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Summary: This is a case of a rare complication of microblading in a middle-aged woman in a developing country, resulting in a right orbital exenteration and a forehead defect associated with bone exposure reconstructed using the crane principle. To the best of our knowledge, this case is the first one to report such an entity. We are aiming to highlight the importance of proper hygiene in such cosmetic procedures and to shed light on the crane principle as a suitable reconstructive choice, especially in circumstances where other reconstructive options are not available, or in specific situations like mass causalities when shorter operation time is required.

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Coronavirus disease-2019 (COVID-19) is a respiratory disease, caused by a novel coronavirus (SARS-COV-2). This disease has been raising international public health concerns since its recent outbreak in December 2019. As the virus is easily transmitted by respiratory droplets, all hospital departments needed to change their practices in an attempt to control the spread of this virus. Burn units and clinics are particularly affected by this pandemic because of the larger risk of contamination for both patients and caregivers. Furthermore, cross-clinical aspects especially pain management and complications such as coagulopathy might be caused by both extensive burns and COVID-19 infections, which makes the management of these patients particularly challenging. That’s why we covered both main aspects in this review. In addition, we present briefly a synthesis of guidelines from several entities to help manage the health crisis and provide optimal care for all burn patients during this pandemic. Highlights: • All new burn patients, including pediatric burn patients, should undergo solitary isolation for 3–5 days, 14 days is recommended if possible, for medical observation. • Preliminary screening, which includes blood routine and chest CT examinations, is performed routinely on all newly admitted patients. • Severe burn patients should be admitted to burn intensive care unit (BICU) and should be treated as suspects of COVID-19. • Sputum absorption, airway lavage, and other invasive operations should be minimized as much as possible. • For urgent surgeries, lung CT and routine blood tests must be performed right before any surgical procedure, and the COVID-19 PCR test should be performed based on clinical symptoms and epidemiology. • Surgery is the highest risk point of COVID-19 infection exposure especially in the early treatment of burn patients. • For patients with negative COVID-19 testing, urgent procedures have to be administrated in negative-pressure operating rooms, and healthcare staff must take proper protective precautions. • Patients are advised to do an online check-in and share their status and improvement of rehabilitation. • It is recommended to suspend the rehabilitation treatment with close contact. • The therapeutic strategy for underlying pain management in COVID-19 burn patients remains similar to the regular burn patients; however, more attention for the opioid administration should be paid. • Burn patients associated with COVID-19 require strict monitoring and follow-up. Routine chemical venous thromboembolism (VTE) prophylaxis should be also applied. An escalated dose VTE prophylaxis should be seriously considered as the risk of coagulopathy notably increases in such cases.

A gastro-duodenal fourth segment fistula following a penetrating benign gastric ulcer is extremely rare to be found. To the best of our knowledge, our case is the eighth case to describe the gastro-duodenal third and fourth segment fistula, and it is the third to be diagnosed in living patients as all the other cases were diagnosed in autopsies. The case, we are presenting, is of an elderly patient with severe peptic symptoms and a primary diagnosis of gastric outlet obstruction. During our indicated surgery, we accidently diagnosed this rare type of fistula. In the following article, we will describe the clinical features of this fistula, discuss the steps of our unique surgical management, and summarize our follow-up for the patient.

Cholestasis following hepatitis A affects around 0.8% of hepatitis A patients. It is considered a distressing complication in spite of its good prognosis. Despite being subject to multiple studies, causes of cholestasis are still controversial. Many treatments (discussed later) have shown some improvements of the accompanied pruritus. In the following article, we present two cholestatic hepatitis A patients who suffered from severe pruritus. Prednisolone was administered via two different methods: prolonged and pulsed. Both showed great improvement of the pruritus in a short time frame. To the best of our knowledge, our management using pulsed corticosteroid therapy in treatment of pruritus in cholestatic hepatitis A is considered the first experimental management in medical literature. The importance of this experimental case lies in reducing the doses and the duration of steroid intake, thus reducing steroid side effects as far as possible.

A primary spinal Ewing sarcoma is extremely rare to be found. To the best of our knowledge, it is the first reported case for bilateral foot drop as a prodromal symptom of sacral Ewing sarcoma. The case, we are presenting, is of an 18-year-old athletic female, who was presented to the emergency department suffering from sudden severe low back pain radiated to the lower limbs, associated with bilateral foot drop and later urinary incontinence. Following the indicated surgery and subsequent histopathology study, we diagnosed this rare type of tumors. In the following article, we are describing the clinical presenting features of this tumor and discussing the clinical aspects.