Introduction and importance Single-port video-assisted thoracoscopic surgery is a less invasive approach for patients undergoing a bullectomy. This report demonstrates a case of post-single-port video-assisted thoracoscopic surgery of rhomboid muscle herniation into the thoracic cavity. Case presentation A 35-year-old lady presented with a 1-month history of dyspnea due to single large lung bullae of 13 cm × 10 cm. She underwent bullectomy using single-port video-assisted thoracoscopic surgery and recovered well thereafter. Four months later, the patient presented with pain at the site of the incision with a severe cough. During the workup, radiographic images showed herniation of the rhomboid major muscle into the thoracic cavity. Clinical discussion Intercostal herniation of thoracic soft tissues can be in the form of lung herniation or inverted intercostal herniation of other soft tissues. It is an extremely rare disorder and mainly occurs after an anterior thoracotomy. Conclusion Muscle herniation is a rare complication following video-assisted thoracoscopic surgery. Proper closure of the wound including periosteal stitches might be necessary to prevent this complication. Highlights

BackgroundCardiac myxoma is a rare cardiac tumor that may be asymptomatic or can cause embolization or intracardiac obstruction, leading to heart failure, sudden cardiac death, and arrhythmia. This study aims to report an 11-year experience of a single center in the management of cardiac myxoma.MethodThis study is a single-center retrospective case series. Eighty cases of cardiac myxoma were collected in Ibn Albitar's specialized center for cardiac surgery. Transthoracic echocardiography was used to make the preoperative diagnosis in all patients. The surgeries were undertaken through the standard approach of a median sternotomy. All four cardiac chambers were thoroughly explored for additional myxomas. The major objective of the operations was complete tumor resection.ResultThe mean age of the patients was 46.3 years. Females (67.5%) were predominant over males (32.5%). Shortness of breath was the most common symptom (86.25%). The left atrium was the most affected site (83.75%), followed by the right atrium (13.75%). Coronary artery bypass grafting was required as the secondary or associated intervention in 19 (23.75%) cases. The recurrence rate was 11.25%, with a mortality rate of 3.75%.ConclusionRecurrence and tumor embolism are risks of surgical intervention for myxoma. Good preparation using transthoracic echocardiography as a diagnostic tool and standard median sternotomy to complete resection of the tumors can decrease the rate of recurrence, embolism, and even mortality.

Introduction Pericardial hydatid cyst comprises 7% of all cardiac hydatidosis, but its occurrence is concomitant with several life-threatening complications. This study is a review of the reported studies of pericardial hydatid cysts. Methods A systematic review of the published studies of pericardial hydatid cysts was conducted. The studies of cardiac hydatid cysts with the following properties were included: 1) The pericardium infection was confirmed by diagnostic modalities, surgical findings, or histopathology. 2) The case presentation was provided in the study. 3) The cyst (s) originally located or adhered to the pericardium and did not rupture into it from the other adjacent cardiac structures or organs. Results Overall, 106 studies were compatible with the inclusion criteria. Most of the cases (29.72%) were reported in Turkey, followed by India (18.24%). There was no gender predilection, and the age of the patients was distributed between 5 and 80 years old. The most common symptoms were chest pain (43%), and dyspnea (36%). Hydatid cysts were only found in the pericardium in 56% of cases and multiloculated in 44%. Surgery was the treatment of choice (87.8%), and cystectomy (72.3%) was the major technique of cyst removal. The total number of recurrences was 3 cases (2%). There was a significant correlation between recurrence and the history of hydatidosis. The mortality rate was 2.7%. Conclusion Pericardial hydatid disease is more common in subtropical regions. The definitive treatment of a pericardial hydatid cyst is surgery, mainly through a median sternotomy. A history of hydatidosis increases the likelihood of recurrence.

Introduction: Although some recent studies have found that original and generic clopidogrel brands are acceptable and have the same pharmacokinetic and pharmacodynamic properties, there is insufficient evidence to compare the clinical effectiveness and safety of brand and generic clopidogrel. The current study aims to evaluate the clinical safety of brand and generic clopidogrel by comparing clinical outcomes in patients undergoing carotid endarterectomy (CEA). Method: This was a single centre, parallel-arm, phase III, open-label, and randomized group sequential trial. It was conducted to compare the clinical safety of a brand and three generic clopidogrel forms in patients who have undergone CEA. All enrolled subjects were treated perioperatively with dual antiplatelet (aspirin and clopidogrel). The involved participants were assigned randomly into four groups based on the type of clopidogrel. Safety parameters were measured, including haematoma, blood draining from drainage, mouth deviation, tongue deviation, and stroke. SPSS software was used to perform the data analysis. Results: The trial included 80 patients in total (20 patients per group). Thirty-one (38.8%) patients were male. The mean age of patients was 65.6 years (49–79). Eighteen (22.5%) patients had a history of previous coronary intervention, and seventeen (21.3%) had symptomatic carotid artery stenosis. Overall, Plavix or Piax combined with aspirin were linked to better clinical safety than the other two generic clopidogrel, as the amount of bleeding was nearly two times lower in patients treated with Plavix or Piax (270±92.39 and 271.5±80.60, respectively) compared to PlavigrelAwa or Plavineer (505.7±169.1 and 496.5±174.6, respectively) (P≤0.001). Conclusion: The findings of the current study showed diversity in clinical safety of different clopidogrel formulations that were provided perioperatively in CEA patients.

