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Key Clinical Message: This case highlights the significant challenges in the diagnosis and management of eumycetoma, particularly in regions like Sudan, where socioeconomic factors and ongoing conflict severely impact patient care. Delayed diagnosis and inadequate access to effective treatment can lead to poor adherence to prescribed therapies, prompting patients to resort to unproven self-treatment methods. Comprehensive, multidisciplinary approaches that include education, improved accessibility to care, and addressing the impact of social determinants on health are essential to enhance the management of mycetoma, reduce disability rates, and improve patient outcomes in underserved communities. Abstract: Mycetoma is a chronic and debilitating infectious disease characterized by localized swellings and granulomatous lesions. It primarily affects individuals in tropical and subtropical regions and is caused by certain fungi or bacteria. This case report outlines the presentation, diagnosis, and management of a 37-year-old male from central Sudan with black grain eumycetoma, a challenging condition. The patient presented with recurring painless swelling in his right foot, which progressed over 5 years to include sinuses discharging black grain-like materials. Despite initial treatment with itraconazole and folic acid, the patient discontinued medication due to war-induced hardships including financial and accessibility to treatment and healthcare guidance, resulting in resorting to none-effective and potentially harmful herbal remedies. Multidisciplinary management involving dermatologists, infectious disease specialists, and pharmacists supported with community health workers for health education is essential for enforcing adherence to treatment and successful recovery.

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BACKGROUND: Stage IIIA-N2 non-small cell lung cancer (NSCLC) poses a significant clinical challenge, with low survival rates despite advances in therapy. The lack of a standardised treatment approach complicates patient management. This study utilises real-world data from Guy's Thoracic Cancer Database to analyse patient outcomes, identify key predictors of overall survival (OS) and disease-free survival (DFS), and address the limitations of randomised controlled trials. METHODS: This observational, single-centre, non-randomised study analysed 142 patients diagnosed with clinical and pathological T1/2 N2 NSCLC who received curative treatment from 2015 to 2021. Patients were categorised into three groups: Group A (30 patients) underwent surgery for clinical N2 disease, Group B (54 patients) had unsuspected N2 disease discovered during surgery, and Group C (58 patients) received radical chemoradiation or radiotherapy alone (CRT/RT) for clinical N2 disease. Data on demographics, treatment types, recurrence, and survival rates were analysed. RESULTS: The median OS for the cohort was 31 months, with 2-year and 5-year OS rates of 60% and 30%, respectively. Group A had a median OS of 32 months, Group B 36 months, and Group C 25 months. The median DFS was 18 months overall, with Group A at 16 months, Group B at 22 months, and Group C at 17 months. Significant predictors of OS included ECOG performance status, lymphovascular invasion, and histology. No significant differences in OS were found between treatment groups (p = 0.99). CONCLUSIONS: This study highlights the complexity and diversity of Stage IIIA-N2 NSCLC, with no single superior treatment strategy identified. The findings underscore the necessity for personalised treatment approaches and multidisciplinary decision-making. Future research should focus on integrating newer therapeutic modalities and conducting multi-centre trials to refine treatment strategies. Collaboration and ongoing data collection are crucial for improving personalised treatment plans and survival outcomes for Stage IIIA-N2 NSCLC patients.

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Foreign body (FB) aspiration is one of the most common life-threatening emergencies in children and one of the leading causes of mortality in the pediatric population. Most commonly, aspirated items are organic materials, such as nuts and seeds. Inorganic objects are usually plastic or metal. Symptoms of aspiration can vary depending on the location, area and amount of blockage, and object size and shape. Because of the difficult airway anatomy of children, a multidisciplinary approach - including otolaryngology, pulmonology, anesthesia, and general surgery - for the removal of airway FBs is necessary and prudent to avoid more invasive surgical involvement. This report discusses a nine-year-old male who aspirated two ball magnets, which became lodged in his tracheobronchial tree and required a multidisciplinary approach for removal.

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Schwannomas, originating from the Schwann sheath of peripheral or cranial nerves, are rare tumors commonly found in the head and neck or extremities. Adrenal schwannomas, however, are exceedingly rare, accounting for less than 1% of all adrenal tumors. Here, we present a case of a 31-year-old Caucasian woman diagnosed with an adrenal schwannoma, which was incidentally discovered during imaging studies for an unrelated issue. Following laparoscopic adrenalectomy, the patient developed chylous ascites (CA) and coexistent chylothorax, posing a diagnostic challenge and necessitating a multidisciplinary approach to management.

