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Introduction Nasal and paranasal sinus inflammation, specifically chronic rhinosinusitis with nasal polyps (CRSwNP), is a prevalent condition often addressed through endoscopic sinus surgery (ESS). Despite the commonality of this surgical intervention, recurrence rates post-ESS remain significant. This study explores the relationship between the expression of KI67, a protein indicating cell proliferation, and the likelihood of recurrence in CRSwNP patients who have undergone ESS. Methods Thirty patients undergoing ESS for CRSwNP were enrolled in this prospective study conducted between January 2023 and December 2023. Nasal polyp tissue samples, obtained during the surgical procedure, were subjected to immunohistochemical analysis to determine KI67 expression levels. Post-surgical follow-up was conducted for a period of six months to monitor for recurrence, indicated by the reappearance of nasal polyps upon endoscopic examination. Results The average number of KI67-positive cells per high-powered field (HPF) was 63.7 (range, 21-82). Nasal polyp recurrence was observed in 9 patients (30%) within 6 months following ESS. A statistically significant difference in mean KI67 expression was found between patients experiencing recurrence and those who did not (74.3 ± 11.1 vs. 53.1 ± 11.6, p=0.003). Furthermore, a positive correlation emerged between KI67 expression and Sino-Nasal Outcome Test-22 (SNOT-22) scores (Pearson correlation coefficient, r=0.42, p=0.02). Conclusion The results of this study indicate that KI67 expression could potentially serve as a predictor of recurrence and disease severity in CRSwNP patients following ESS. Confirmation of these findings and determination of the clinical utility of KI67 as a prognostic marker will necessitate further investigation with an expanded sample size and extended follow-up period.

Background Hepatitis B, a widespread and potentially life-threatening viral infection, affects millions globally. Transmission occurs through exposure to the bodily fluids of infected individuals, placing healthcare workers (HCWs) at heightened risk due to frequent contact with patients. This study evaluated hepatitis B vaccination rates, causes of incomplete immunization, and incidents of needlestick injuries among HCWs at Khartoum Teaching Hospital, Sudan. Methods Seventy-three HCWs from the different departments of Khartoum teaching hospital departments were recruited. Participants completed a self-administered questionnaire following informed verbal consent. The collected data focused on hepatitis B vaccine adherence and barriers to full vaccination. Results Of the 73 HCWs (primarily aged 20-30 years), 30 (41.1%) had completed the three-dose vaccination regimen as per guidelines. In contrast, 14 (19.2%) received partial doses, and 29 (39.7%) were unvaccinated. The predominant reason cited for incomplete or absent vaccination was vaccine unavailability. Additionally, 25 (34.2%) reported prior needlestick injuries or exposure to contaminated materials, with fully vaccinated HCWs showing a statistically significant association with reduced exposure risk (p<0.05). Conclusion Inadequate vaccine coverage and supply shortages resulted in incomplete immunization among HCWs. Contributing factors include insufficient awareness and underestimation of hepatitis B's severe outcomes by medical professionals.

Pediatric cardiac surgery is a highly challenging medical subspecialty requiring technical precision, adaptability, and extensive multidisciplinary support. Unlike adult cardiac surgery, which often addresses standardized acquired conditions, surgery for congenital heart disease (CHD) in neonates, infants, and children involves unique anatomical and physiological complexities. These patients often need individualized surgical plans, and many benefit from staged interventions to accommodate growth. The steep learning curve for pediatric cardiac surgeons, combined with limited exposure to rare forms of CHD, underscores the importance of mentoring and specialized training. The limited cardiovascular reserve of younger patients makes them susceptible to physiological fluctuations, necessitating precise intraoperative management. Postoperatively, pediatric patients with CHD require intensive monitoring in specialized units and long-term follow-up because of their vulnerability to complications and delayed neurological developments. This field also places considerable psychosocial and financial burdens on families, highlighting the need for comprehensive, family-centered care. Global disparities in access to specialized resources perpetuate inequities in patient outcomes. Addressing these challenges requires a multidisciplinary approach integrating surgical expertise, holistic family support, and policy initiatives to improve worldwide access to care. Such a strategy is essential for advancing outcomes and ensuring equitable treatment for pediatric patients with CHD everywhere.

