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usion Our study shows an improved trend in-hospital mortality outcomes and a decreased length of stay likely related to the advancement in CDI treatments. Hospital charges were increased from 2007 to 2011 in spite of a decrease in hospital length of stay. Copyright © 2020, Mohammed Abdul et al.Primary leiomyosarcomas of the central nervous system are extremely rare tumors, with few cases reported in the literature. In this article we report the case of a patient with an intracranial leiomyosarcoma of the cavernous sinus. This is the case of a 23-year-old man with a history of human immunodeficiency virus (HIV) and Epstein-Barr virus infection, with clinical picture of headache and left palpebral ptosis, who underwent nuclear magnetic resonance imaging that showed a lesion that occupied the cavernous sinus. Excisional biopsy reported fusocellular mesenchymal neoplasm with smooth muscle differentiation by immunohistochemistry compatible with low-grade leiomyosarcoma. The patient was initially taken to a partial resection, without treatment. Subsequently, the patient presented progression of his disease, so the area of neurosurgery considered that the lesion was unresectable due to its location and the risk of sequelae. It was then decided to treat the patient with intensity-modulated radiation therapy technique external radiotherapy. At six months of treatment, the patient continues asymptomatic with a stable disease. Copyright © 2020, Morales R et al.Fractures of the distal radius are a common orthopaedic presentation in Irish emergency departments. As a nation, Irish people tend to ice-skate seasonally with a peak of interest seen during the Winter months in temporary ice-rinks. This case series describes winter ice-skating as a significant cause of wrist fractures in the younger patient, including five cases of distal radius fractures, four of which ultimately required internal fixation, under general anaesthesia, over a single weekend in the month of December. Despite all five patients being amateur ice-skaters, all denied ever having taken ice-skating lessons. this website This demonstrates the dangers of wrist trauma in the inexperienced or beginner ice-skaters on temporary ice-rinks; the seasonal morbidity suffered as a result. Copyright © 2020, Davey et al.Objectives Childhood brucellosis is a common public health problem in developing countries. The diagnosis of brucellosis based on nonspecific symptoms is an ongoing problem for physicians, especially in endemic areas. In this study, it is aimed to discuss the efficacy of frequently used test methods in the differential diagnosis of brucellosis. Methods The records of 332 patients admitted to pediatric clinic on suspicion of brucellosis were retrospectively analyzed. Patients with brucellosis were included in the positive group (n = 262) and those without brucellosis were included in the negative group (n = 70). Results As a result of biochemical analysis of the cases, median alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) values were significantly higher in the positive group than that in the negative group (p0.05). Receiver operating curves were plotted to compare predictive values of CRP (area under curve (AUC) 0.635, p= 0.001), ESR(AUC0.701, p less then 0.001), AST(AUC 0.595, p=0.015), ALT(AUC0.604, p=0.007), and GGT(AUC0.593, p=0.016) in 332 patients with suspected brucellosis. Conclusions Increased levels of AST, ALT, GGT, CRP, and ESR may have a complementary role in the differential diagnosis of childhood brucellosis. However, all of these markers should be evaluated with clinical findings due to their low specificity and sensitivity. Copyright © 2020, Kazanasmaz et al.A previously healthy three-year-old girl was brought into the emergency department by ambulance after being found unresponsive with a family member's fentanyl patch found adherent to her lower back. A head CT scan showed global cerebral edema and the patient progressed to brain death. An initial standard urine drug screen was negative for opiates, however, subsequent specific urine assay testing was found to be positive for fentanyl and norfentanyl. This case highlights the dangers of not properly disposing of used fentanyl patches as they may still contain enough fentanyl to cause respiratory failure and subsequent unintentional death in children. Prescribing physicians and pediatricians should advise care providers that fentanyl patches should be carefully stored, monitored, and disposed of properly in order to prevent accidental exposure to the pediatric population. Furthermore, synthetic opiates such as fentanyl will not read as positive on routine urine drug screens and will require specific urine assays. Copyright © 2020, Hilado et al.Tumefactive multiple sclerosis (TMS) is a rare variant of multiple sclerosis (MS) with atypical features that pose a diagnostic challenge. In this study, we report a case of cervical MS in a 19-year-old patient that was diagnosed based on the MRI findings and cerebrospinal fluid analysis. The patient was treated with high-dose steroid and five sessions of plasma exchange with significant improvement. Copyright © 2020, Mamilly et al.Giant ovarian cysts, which are described in the literature as measuring more than 10 cms in size in their largest diameter, are rare in occurrence. With the availability of multiple imaging modalities and routine physical examinations, it has become even rarer to find such cases. Ovarian serous cystadenomas, which are benign tumors arising from the ovarian epithelium, represent the most common type. We present a case of a 58-year-old female who came to establish primary care in our clinic. She reported ongoing symptoms of constipation, abdominal discomfort, bloating, as well as intermittent postmenopausal bleeding for the past few months. The patient reported taking over-the-counter medications for her predominant gastrointestinal symptoms with no improvement at all. Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) of the pelvis revealed the presence of giant bilateral ovarian masses measuring more than 17 X 10cms each. Further testing revealed highly elevated levels of tumor markers cancer antigen 125 (CA-125) and human epididymis protein 4 (HE-4).
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