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Introduction: Diabetic foot is a common complication of diabetes mellitus, affecting approximately 15-20% of individuals with diabetes. It is a comorbid condition that significantly impacts the routine life of patients. This study aimed to assess multidisciplinary management strategies and their impact on the outcomes of patients with diabetic foot. Methods: A prospective observational study was conducted on 56 patients with diabetic foot. Outcome measures included the type of surgery, frequency of surgery, morbidity, mortality, patient satisfaction, return to work, and the number of patients using prostheses. Results: The majority of the patients (87%) received surgical treatment. The most common type of surgery performed was debridement (55%), followed by minor amputations (toes amputation/forefoot amputation) (28%) and major amputations (below-knee (B/K) or above-knee (A/K)) (15%). More than 70% of patients had multiple surgeries. The mortality rate was low (7%), and 71% of surviving patients were satisfied with their treatment. Sixty-seven percent of patients had an early return to work. The number of patients using prostheses was also high (73% of major amputation cases). Conclusion: Multidisciplinary management is the most effective approach for diabetic foot patients. These patients may experience less morbidity and an early return to work. A specialized care clinic for diabetic foot patients is essential to prevent treatment failure, loss of follow-up records, permanent limb loss, and economic burdens on society.

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Hepatocellular adenoma (HCA) is an uncommon benign liver tumor that exhibits a variety of subtypes, each distinguished by unique molecular alterations. This case report describes a 43-year-old man with a history of alcoholism who presented with stomach pain. Imaging revealed multiple hepatic lesions and sigmoid colon inflammation, while laboratory tests showed mild neutrophilic leukocytosis and elevated liver enzymes. Tumor markers were normal. A liver biopsy confirmed HCA with hepatocyte nuclear factor-1 alpha (HNF-1α) inactivation, characterized by negative immunostaining for glutamine synthetase, nuclear beta-catenin, serum amyloid A, C-reactive protein, and liver fatty acid-binding protein (L-FABP). This case is unique due to the patient's gender and the absence of typical risk factors such as abnormal hormone levels. HCAs in males, particularly with HNF-1α inactivation, are rare and pose diagnostic challenges. Comprehensive diagnostic approaches, including biopsy and immunohistochemical analysis, are crucial for accurate subtype identification. The potential for malignant transformation, particularly in male patients, underscores the need for vigilant monitoring and appropriate management. This case highlights the importance of considering HCA in differential diagnoses regardless of gender and typical risk factors, contributing valuable insights into the diverse presentations and risks associated with HCA, and emphasizing the need for awareness and further research to improve diagnosis and management of this rare condition.

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Key Clinical Message: This case report presents the interest of multidisciplinary management of extreme peri-implantitis requiring removal of implant emphasizing the different surgical and showing that the ovate pontic of conventional bridge is an optimal alternative for rehabilitation of the premolar sector, despite the fact that its main diffusion has been in the anterior sector due to the high demand aesthetic. Abstract: Peri-implantitis leads to gradual peri-implant bone loss. Severe and extreme cases lead to complete implant failure and imply lost implants have to be removed. Residual ridge deformity management after implant removal is one of the factors contributing to improved aesthetic and functional results. Various grafting procedures have been developed to achieve this goal. This report describes a case of implant removal from the upper right first premolar due to advanced peri-implantitis in a 51-year-old female patient. Guided bone regeneration with a alloplastic bone graft and resorbable collagen membrane combined with roll pedicle connective tissue graftt was used for both socket and soft-tissue augmentation. This was combined with ovate design conventional provisional bridge. After a 6-month of healing phase, a perfect adaptation of the marginal gingiva around the provisional restoration was obtained. Cone beam computed tomography revealed significant bone fill and buccolingual dimensional stability. A conventional all-ceramic bridge with an oval pontic design was chosen as a definitive prosthetic solution to compensate for edentulism and maintain the good aesthetic results. According to the encouraging result obtained in this clinical case, the conventional prosthetic restoration associated with surgical reconstruction of failing tissues can be considered as a successful treatment in the case of advanced peri-implantitis requiring implant removal.

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Congenital anomalies syndrome without an identified genetic mutation often presents significant challenges in pediatric care, requiring coordinated efforts across multiple specialties. This case reports a 10-year-old female patient with complex medical conditions, which exemplifies the intricate nature of managing children, necessitating long-term follow-up and comprehensive care. This case report aims to provide an in-depth analysis of her medical journey, including various interventions like tracheostomy and G-tube placement, and management strategies employed to address her congenital anomalies and associated health issues.

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Sarcoidosis presents a diagnostic challenge due to its diverse clinical manifestations and potential to mimic malignancies. We report a clinical case involving a 46-year-old woman diagnosed with localized synchronous ovarian and endometrial carcinomas treated with surgery. Following adjuvant chemotherapy and radiotherapy, the patient developed suspicious pulmonary micronodules and lymphadenopathy observed in imaging studies, raising concerns about cancer recurrence. Histopathological analysis revealed chronic granulomatous inflammation without evidence of malignancy, leading to a diagnosis of a sarcoidosis-like reaction secondary to chemotherapy. Remarkably, these lesions resolved spontaneously without specific intervention. This case emphasizes the importance of a multidisciplinary approach in managing complex oncological presentations and underscores the significance of histopathological examination in distinguishing between malignancy and chemotherapy-induced sarcoidosis-like reactions.