Inflammatory pseudotumor (IPT) is a benign inflammatory lesion that is exceptionally rare in the biliary tree. Its clinical and radiological presentation mimics neoplastic disease, so diagnosis often relies on histology. Surgical resection is the mainstay of treatment. A case of histologically confirmed IPT in a 52-year-old female, successfully managed with surgical resection, is presented. A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify case reports and case series of IPT involving the extrahepatic bile ducts and liver hilum. Searches of PubMed and Embase (from January 1960 to December 2024) yielded 23 original articles that met inclusion criteria. Data on clinical presentation, management, and outcomes were analyzed. A total of 33 cases of hilar and extrahepatic IPT have been reported in the literature. Obstructive jaundice was the most common presentation (79% n=26/32) accompanied by biochemical elevation of liver function tests (91% n=21/23) and bilirubin (77% n=17/22). Surgical resection was the most common treatment (82% n=27/33) with excellent outcomes and only one case of recurrence. However, the follow-up period was relatively short (median of one year). Of five cases initially treated with steroids, three were successfully managed with steroids alone. The other two cases proceeded to surgical resection due to disease progression. Serum immunoglobulin-G4 was high in successfully managed cases and not reported in failed cases. Hilar and extrahepatic IPT is a rare pathology with a similar presentation to neoplastic disease, which can make diagnosis and management challenging. Surgical resection is the mainstay of management, however, in select cases, preoperative biopsy may help avoid unnecessary surgical intervention. Further studies with extended follow-up are needed to optimize diagnostic and therapeutic strategies.

Background: Tonsillectomy and appendectomy are the most frequently performed surgical procedures in pediatric and adult populations. However, comprehensive data examining their occurrence within the same hospital setting remain sparse. This study aimed to characterize the demographic and clinical profiles of patients undergoing tonsillectomy and assess the frequency and outcomes of those who additionally underwent appendectomy.

Methods: A retrospective review was performed on 337 patients who underwent tonsillectomy at a tertiary care hospital from 2015 to 2017. Data collected included age, nationality, sex, year of tonsillectomy, and details of any concurrent or subsequent appendectomy, such as complicating factors (e.g., perforation and abscess), imaging findings (appendicolith), and pathology results. Statistical analyses were performed using Minitab 18 (Minitab, Inc., State College, PA).

Results: Among 337 patients, five (1.5%) underwent appendectomy in addition to tonsillectomy. Overall, 78.3% (264/337) of the tonsillectomy group were pediatric vs. 21.7% (73/337) adult, while 60% (3/5) of the appendectomy group were pediatric and 40% (2/5) adult (p = 0.33). The mean (standard deviation) age across the entire cohort was 16.17 (10.48) years, and 55.2% (186/337) were men. No cases of complicated appendicitis were identified among the appendectomy patients, although three (representing 0.9% of the total cohort and 60% of the appendectomy subgroup) exhibited an appendicolith on imaging. Pathology findings confirmed acute appendicitis in four (1.2%) of these cases and a normal appendix in one (0.3%). Statistical comparisons revealed no significant difference in median age between patients undergoing tonsillectomy alone and those who also had an appendectomy (p = 0.86), nor in distribution by gender across procedures (p = 0.78).

Conclusion: This review highlights the young demographic profile of patients undergoing tonsillectomy in a tertiary care hospital and underscores the relatively low incidence of appendectomy in this cohort. Despite the small subset of appendectomy cases, timely intervention may have contributed to the absence of complicated appendicitis. Notably, institutionwide data suggest that negative appendectomies remain rare overall, indicating a need for further research into this phenomenon. These findings underscore the need for continued surveillance and future multicenter studies to better elucidate potential shared risk factors and outcomes associated with these commonly performed surgical procedures.

