Articles

Background: Bladder exstrophy is a rare congenital abnormality that is usually managed with multiple surgical interventions. Long-term consequences include recurrent urinary tract infections, bladder stones, fistulae, and metaplastic changes with malignant potential.Case Presentation: We present a case of a 21-year-old male with a history of failed childhood surgeries for bladder exstrophy who presented with a vesicocutaneous fistula and a 7 cm bladder stone. He underwent an open cystolithotomy with bladder augmentation and creation of a Benchekroun continent valve. However, the patient developed recurrent fistulae due to poor tissue quality. Histopathological examination confirmed early squamous metaplasia in the bladder mucosa. After discussion in a multidisciplinary meeting, the patient underwent a radical cystectomy with ileal conduit urinary diversion using the Bricker technique. He is doing well at 3 months with no evidence of any complication.Conclusion: This case illustrates the difficulties encountered in managing adult patients with bladder exstrophy and failed reconstructions. The presence of squamous metaplasia, poor bladder tissue, and recurrent complications all contributed to the decision for radical cystectomy. It is important to recognize these changes and address them appropriately in a timely manner to prevent further complications and possible malignant changes.

Background: Paratesticular liposarcoma is a rare entity, with dedifferentiated liposarcoma (DDLPS) representing the most aggressive subtype. Late recurrences with unusual patterns of spread have been documented but remain poorly characterized.Case presentation: We report a case of a 68-year-old male with a 10-year recurrence of paratesticular DDLPS following right orchiectomy. The patient initially underwent resection of a 5×4×4.5 cm paratesticular mass in 2015, with histopathology confirming DDLPS and negative distal spermatic cord margins. After loss to follow-up, he presented in 2026 with extensive regional recurrence involving bilateral pubic soft tissues, abdominal wall musculature, and right external iliac lymphadenopathy. Biopsy confirmed recurrent DDLPS with Mouse double minute 2 homolog (MDM2) positivity. Given the multi-site infiltrative nature and muscle involvement, the multidisciplinary team recommended neoadjuvant chemotherapy with ifosfamide and doxorubicin before consideration of surgical resection.Conclusion: This case illustrates the propensity for late regional recurrence in paratesticular DDLPS and highlights the unusual pattern of spread along anatomic pathways, including the abdominal wall and inguinal region. The case underscores the importance of long-term surveillance, aggressive initial surgical margins, and multidisciplinary management in this rare malignancy.

Inverted Urothelial Papilloma (IUP) is an unusual variety of urothelial tumors that typically occurs in adults, with a predominance in males. The definitive diagnosis of IUP relies on histopathological examination, as the clinical presentation and endoscopic appearance are non-specific. The recommended treatment for IUP includes the complete transurethral resection, with some controversy regarding the need for cystoscopic follow-up. In this case, we present an atypical instance of IUP in a 21-year-old male patient, diagnosed with gross hematuria and irritative lower urinary tract symptoms. A clinical assessment revealed a 3.0 × 2.6 cm intravesical mass. The definitive diagnosis was confirmed histopathologically and further substantiated by immunohistochemistry, which demonstrated low expression of p53 and Ki-67, effectively ruling out malignancy. This case underscores the diagnostic challenges posed by bladder masses in young adults, emphasizing the necessity of integrating morphological and immunohistochemical findings to prevent overdiagnosis of urothelial carcinoma. The paper focuses on the diagnostic approach and management of this rare condition in the young male population.