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Leptospirosis, a zoonotic disease caused by spirochetes of the genus Leptospira, poses unique challenges in pregnancy due to its varied clinical presentation and potential adverse outcomes for both mother and fetus. We present a case of a 24-year-old primigravida at 35 weeks of gestation who presented with fever, dyspnea, and abdominal pain, and was ultimately diagnosed with leptospirosis complicated by acute respiratory distress syndrome (ARDS). Prompt initiation of antibiotic therapy, supportive care, and timely delivery via emergency cesarean section led to favorable maternal and neonatal outcomes. This case report underscores the importance of considering leptospirosis in pregnant patients presenting with similar symptoms, particularly in endemic regions, and highlights the critical role of multidisciplinary management in optimizing outcomes.

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Blunt abdominal trauma can result in a spectrum of injuries, ranging from superficial contusions to severe hollow viscus perforations. We present the case of a 52-year-old male involved in a bicycle-truck collision, leading to complex intra-abdominal injuries. The patient presented with acute abdominal pain and signs of peritonitis, prompting urgent diagnostic workup and surgical intervention. Imaging studies revealed pneumoperitoneum, free fluid, and multiple rib fractures indicative of significant trauma. Exploratory laparotomy unveiled a perforated jejunal loop with an associated mesenteric tear and intussusception, necessitating segmental bowel resection and repair. Histopathological analysis confirmed acute hemorrhagic inflammation consistent with traumatic perforation. This case highlights the challenges and complexities associated with blunt abdominal trauma, emphasizing the importance of prompt recognition, multidisciplinary management, and surgical intervention in optimizing patient outcomes.

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BACKGROUND: Synovial sarcoma is a rare soft tissue malignancy, occasionally found in the head and neck region. The diagnosis necessitates a multidisciplinary approach involving the clinical presentation, proper imaging studies and histological confirmation, with molecular testing for definitive identification. Treatment entails surgical resection with adjuvant therapies as needed. CASE PRESENTATION: A 33-year-old male patient presented with globus sensation concomitant with right-sided neck swelling. He was clinically found to have right tonsil enlargement with posterior extension. Therefore, he underwent right tonsillectomy with pharyngoplasty. Histopathological examination revealed a biphasic tumor consistent with synovial sarcoma, confirmed by immunohistochemistry and fluorescence in situ hybridization. CONCLUSIONS: Tonsillar synovial sarcoma represents a diagnostic challenge, requiring a high index of suspicion and comprehensive evaluation. With only twenty previously published cases documented in the literature, awareness of this rare presentation is crucial for prompt diagnosis and appropriate management. Collaboration among multidisciplinary healthcare teams and ongoing research efforts are essential for optimizing diagnostic accuracy, treatment efficacy, and patient outcomes in this rare malignancy.

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Cancer remains a major cause of mortality worldwide, and urological cancers are the most common cancers among men. Several therapeutic agents have been used to treat urological cancer, leading to improved survival for patients. However, this has been accompanied by an increase in the frequency of survivors with cardiovascular complications caused by anticancer medications. Here, we propose the novel discipline of uro-cardio-oncology, an evolving subspecialty focused on the complex interactions between cardiovascular disease and urological cancer. In this comprehensive review, we discuss the various cardiovascular toxicities induced by different classes of antineoplastic agents used to treat urological cancers, including androgen deprivation therapy, vascular endothelial growth factor receptor tyrosine kinase inhibitors, immune checkpoint inhibitors, and chemotherapeutics. In addition, we discuss possible mechanisms underlying the cardiovascular toxicity associated with anticancer therapy and outline strategies for the surveillance, diagnosis, and effective management of cardiovascular complications. Finally, we provide an analysis of future perspectives in this emerging specialty, identifying areas in need of further research.

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Central neurocytoma, a rare intracranial tumor predominantly located in the lateral and third ventricles, presents a diagnostic and therapeutic challenge due to its varied clinical manifestations. We report the case of a 53-year-old male presenting with right upper and lower limb weakness, headaches, blurred vision, and tingling sensations, leading to the diagnosis of central neurocytoma with associated hydrocephalus. Initial evaluation, including magnetic resonance imaging (MRI) and subsequent computed tomography (CT) scans, revealed characteristic features of the tumor. The patient underwent a two-stage surgical intervention, including tumor excision and ventriculoperitoneal shunting, followed by a tracheostomy due to respiratory complications post-surgery. Histopathological examination confirmed the diagnosis of central neurocytoma, prompting multidisciplinary management and further referral for long-term follow-up. This case underscores the importance of comprehensive evaluation, multidisciplinary collaboration, and continued research in optimizing the diagnosis and management of central neurocytomas.