Introduction and importance: Acute pancreatitis is an inflammatory disease that can affect both the peripancreatic tissues and distant organs. There are few reports of acute pancreatitis caused by endourological procedures. However, an obstructing ureteral calculus causing acute pancreatitis is very rare. Case presentation: A 36-year-old male patient presented with epigastric, and right loin pain with decreased urine output for 3 days. On physical examination, he had central abdominal and right flank tenderness. An abdominal ultrasound showed mild to moderate ascites, a hyperechoic pancreas, a small (26×77 mm) left kidney with increased echogenicity, right renal hypertrophy with moderate hydronephrosis, and a dilated upper ureter due to a 10 mm obstructing stone with a perirenal fluid collection. The diagnosis of acute pancreatitis with an obstructing right upper ureteric stone was established. Under spinal anesthesia, an emergency ureteroscopy with laser fragmentation of the stone was performed, and a JJ stent was inserted. He developed postobstructive diuresis and his renal function was improved with a rapid decline of pancreatic enzymes as well. Clinical discussion: Two theories explain the presentation of acute pancreatitis by ureteral obstruction. First, the obstructed severe hydronephrotic kidney compresses the duodenum and head of the pancreas, obstructing the distal part of the common bile duct and triggering the elevation of pancreatic duct pressure, bile reflux, trypsin activation, and pancreatic autodigestion. The second theory states that acute pancreatitis develops when urine is extravasated from an obstructed kidney into the adjacent tissues, irritating the uncinate process of the pancreas. Conclusion: Although mentioning ureteral obstruction as a cause of pancreatitis is scarce, the clinician should be aware that in each case of ureteral obstruction, the emergence of acute pancreatitis is a possible complication.

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Introduction There are multiple management modalities for idiopathic granulomatous mastitis, but the treatment of choice is still under debate. This study aims to evaluate the diagnosis and outcomes of different management modalities in patients with idiopathic granulomatous mastitis and to identify the risk factors associated with recurrence. Method This is a single-group cohort study that included those patients who had idiopathic granulomatous mastitis. Ultrasonography was conducted for all of the cases using LOGIQ E9 with an ML6-15 transducer (5-15 MHz). A core needle biopsy was conducted to take samples from the cases for histopathological examination. The patients were put on steroid therapy. Whenever the cases did not respond to the steroid therapy, treatment with a combination of low-dose steroids and methotrexate was started. In the lack of response to conservative treatments, surgical interventions were started. Results Sixty-three cases with a confirmed histopathological diagnosis of granulomatous mastitis were included. The mean age of patients was 35.7 years. The history of more than one childbirth was positive in a large portion of the cases (82.5%). The lesion side was unilateral in 58.7% of the cases. A large proportion of the lesions were classified as BI-RADS category 2. The best treatment outcome was yielded by a combination of low-dose steroids and incision and drainage. The factors of age, lesion area (cm2), skin thickening, and white blood cell count enhanced the chance of recurrence. Conclusion Incision and drainage in combination with a low dose of steroids can give an acceptable outcome with a low rate of recurrence.

Introduction: ChatGPT and Bard are large language models, both are artificial intelligence designed to understand natural language and generate human-like responses to text-based inputs. The aim of this study is to assess the ChatGPT and Bard Recommendations for the general populations; general practitioners and pediatricians for reducing the burden of meningitis outbreaks. Methods: We asked ChatGPT PLUS and Bard, on 5 April 2023 for their advice and recommendations in controlling the meningitis outbreak, the same question was repeated three times, one for the general population, one for the general practitioners, and the last one for the pediatricians. The responses were recorded, compared assessed. Results: ChatGPT and Bard replied to the three questions with general advice including early recognition of the disease, insisting on the vaccination, strict hygiene, infection control strategy, and staying up to date about the latest developments regarding the outbreak. Conclusion: ChatGPT and Bard have the potential to be valuable tools for the general population during outbreaks of infectious diseases. However, advanced information for professionals might be impossible to be provided by ChatGPT PLUS and Google Bard at the time being.