Introduction Anastomotic leakage (AL) is one of the most severe complications following rectal cancer (RC) surgery, with significant implications for morbidity, mortality, and oncological outcomes. Identifying risk factors associated with AL may enhance surgical decision-making and improve patient prognosis. Methods A retrospective cohort study was conducted, including 42 adult patients who underwent RC resection at a hospital in Mexico City between January 2015 and December 2022. Demographic, clinical, pathological, and surgical variables were analyzed to assess their association with AL. Univariate and multivariate statistical analyses were performed to identify independent risk factors. Results The overall incidence of AL was 11.9%, consistent with previous literature. Univariate analysis revealed no significant differences in patient-related factors such as age, BMI, ASA classification, diabetes mellitus, smoking, or biochemical markers (p>0.05). Treatment-related factors such as neoadjuvant therapy and diverting stoma (DS) placement did not show a significant association with AL. However, surgical factors played a crucial role: operative time was significantly longer in patients with AL (349.0 vs. 232.9 minutes, p=0.024), intraoperative blood loss was markedly higher (800.0 vs. 198.6 mL, p<0.001), and transfusion rates were elevated (60.0% vs. 13.5%, p=0.040). Tumor location in the middle rectum was more frequent among AL cases (60.0% vs. 18.9%, p=0.090). Postoperative complications were significantly more severe in patients with AL, with prolonged hospital stays (20.0 vs. 10.2 days, p=0.043) and increased reintervention rates (80.0% vs. 5.6%, p<0.001). In the logistic regression model, none of the analyzed variables reached statistical significance (p>0.99). However, operative time showed an odds ratio (OR) of 1.736 (p=0.997), suggesting that for each additional minute of surgery, the risk of AL could increase by 73.6%. Despite this trend, the wide confidence interval limits its precision and clinical applicability. Age showed an OR of 0.023 (p=0.998), potentially suggesting a 97.7% reduction in leakage risk for each additional year, although this result was not statistically significant and should be interpreted with caution. Conclusion Although no statistically significant risk factors were identified in the multivariate analysis, intraoperative variables such as prolonged surgical time, high blood loss, and transfusion requirement emerged as clinically relevant trends. These findings emphasize the need for optimizing surgical techniques and perioperative management to mitigate AL risk. Further studies with larger sample sizes are necessary to validate these associations and improve risk stratification models.

Delta-8-tetrahydrocannabinol (Δ8-THC) products, made from hemp-derived cannabidiol, have become more widely available since changes in legislation allowed hemp to be excluded from controlled substances. These products are often perceived as a safe, legal, and accessible alternative to marijuana or delta-9-tetrahydrocannabinol. However, scientific research on their effects remains limited. There have been reports of psychiatric symptoms associated with Δ8-THC use, although the literature is not yet comprehensive. In this report, we present three cases of patients with distinct preexisting psychiatric disorders who developed various psychiatric manifestations, including psychosis, after using Δ8-THC products. All three individuals had purchased these products legally, believing them to be safe and effective for managing their symptoms. However, their use ultimately led to psychiatric symptoms severe enough to require hospitalization. This case series highlights the need for greater awareness of the potential psychiatric effects of Δ8-THC, particularly among individuals with preexisting mental health conditions, and underscores the critical gap in research on these products.

Anorectal malformations (ARMs) is a congenital abnormality that is commonly seen in newborns without a normal or ectopic anal opening. H-type fistula is a rare subtype and is commonly diagnosed in females after a history of passing stool from the vagina which may be the first and only sign of an underlying ARM which necessitates further diagnostic modalities, treatment, and follow-up. These children may have a normal anal opening. We report on a rare case of rectovaginal fistula presenting with a left labial abscess.

Introduction Obsessive-compulsive disorder (OCD) is a persistent psychiatric condition that causes significant clinical and functional impairments. Recent research suggests a link between deficiencies in micronutrients, particularly vitamin B₁₂, folic acid, and elevated homocysteine, and the development of OCD. This study investigates the blood levels of these micronutrients and their relationship to OCD severity, with an emphasis on potential gender differences. Methods This cross-sectional study included 300 drug-free OCD patients. Serum levels of vitamin B₁₂, folic acid, and homocysteine were measured using established biochemical methods. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess clinical severity. Data were examined to determine relationships between micronutrient levels and OCD severity and differences between male and female patients. Results This study found that women had higher levels of vitamin B₁₂ (405.3 ± 15.1 vs. 360.4 ± 14.3) and folic acid (7.18 ± 0.27 vs. 5.76 ± 0.25) but lower levels of homocysteine (9.35 ± 0.64 vs. 14.4 ± 0.60) compared to men. Higher folic acid levels were linked to study participants having higher levels of education (at a college or university, where subjects are studied at an advanced level) compared to those with primary-level education. Lower vitamin B₁₂ levels were linked to family mental health history and noncommunicable diseases. Women exhibited lower levels of substance use but higher rates of self-harm and suicide attempts. Elevated homocysteine levels were linked to longer illness duration and more severe OCD symptoms. Conclusion These findings suggest that imbalances in micronutrients, particularly vitamin B₁₂, folic acid, and homocysteine, may contribute to OCD severity and treatment resistance. Gender-specific variations in micronutrient levels could provide valuable insights into personalized OCD therapy choices. Further longitudinal studies are needed to understand these relationships and their potential as therapeutic targets.