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Background The COVID-19 pandemic and its related restrictions were associated with changes in emergency department (ED) utilization, with reductions reported in many regions worldwide. In Brazil, where EDs often serve non-urgent cases, the long-term impact remains unclear. Therefore, this study evaluated ED utilization trends across pre-pandemic, pandemic, and post-pandemic periods in a large tertiary hospital. Methods This retrospective observational study analyzed all ED visits recorded at the University of Campinas Clinics Hospital, a tertiary care referral hospital in southeastern Brazil, from January 2018 to December 2024. Data from the electronic medical record system were categorized into pre-pandemic, pandemic, and post-pandemic periods. Temporal trends in total, adult, and pediatric ED visits, as well as by medical specialty, were evaluated using joinpoint regression (Joinpoint Regression Program, version 4.9.0.1). Results Between Jan/18-Feb/20 (pre-pandemic), Mar/20-May/23 (pandemic), and Jun/23-Dec/24 (post-pandemic), 388,733 ED visits were recorded, including 329,111 adults and 59,622 pediatrics. Total visits declined by 39.5% from 2019 (69,519 visits) to 2020 (41,991), with reductions of 34.8% among adults (56,813 to 37,013) and 60.8% among children (12,706 to 4,978). Joinpoint analysis for total visits identified a sharp negative trend at the onset of the pandemic (p = 0.03), followed by a gradual recovery that did not reach pre-pandemic levels by 2024 (77.8% of baseline; pre-pandemic mean = 70,701; visits in 2024 = 54,987). Temporal patterns varied by specialty: neurology and some surgical specialties showed growth, while internal medicine, psychiatry, and ophthalmology exhibited distinct fluctuations and incomplete recovery. Conclusion The COVID-19 pandemic caused a marked and prolonged disruption in ED services utilization. Although visit volumes gradually recovered, they remained below pre-pandemic levels, with variable patterns across age groups and specialties. These findings highlight lasting shifts in healthcare-seeking behavior and the need for adaptive planning for future health crises.

Tics are sudden, rapid, non-rhythmic movements or vocalizations. Bupropion XL, a norepinephrine-dopamine reuptake inhibitor (NDRI), is approved for depression and smoking cessation. While tics are a known adverse effect of stimulants and have been rarely reported with selective serotonin reuptake inhibitors (SSRIs), they are exceptionally uncommon with bupropion. We present the case of a 27-year-old male patient with no prior history of tic disorder who developed motor (clapping) and vocal (whistling, laughing) tics following the initiation of bupropion XL for depressive symptoms. The tics subsided completely upon discontinuation of bupropion and initiation of low-dose risperidone. This case highlights a rare but clinically significant adverse effect of bupropion, underscoring the need for clinical vigilance when prescribing this agent.

Idiopathic intracranial hypertension (IIH) presenting with focal neurological deficits is rare and may mimic acute stroke, complicating timely diagnosis. We report the case of a 43-year-old Malay woman with progressive headache, intermittent visual symptoms, and acute-onset, progressive right-sided weakness over two days. Dilated fundus examination revealed bilateral grade 2 papilledema, and neurological examination showed mild hemiparesis. Non-contrast CT and CT angiography of the brain were normal. Lumbar puncture (LP) demonstrated elevated opening pressure with normal CSF findings. She improved significantly following LP and acetazolamide, with complete resolution of hemiparesis within one week. This uncommon presentation highlights the importance of prompt neuroimaging, early ophthalmological assessment, and LP. IIH should be considered in patients with persistent headache and acute hemiparesis once structural and vascular causes have been excluded.

Acute appendicitis is widely recognized as the leading cause of acute abdominal pain in patients seeking hospital treatment. The standard of care and golden approach has traditionally involved performing an appendicectomy, which nowadays is more often performed using laparoscopic techniques. As with any laparoscopic procedure, there is a risk of iatrogenic organ injury, particularly during trocar insertion; one such organ at risk is the urinary bladder (0.17-0.73%). Most reported cases of urinary bladder injuries occur due to trocar insertion in the suprapubic area. In this report, we present a case of a patient with an occult bladder injury diagnosed postoperatively on day 3 via creatinine level in drain fluid after undergoing a laparoscopic appendicectomy. We also include a review of the literature regarding the presentation, diagnosis, and management of this complication.