Antimicrobial resistance (AMR) is a serious global health crisis. It is getting worse every year. Low- and middle-income countries (LMICs) are the most affected. This is mainly because infectious diseases are very common there. Poor water, sanitation, and hygiene (WASH) systems make things worse. On top of that, vaccination rates in these countries remain very low. All these factors together make AMR a much bigger threat in LMICs than anywhere else.The recent data showed that bacterial AMR was linked to about 4.95 million deaths worldwide, and 1.27 million of the deaths were directly attributable in 2019. Using information from the Global Burden of Diseases, Injuries and Risk Factors Study 2021. The GBD Antimicrobial Resistance Collaborators employed statistical modelling to evaluate AMR trends from 1990 to 2021 and to forecast the burden through 2050 across 204 nations and territories.The results are concerning. AMR-related deaths have increased significantly. Older adults aged 70 and above are the most affected group. However, there is some good news too. Deaths among children under five have dropped by nearly 50%. This is a big achievement. Better infection prevention has played a major role in this. Vaccination programs have also made a real difference. Improved water and sanitation (WASH) initiatives have helped as well. These combined efforts have clearly saved many young lives.Key pathogens contributing to AMR mortality include Klebsiella pneumoniae, Escherichia coli, Streptococcus pneumoniae and meticillin-resistant Staphylococcus aureus (MRSA). In the absence of improved interventions, deaths attributable to AMR are anticipated to rise to 1.91 million annually by 2050. It is important to strengthen infection prevention, surveillance, vaccination, and WASH with integrated One Health approaches to ease the future impact of AMR.

A basic component of complementary and alternative medicine, bloodletting is also referred to as blood cupping (CP) or cupping therapy (CPT) and blood-letting puncture (CP), which refers to a superficial needle prick in the skin. In East Asia, BL or CPT is a non-medical treatment that is referred to as traditional therapy. Insulin-resistant iron overload syndrome, ischemic stroke, hemochromatosis, iron, external rheumatism, psoriasis, metabolic syndrome, and mental pain in patients with migraine porphyria cutanea-tarda, diabetes, fever, infections, and bronchopneumonia are among the various diseases for which BL is currently used. By using mechanical pressure under vacuum to influence local soft tissue microcirculation, BL improves capillary vascular permeability, increases regional blood circulation flow, stimulates the immune system for feedback control, and improves metabolism. The effectiveness of BLT in various therapies varies depending on the conditions and diseases. The results of laboratory assays indicated the effectiveness of BLT in diseases, and the meta-analysis’s showed that it is an assessment, controlling, and less side effect method than other medical methods. The various types of articles in therapy by the association of BL, titled, studied: for instance, may be helpful as a complementary therapy for acute stroke and eye drops, while BLT may boost lead absorption by lowering iron serum.

Bacteriolysis of peptidoglycan (PGN) cell wall destruction on cleavage, hydrolysis, and decomposition by copper nitrate and zinc sulfide solutions has been investigated on the ground of the results obtained from halo antibacterial susceptibility tests in metal sulfate solutions against Staphylococcus epidermidis, in which from halo-antibacterial susceptibility tests of metallic ion concentration of 100 mM/L against Staphylococcus epidermidis, the order of bacterial effect for the metal nitrate solutions is as follows, Cu2+>Zn2+ >Ag+>Pb2+>Al3+, and the other, in the metal sulfate solutions, the antibacterial effect order is found to be Zn2+>Cu2+>Ag+>Al3+. Cu(Ⅱ)-, Zn(Ⅱ)-ions induced bacteriolytic destructions for PGN cell wall on cleavage, hydrolysis, and decomposition within Cu(NO3)2 and ZnSO4 solutions have been elucidated that Cu(Ⅱ) and Zn(Ⅱ) ions can inhibit PGN biosynthesis Transpeptidase (TP)/Tranｓ-glycosylase (TG) and PGN elongation, PGN cleavage occurs by copper ions- and zinc ions-containing autolysins amidase; AmiE, Rv3717, AmiA, PGN cell wall is hydrolyzed by copper-, and zinc-containing enzymes; PGRPs, MurA, LytA, LytM=Endopeptidase, Hydrolase LytB, and PGN decomposition by copper-, zinc-containing PGN inhibitive elongation occurs. Thus, Cu(Ⅱ) and Zn(Ⅱ) within Cu(NO3)2 and ZnSO4 solutions inhibit PGN biosynthesis and activate bacterial PGN autolysins against Staphylococcus epidermidis.

