Introduction: In contrast with victims of major trauma, patients who suffer minor injuries receive little specialist input. In most cases, this causes no difficulty, but there are situations where minor trauma results in persistent disability affecting the quality of life. Case Presentation: A young man sustained a perineal puncture wound resulting from a fall onto a bush. Following an initial delay, he sought medical advice for a continual pain in his right leg, and a discharging perineal wound. A computed tomography (CT) scan and flexible sigmoidoscopy failed to identify the cause, and he was subsequently discharged from hospital. One year after his initial presentation, a magnetic resonance imaging (MRI) scan identified a retained foreign body consistent with a fragment of wood. Conclusions: Penetrating trauma from wooden fragments provides a diagnostic challenge. A stubborn discharge from a wound must always raise the suspicion of retained fragment. Early and appropriate surgical exploration is imperative.

Cementoblastoma is a rare neoplasm accounting for less than 1% of all odontogenic tumors. It mostly arises in the mandible but rarely in the maxilla. The tumor appears as a slow-growing solitary mass which usually results in pain and swelling.In this report, the clinical, radiographic and histopathologic characteristics of cementoblastoma in a case of maxillary cementoblastoma with DELAYED DIAGNOSIS are presented.

Average age at DIAGNOSIS, clinical features, and karyotype analysis of 40 girls with turner's syndrome (TS) were studied. The medical records of 40 girls with TS were reviewed for age at DIAGNOSIS, clinical features, karyotype analysis and reasons of admission in pediatric endocrinology ward. Although lymphedema is the key to DIAGNOSIS in newborn period, none of the cases were diagnosed in infancy. The average age at DIAGNOSIS was 13.4 years. All of the cases admitted for evaluation of short stature, and 14 of them had DELAYED puberty too. 50 percent of the patients had a chromosomal constitution 45X, 22.5% were mosaic, 15% isochromosom and the remaining 12.5% had other karyotypes. The DIAGNOSIS of TS is often DELAYED, and this deranged the appropriate treatment of short stature. We recommend cytogenetic analysis of all girls with lymphedema, unexplained short stature, webbed neck, short neck, low posterior hairline and multiple nevi.

Five decades of tuberculosis control programs using potentially effective medications have been unsuccessful in diminishing the prevalence of the infection in most parts of the world and tuberculosis continues to kill all age groups. Tuberculosis may manifest with atypical clinical manifestations and DELAYED DIAGNOSIS may give rise to unexpected grave outcomes. As a result, high degree of clinical suspicion is required to prevent late DIAGNOSIS.

Introduction: Spontaneous nephrocutaneous fistula is a rare manifestation of renal disease that can occur due to various etiologies, such as renal calculus, chronic pyelonephritis, stricture of the ureteropelvic junction, and renal tuberculosis (TB). An autonephrectomy with a nephrocutaneous fistula due to renal tuberculosis can be diagnosed quite late if it is not suspected.Case Presentation: We report a case of a spontaneous nephrocutaneous fistula with tuberculous autonephrectomy. A 40-year-old white male with recurrent flank pain and intermittent purulent drainage from his right flank region for the previous 14 years was admitted to our outpatient clinic. Fistulography and computerized tomography demonstrated a 5160mmarea with a soft-tissue appearance that implied autonephrectomy of the right kidney, and a fistula tract with a 9mmdiameter between the skin and the retroperitoneal space. The patient was successfully treated with nephroureterectomy and excision of the fistulous tract, followed by antituberculous treatment. The pathological examination of the surgical specimen revealed chronic atrophic pyelonephritis, calcifications, and necrotizing granulomatous inflammation suggestive of TB.Conclusions: Urogenital TB is difficult to diagnose due to the lack of specific symptoms and signs. In the case of a nonfunctioning kidney without an obvious cause and a chronic spontaneous nephrocutaneous fistula, the possibility of associated renal TB should be kept in mind, especially in immunocompromised patients or in places where TB is a common health problem.

A 19 year old man was admitted to emergency department (ED) because of motorcycle to motorcycle accident. In ED he was evaluated as a multiple trauma patient and after overnight observation, was discharged with stable vital signs (VS) next morning. Twenty four hours later, he developed chest pain and dyspnea, and was admitted to ED for the second time. This time he was evaluated as a chest trauma patient and chest X ray and CT scanning were performed. According to cardiology consult, an electrocardiogram was recorded and extensive anterolateral ST elevation myocardial infarction (STEMI) was confirmed. Coronary angiography revealed total thrombotic occlusion of left anterior descending artery (LAD) from ostium. Percutaneous coronary intervention (PCI) was performed and LAD stented successfully. After 10 days of ICU admission, he was discharged with an ejection fraction (EF) of 35%.