Objective: The objective of this study was to compare the diagnostic accuracy of ultrasonography and computed tomography (CT) in the diagnosis of nasal bone fractures (NBFs) and to assess their clinical utility in the context of current evidence-based recommendations.

Methodology: This prospective analytical study was conducted in the Department of Otorhinolaryngology between January 2021 and December 2022, encompassing 126 patients with clinically diagnosed NBFs who provided informed written consent. Ultrasonographic and CT imaging were used to detect and characterize fractures. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ultrasonography and CT in identifying NBFs were calculated with 95% confidence intervals (CIs).

Results: Among 126 patients (mean age: 38.4 years; 90.5% male), clinical examination identified NBFs in all cases. Ultrasonography detected 121 fractures (accuracy: 96.0%), while CT detected 125 fractures (accuracy: 99.2%). Sensitivity of ultrasonography was 88.57% (95% CI: 83.2-92.5%) compared to the CT sensitivity of 97.3% (95% CI: 94.8-98.9%). Both modalities demonstrated 100% specificity. McNemar's test demonstrated a statistically significant difference in sensitivity between CT and ultrasonography (p = 0.008). CT showed superior sensitivity in detecting undisplaced fractures (35 vs. 31 cases, p = 0.047), with no significant difference for displaced or comminuted fractures (p > 0.05).

Conclusion: While CT demonstrates superior sensitivity, particularly for undisplaced NBFs, ultrasonography offers a valuable non-ionizing alternative for initial fracture assessment in appropriate clinical contexts. Both modalities demonstrated high sensitivity for displaced fractures. However, the choice of imaging should balance the superior accuracy of CT against the safety and accessibility of USG, with awareness of operator dependency. Further prospective studies with multi-center participation and varied operator experience levels are warranted to determine optimal imaging strategies.

Background:  Accurate preoperative blood grouping and antibody screening are critical for trauma and orthopaedic (T&O) surgery. Group and Save (G&S) samples are frequently rejected due to labelling discrepancies, incomplete documentation, or sample quality issues. Such rejections delay surgery, increase patient discomfort from repeated venepuncture, and generate avoidable financial and operational burdens. This audit assessed the frequency, underlying causes, and financial implications of rejected GS samples for T&O patients in the Accident and Emergency (A&E) department and developed targeted recommendations to minimise error rates.

Methods:  A retrospective clinical audit was conducted at the Luton and Dunstable Hospital NHS Foundation Trust, United Kingdom, encompassing all patients admitted with neck of femur (NOF) fractures between September 2024 and March 2025. Laboratory information system data and request forms were reviewed to identify rejected samples, categorise causes of rejection, and determine the staff group responsible for collection. Cost estimates were calculated using the hospital's local pathology finance reports. A follow-up re-audit was conducted after implementing the initial audit's recommendations, from July to October 2025.

Results:  Of 171 G&S samples, 64 (37.4%) were rejected. The majority (62.5%, n=40) were taken by A&E staff. Predominant causes were absent signatures, missing date/time, mismatched identifiers, and sample integrity issues (haemolysis/underfilling). Approximately 20% (n=13) of affected patients required ≥2 repeat samples. The direct cost per rejected sample ranged from £12 to £80. After interventions, a re-audit of 84 samples showed the rejection rate fell to 16.6% (n=14).

Conclusions:  Sample rejection in A&E is a preventable source of perioperative inefficiency. Most errors stemmed from documentation/labelling lapses. Implementing standardised bedside labelling, electronic order validation, and mandatory competency refreshers supported by a G&S checklist substantially reduced rejection rates. These measures optimise workflow, reduce costs, and enhance patient safety.

