDepartment of Medicine, All India Institute of Medical Sciences, Jodhpur drrahulfalodia@gmail.comDepartment of Medicine, Khyber Girls Medical College, Peshawar, Pakistan, fareenaa07@gmail.comDepartment of Medicine, Dow Medical College, Karachi, Pakistan, ridashakeel92@gmail.comShalamar Medical and Dental College, Lahore, Pakistan, abdul.eizad1@gmail.comJinnah Medical and Dental College, 22-23 Shaheed-e-Millat Rd, Karachi City, Sindh, Pakistan, fazeelabibi@hotmail.comKabul university of medical science abu ali ibn sina, saidhamidsadat788@gmail.comCorresponding Author: Said Hamid SadatEmail address: saidhamidsadat788@gmail.com

Delayed Ileal Perforation with Psoas Abscess and Fistulization into the Inferior Vena Cava Post-Dilation and Curettage - A case report

Unmasking the Silent Glomus Tumor of the Index Finger – A Case Report and Literature Review

IntroductionAmong invasive fungal infections, mucormycosis is the third most common cause [1]. This life-threatening condition results from infections caused by Mucorales fungi and is associated withsignificant mortality rates in hospitalized patients [2]. Although these infections are rare, a rising number of instances are being reported in immunocompromised individuals. Major risk factors for mucormycosis include poorly controlled diabetes, prolonged high-dose glucocorticoid use, neutropenia, organ transplantation, iron overload, and, more recently, COVID-19 infection [3,4]. Mucorales infections can manifest in different ways, such as cutaneous and soft tissue infections, rhino-orbito-cerebral disease, pulmonary or gastrointestinal involvement, disseminated infection, and other rare presentations. Diagnosis relies on detecting distinctive, broad hyphae in tissue specimens or isolating the fungus through mycological culture. Delayed treatment significantly raises mortality [5,6,7]. Chronic HBV infection may lead to varying degrees of liver dysfunction and immune dysregulation, potentially increasing susceptibility to opportunistic pathogens [8,9]. In this report, we present a rare and clinically significant case of mucormycosis in a patient with chronic hepatitis B. Through this case, we aim to highlight the importance of maintaining a high index of suspicion for invasive fungal infections even in non-traditional hosts. To our knowledge, very few cases of mucormycosis associated with hepatitis B infection have been reported in the literature.

Introduction:Platelet-rich plasma (PRP) is a concentrated blood derivative that contains high levels of platelets and growth factors. It is formed by centrifuging a patient’s own blood and isolating the platelet-rich portion, which is then injected or applied topically back into the same patient for cosmetic purposes(1).It recently has emerged as a new treatment modality in regenerative plastic surgery, and evidences suggest that it might have a beneficial role in hair regrowth(2). As an autologous concentration of platelets, it also has a concentration of the 7 fundamental protein growth factors including the platelet-derived growth factor (PDGF),transforming growth factors-β (TGFβ), vascular endothelial growth factor, and epithelial growth factor(3).Since the last decade, it has served as a valuable therapeutic tool in various specialties such as maxillofacial surgery, plastic surgery, orthopedics and sports medicine and recently has PRP been utilized for dermatologic purposes, more specifically, for the treatment of male and female pattern hair loss(4),for skin revitalization where higher-quality, less biased studies have supported PRP as a reliable and safe therapeutic option(5).However, all therapies have side effects and since no solution is perfect, questions still remain around whether it is completely safe, though known to be autologous, meaning that it comes from the patient’s own body, and, allergic reactions cannot occur to one’s own blood and the body will not reject it(6).Among the diverse effects linked to PRP are local infection with Staphylococcus aureus(7), Spondylodiscitis due to Cutibacterium acnes infection(8),Septic arthritis in the left knee due to Streptococcus mitis infection(9), wound infection(10), Super-infection of the ulcer bed(11), irreversible blindness(12),Development of multiple slightly reddish nodules at injection sites(13) and Serum sickness disease(14).Despite their general safety, a rare but severe complication associated with these is visual impairment, including blindness(15).

IntroductionLateral meningocele is a rare form of spinal dysraphism where meningeal diverticula herniate through the neural foramina. While most meningoceles are dorsal and lumbosacral, lateral meningoceles typically occur in the thoracic region. The etiology is incompletely understood but is thought to involve failed caudal neural tube closure, influenced by folate deficiency, genetic factors, and environmental exposures [1, 2]. Associations with neurofibromatosis type 1 (NF-1) and connective tissue disorders like Marfan syndrome have been described [3].In rare instances, lateral meningoceles are a cardinal feature of Lehman syndrome, an autosomal dominant disorder caused by NOTCH3 gene mutations [4]. This syndrome’s phenotype includes distinct craniofacial dysmorphisms, growth deficiency, congenital heart defects, and feeding difficulties [2, 5]. While cognitive impairment and hearing loss have been documented, fewer than half of the 22 reported patients with Lehman syndrome had confirmed loss-of-function NOTCH3 mutations. [5, 6, 7]Here, we report a unique case of bilateral thoracic lateral meningoceles in a 6-month-old infant who presented without clinically apparent syndromic features. This case highlights the importance of including rare spinal anomalies in the differential diagnosis for infants with unexplained recurrent chest infections.