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BACKGROUND: Trigeminal schwannoma is a rare type of tumor that arises from the Schwann cells of the trigeminal nerve. METHOD: We present a case of a patient with a giant V2 trigeminal schwannoma with painful swelling in the left maxilla. A complete resection using a combined open maxillectomy and endoscopic endonasal approach was performed. CONCLUSION: This case highlights the importance of a multidisciplinary approach to perform a combined open and endoscopic approach for safe resection while preserving adequate speech and swallowing.

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Lupus nephritis (LN), a severe complication of systemic lupus erythematosus (SLE), leads to significant kidney inflammation and damage and drastically increases mortality risk. Predominantly impacting women in their reproductive years, LN poses specific risks during pregnancy, including pre-eclampsia, growth restrictions, stillbirth, and preterm delivery, exacerbated by lupus activity, specific antibodies, and pre-existing conditions like hypertension. Effective management of LN during pregnancy is crucial and involves carefully balancing disease control with the safety of the fetus. This includes pre-conception counseling and a multidisciplinary approach among specialists to navigate the complexities LN patients face during pregnancy, such as distinguishing LN flare-ups from pregnancy-induced conditions. This review focuses on exploring the complex dynamics between pregnancy and LN, emphasizing the management difficulties and the heightened risks pregnant women with LN encounter.

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Moebius syndrome is a collection of orofacial anomalies with highly variable features affecting many different systems but characterised by bilateral facial palsy and absent eye abduction. We largely regard Moebius syndrome as a diagnosis of exclusion. Lack of awareness and knowledge means that children often fall between services, leading to treatment delays and difficulty interfacing with social care and schools, with long-term impact on physical health and psychosocial development. We developed a multidisciplinary team comprising core clinicians (lead physician, geneticist, speech and language therapist, psychologist and specialist nurse) and an expanded group to encompass the other affected systems. The interactions between our specialties lead to the development of a treatment protocol, which we present. The protocol harnesses the aspects of care of children with a range of other rare diseases at a specialised paediatric centre and synthesises them into a holistic approach for MBS and related conditions. Management is sequenced on an "ABC-style" basis, with airway, feeding, vision and speech taking priority in the early years. We define management priorities as airway stabilisation with swallow assessment, ocular surface protection and maintenance of nutritional support. Management principles for issues such as speech, reflux, drooling and sleep issues are outlined. In later years, psychological support has a prominent role geared towards monitoring and interventions for low mood, self-esteem and bullying.

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Hemophagocytic lymphohistiocytosis (HLH) associated with dengue infection presents a unique challenge in clinical practice due to its rarity, rapid progression, and overlapping clinical features. This comprehensive review navigates the complexity of HLH-dengue syndrome by examining its pathophysiology, clinical manifestations, diagnostic criteria, and therapeutic strategies. HLH, characterized by uncontrolled immune activation and cytokine dysregulation, can occur as a secondary complication of dengue infection, leading to severe multiorgan dysfunction and high mortality if not promptly recognized and treated. The review underscores the significance of early diagnosis through vigilant clinical monitoring and appropriate diagnostic tests, such as bone marrow examinations and genetic studies. Collaboration between infectious disease specialists, hematologists, and critical care teams is essential for optimal management. Despite advancements in understanding HLH-dengue syndrome, further research is needed to elucidate its underlying mechanisms and explore novel treatment approaches. This review provides insights into the clinical implications of HLH-dengue syndrome and emphasizes the importance of a multidisciplinary approach to improve patient outcomes in this challenging clinical scenario.

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Long COVID, characterized by persistent symptoms following a SARS-CoV-2 infection, presents a significant public health challenge with wide-ranging implications. This comprehensive review explores the epidemiology, clinical manifestations, pathogenesis, risk factors, diagnosis, patient impact, management strategies, and long-term prognosis of COVID. Despite a varied symptomatology that spans multiple organ systems, including respiratory, neurological, and cardiovascular systems, this condition is primarily associated with chronic inflammation and potential viral persistence. Prevalence varies, influenced by the initial infection severity, demographic factors, and pre-existing conditions. The review emphasizes the necessity for healthcare systems to adapt to the needs of long-COVID patients by developing standardized diagnostic criteria and personalized, multidisciplinary treatment approaches. Current research gaps and future directions are identified, highlighting the urgent need for further studies on pathophysiological mechanisms and effective therapeutic interventions. This review aims to inform healthcare providers, researchers, and policymakers, enhancing patient care and guiding ongoing and future research initiatives. The continuing global focus and collaborative efforts offer hope for improved outcomes for those affected by long COVID, marking an essential step towards addressing this emergent condition comprehensively.