Craniopharyngiomas are benign suprasellar tumours that can present with symptoms of raised intracranial pressure, visual impairment, or endocrine dysfunction. They are classified into the more common adamantinomatous and less common papillary tumours. Cystic variants may cause obstructive hydrocephalus, necessitating urgent intervention. This video case-based review presents the case of a 61-year-old male who presented with a two-month history of headaches, cognitive decline, and visual changes. Imaging revealed a large 2.8 x 2.2 x 2.2 cm suprasellar mass with cystic components extending into the third ventricle - consistent with a craniopharyngioma, causing bilateral foraminal obstruction and acute hydrocephalus. An urgent right frontal endoscopic septum pellucidostomy, cyst drainage, and ventriculoperitoneal shunt insertion achieved rapid symptomatic relief. Histopathology confirmed a World Health Organization (WHO) Grade 1 adamantinomatous craniopharyngioma. Following neurological stabilisation, a planned second-stage extended transsphenoidal resection achieved near-total removal. Postoperative radiotherapy was delivered to the tumour residuum. Endocrine sequelae, including hypopituitarism and diabetes insipidus, were managed with hormone replacement. At one-year follow-up, the patient remained radiologically stable with no recurrence. A review of current literature further supports neuroendoscopic transventricular cyst aspiration as a temporising measure in cyst-dominant craniopharyngiomas, particularly in the setting of acute hydrocephalus. This strategy offers rapid decompression, symptom relief, facilitating safer, elective definitive surgery. However, as a sole intervention, it is rarely curative, and recurrence risk remains high without subsequent resection and/or radiotherapy. A planned, two-stage approach combining neuroendoscopic decompression with definitive tumour control represents a safe and effective management strategy for giant cystic craniopharyngiomas.

Hyaluronic acid (HA) currently maintains a favorable safety profile in the field of aesthetic medicine. However, severe acute hypersensitivity reactions may occur, clinically defined as angioedema. This condition typically presents immediately after HA injection, with marked swelling, pain, and evident tissue distress secondary to edema and local vascular physiological alterations. These events are more frequently observed in the lips, and although reported cases are scarce, most involve this anatomical location. The etiology of this uncommon complication is not fully understood. Proposed mechanisms include trace protein impurities within HA preparations, as well as the role of CD44-expressing mast cells, which exhibit strong adherence to tissue-bound HA. We present a case report of a patient who developed labial angioedema following HA injection, clinically associated with both viral and bacterial infection. The clinical presentation, diagnostic workup, therapeutic approach, and clinical outcome are described.

Chiari II malformation is commonly associated with hydrocephalus requiring early cerebrospinal fluid (CSF) diversion and may coexist with complex supratentorial developmental abnormalities. As a result, patients with severe congenital structural brain anomalies and long-term ventriculoperitoneal (VP) shunting often experience neurodevelopmental impairment and are at increased risk of epilepsy. We report a 17-year-old girl with Chiari II malformation, repaired myelomeningocele, and ventriculoperitoneal shunting since birth (revision at five years of age), demonstrating marked ventricular improvement over a 16-year interval and a prolonged seizure-free interval despite severe congenital supratentorial malformations.

Teprotumumab is a medication for thyroid eye disease. We conducted a review of studies assessing teprotumumab for thyroid eye disease treatment from MEDLINE (Medical Literature Analysis and Retrieval System Online) and CINHAL (Cumulative Index to Nursing and Allied Health Literature) from inception to September 20, 2025. The outcome of interest was hearing impairment. We included nine studies (four randomized controlled trials and five observational studies). The randomized controlled trials included 153 teprotumumab-treated patients. Using both broad and strict definitions of hearing loss, teprotumumab continued to demonstrate a statistically significant increased risk of hearing impairment (Broad: risk ratio (RR) 3.57, 95% CI 1.27-9.97; Strict: RR 5.23, 95% CI 1.40-19.57). Observational studies included over 2,000 patients treated with teprotumumab. Using the broad definition, the RR amongst observational studies was 2.78 (95% CI, 2.38-3.24); using the strict definition, the RR amongst observational studies was 2.76 (95% CI, 2.30-3.31). Sensitivity analyses were performed, with results remaining statistically significant, without heterogeneity or publication bias. Teprotumumab is associated with hearing impairment using broad and strict definitions, consistent amongst both RCTs and observational studies. Further research is required to address potential treatment options, the likelihood of recurrence with retreatment, and the chance of recovery.