Ureteral double-J stents are a commonly used device in urological practice to allow urinary drainage, avoid ureteral obstruction processes, and protect the upper urinary tract after surgical procedures. However, long indwelling time may give rise to numerous complications, such as infection, migration, and fragmentation of the stent, especially encrustation. Encrustation of stents is a well-known complication that has been closely related to the time active of the stent and can cause significant morbidity if not timely addressed. In severe cases, abundant mineral deposition can result in the development of large calculi encasing the stent and rarely progress to staghorn stones. These cases may pose challenges in terms of the extraction of the stent and may result in complex endourological intervention. The encrustation likelihood is substantially higher if stents are left forgotten or remain in place longer than the advised period. Most patients with heavily encrusted stents have symptoms including flank pain, urinary tract infection, hematuria, or obstructive uropathy, but can present without any symptoms, and this can delay the diagnosis.

Psoas abscess is a rare but potentially life-threatening condition with non-specific clinical manifestations. The condition may be primary or secondary, depending on whether it has an underlying cause. The condition may be diagnosed with the help of imaging studies, especially contrast-enhanced computed tomography (CT).A 55-year-old female patient with a history of treated hypertension presented with a 15-day history of fever and left-sided low back pain. Her laboratory parameters showed a high leukocyte count of 22,000 cells/mm³ and elevated levels of C-reactive protein (367 mg/L). Her renal functions were within normal limits, and the urine culture was negative. Contrast-enhanced CT revealed a large left-sided intra-abdominal fluid collection extending from the diaphragm to the left iliac fossa, measuring 66 x 305 mm with air bubbles. The collection also showed a left-sided intramuscular psoas collection of 66 x 50 x 131 mm. The patient received intravenous broad-spectrum antibiotics (third-generation cephalosporin, aminoglycoside, and metronidazole). The patient underwent mini-lumbotomy, and nearly 1 liter of pus was drained. The patient’s postoperative course was satisfactory with complete resolution of symptoms. The histopathological examination showed non-specific changes.Psoas abscess should be suspected in patients with febrile low back pain and inflammatory syndrome. Contrast-enhanced CT scans are essential for diagnosis and assessment of the extent of disease. In complicated cases with large abscess formation, early surgical drainage along with appropriate antibiotics will provide the best outcome.This case highlights the importance of early diagnosis and adapted management for successfully navigating the complexities associated with this condition.

Renal dysfunction after allogeneic hematopoietic stem cell transplantation (allo-HSCT) often results from common causes like drug toxicity, infection, or transplant-associated thrombotic microangiopathy (TA-TMA). However, renal graft-versus-host disease (GVHD) may be ignored. We discuss a 49-year-old man who experienced worsening kidney function despite being in hematologic remission and having negative results for infections and autoimmune diseases. A renal biopsy showed chronic tubulointerstitial injury consistent with renal GVHD, along with existing TMA. Treatment with eculizumab did not lead to improvement, likely indicating significant chronic damage. This case highlights the need to maintain clinical suspicion and to perform timely renal biopsies in cases of unexplained kidney dysfunction after transplant.

Acriptega, a combination of Dolutegravir, Lamivudine, and Tenofovir, is a cornerstone of modern antiretroviral therapy due to its efficacy and tolerability. However, treatment failures persist despite this optimization, raising questions about barriers to successful treatment. Through the analysis of two clinical cases, this study explores the biological and behavioral factors contributing to these failures following a switch to this molecule.The first case is a 69-year-old female patient, diagnosed with HIV in 2002 following pulmonary tuberculosis, who was regularly monitored with an undetectable viral load and a CD4 count > 500 cells/mm³ until the Acriptega transition and the onset of tumor symptoms in 2024. The second case is a 62-year-old female patient, diagnosed with HIV in 2009 following cerebral toxoplasmosis. She was regularly monitored with good treatment adherence and an undetectable viral load. After switching her triple therapy, she developed gastroenteritis, which led to the discovery of her treatment failure.    This case study highlights that failure after switching to Acriptega is linked to the absence of prior resistance testing (genotyping). A safe switchover requires a rigorous assessment of the patient’s virological history to prevent the emergence of cross-resistance. Close monitoring via genotyping is essential.