Background: Acute intestinal obstruction (AIO) is a major public health problem. Despite advances in surgery and medical imaging, this emergency is still diagnosed late, which explains why its mortality has remained unchanged. We aimed to determine the epidemiological profile of AIO in our institution, as well as the rank of AIO in terms of the volume of our activity. Methods: We conducted a survey of AIO operated in our General Surgery Department of the Central Army Hospital of Algiers over two years (2016–, 2017). The inclusion criteria were all patients aged over 16 years with mechanical AIO. The statistical study was based on Excel software version 2013. Results: AIO represented 10% of all surgical emergencies in our practice. The mean age of patients was 61 years (range 16–, 90). There was a predominance of males in patients with AIO with a sex ratio of 1. 45. The majority of patients (70%) had a past surgical history. Small bowel obstructions were dominated by adhesions in 53% of cases, and 72% of colonic obstructions were caused by cancer. The mortality rate was 7. 6%. Conclusions: The high rate of AIO due to cancer should call on the health authorities in our country to undertake an urgent plan for targeted screening of populations at risk of developing colorectal cancer.

Introduction: Breast cancer is the most common cancer in Iran. Delay in DIAGNOSIS is one of the causes of increased mortality in these patients. There are several obstacles to achieving an early DIAGNOSIS. This study seeks to identify the social determinants influencing breast cancer DIAGNOSIS. Methods: This qualitative study was conducted at Reza Oncology Clinic in Mashhad in 2019-2020. The study sample included 21 patients with breast cancer selected via purposive sampling. Data were collected using semi-structured in-depth interviews. Data were recorded, handwritten, and coded, subthemes were identified, and then the original themes were refined. By integrating the subthemes, they became the main themes. Findings: Economic status, life crises, social support, stigma, family history of cancer, fateful beliefs, preventive behavior, disease recognition, role conflicts, gender inequalities, and access to medical opportunities were the social factors mentioned in the narratives. Conclusion: This study has shown that social, cultural, and economic factors influence breast cancer DIAGNOSIS. Therefore, any effort to improve disease DIAGNOSIS requires a multidisciplinary approach that addresses biomedical, social, cultural, and economic factors simultaneously.

Purpose: To report the clinical, paraclinical and histopathologic features of eyelid mass lesions in a patient with tuberous sclerosis.Case report: A 14 year old boy with a slowly progressive right upper lid mass and history of seizures, mental retardation and multiple skin lesions on the face and body was referred to Labbafinejad Medical Center. Cortical tubers and subepandimal nodules were reported in neuroimaging and fibroadenoma with sebaceous hyperplasia were observed on histopathologic assessment. A DIAGNOSIS of tuberous sclerosis was made based on multiple major signs and the patient was referred to other subspecialities for comprehensive medical care. Conclusion: The ophthalmologist may be the first specialist to diagnose tuberous sclerosis because of associated ocular signs. Attention to systemic signs is necessary to establish a DIAGNOSIS.

Background: Primary immunodeficiency disorders are a diverse group of rare genetic diseases that are often under-recognized. Therefore, significant morbidities and mortalities ensue due to DIAGNOSIS delay. This is an evaluation of clinical presentations and laboratory data of children referred to Mofid University Hospital during a 10-year period. The aim of this study is to provide epidemiologic data for early DIAGNOSIS and proper management of these patients. Methods: A total of 80 children referred to Mofid’ s Children Hospital suspected to primary immunodeficiencies (PIDs) were evaluated clinically. The demographic, clinical, and laboratory data were collected in detail and were analyzed as a cross-sectional study. Missing data were completed in follow-up visits. Results: The prevalence of antibody deficiencies, phagocytic defects, and combined immunodeficiencies in 80 children with primary immunodeficiency syndromes were respectively 36. 25%, 32. 5%, and 31. 25%. Common variable immunodeficiency (13. 75%) and severe combined immunodeficiency (12. 5%) had the highest prevalence among these disorders and the lowest prevalence were reported for cyclic neutropenia (5%), ataxia-telangiectasia (5%), and transient hypogammaglobulinemia of infancy (3. 75%). The most common mode of inheritance detected was an autosomal recessive pattern. Pneumonia, otitis media, and diarrhea were the most common complications in the course of these disorders, which were seen respectively in 30%, 18. 8%, and 15% of the patients. Conclusions: Issues regarding clinical presentation and management of primary immunodeficiencies continue to puzzle the clinical practitioner. Epidemiological data are needed to increase the awareness of the physicians regarding primary immunodeficiency disorders and to support the benefits of early DIAGNOSIS and treatment. DIAGNOSIS delay is associated with increased morbidities and even mortalities.