Primary sternal osteomyelitis is a rare condition that is frequently caused by Staphylococcus aureus. It is often confused with other cardiac and pulmonary conditions. Early antimicrobial treatment and surgical debridement is the cornerstone of treatment. A 51-year-old male adult came to the emergency room (ER) with a 2-week history of chest pain, fever, and malaise. His past medical history was unremarkable. Examination revealed a tender anterior chest wall swelling. White Blood Cells (WBCs) (21.6 × 10⁴)/mm³) and C-reactive protein (CRP) (294.10 mg/L) were elevated. Pus from the swelling and blood samples were sent for culture and sensitivity. Electrocardiogram (ECG) was normal and a computed tomography (CT) scan of the chest showed a large dense anterior chest wall abscess extending deep in the chest and to both axillae which caused bony erosion of the sternum. Incision and drainage of the abscess were performed, followed by surgical debridement of the wound. Cultures along the course showed both Staphylococcus aureus and Enterococcus. The patient improved gradually and 2 months after his initial presentation, he became free of symptoms, and CT has shown complete resolution. Osteomyelitis usually happens after an external bacterium seeds the bone where it begins to grow and thrive, leading to the destruction and pus accumulation under the periosteum. For the treatment, identifying the causative agent is critical in giving intravenous (IV) antibiotic. Thereafter, incision and drainage of an abscess can be performed, similar to what was done with the patient mentioned. Radiography, specifically a CT scan, is crucial as it clearly reveals bony margins and can differentiate between a sequestrum and an involucrum. It also identifies cortical erosion, intraosseous gases and periosteal reactions. Sternal osteomyelitis can have a nonspecific clinical presentation. Laboratory investigations and radiological findings are crucial for a prompt diagnosis. To prevent the progression of the disease and complications, early intervention is vital to ensure a good prognosis.

Background: COVID19 infection is caused by the highly contagious SARS-CoV-2(Severe acute respiratory syndrome coronavirus 2). The first outbreak of this infection was in Wuhan, China in December 2019. Since then, it has spread rapidly across the world, with more than 100000 new cases each day. Among those infected with SARS-COV-2 up to 20% develop severe disease requiring hospitalization. Among those who are hospitalized, one quarter will need ICU admission. Admission to the ICU is due to respiratory failure or pneumonia. The pneumonia associated with COVID19 infection may lead to respiratory failure requiring endotracheal intubation and mechanical ventilation. An important complication of mechanical ventilation is barotrauma. Barotrauma appears to be common in COVID19 patients. Pneumothorax developed in 25% of COVID19 patients who had barotrauma. In COVID19 the percentage of patients with mild symptoms who develop a pleural effusion is 8% compared to 28% in patients who are critically ill. Most of the COVID19 infected that have a pneumothorax or pleural effusion need a thoracostomy. In trauma cases most, thoracic injuries (leading to pneumothorax or hemothorax) are effectively treated with tube thoracostomy. Objectives: First objective is to compare the therapeutic effect of tube thoracostomy on COVID19 infected patients who have pneumothorax or pleural effusion to those non-COVID19 infected patients who had traumatic pneumothorax or pleural effusion treated by tube thoracostomy. Second objective is to study the morbidity associated with tube thoracostomy in COVID19 infected patients who have pneumothorax or pleural effusion. Patients and methods: This study was conducted in Sheikh Khalifa medical city Ajman, United Arab Emirates. It is a descriptive, observational, retrospective cohort study. One hundred patients were recruited from the January 1, 2020 to the December 31, 2020. Patients were divided into two groups. First group includes fifty adult COVID19 infected patients who had no trauma. Second group includes fifty adult COVID19 infection free patients who had trauma. Inclusion criteria for the first group: COVID19 infected patients with an age equal to or above 18 years, of both genders, with history of pneumothorax, pleural effusion or both of them, needed insertion of thoracostomy chest tube. Inclusion criteria for the second group: Patients with an age equal to or above 18 years, of both genders, with history of traumatic pneumothorax, pleural effusion (hemothorax) or both of them, needed insertion of thoracostomy chest tube. Exclusion criteria for the first group: Children, Adult COVID19 infected patients who didn't have pneumothorax or plural effusion, adult COVID19 infected patients who had pneumothorax or plural effusion without a need for tube thoracostomy. Exclusion criteria for the second group: Adult non-COVID19 infected patients who had trauma, but didn't have pneumothorax or pleural effusion, adult non-COVID19 infected patients who had traumatic pneumothorax or pleural effusion without a need for tube thoracostomy. The collected data was revised, coded, tabulated and introduced to a PC using Statistical package for Social Science (SPSS 25). Mann Whitney Test (U test) was used to assess the statistical significance of the difference of a non-parametric variable between two study groups. Chi-Square test was used to examine the relationship between two qualitative variables. Fisher's exact test was used to examine the relationship between two qualitative variables when the expected count is less than 5 in more than 20% of cells. Results: Most of patients in trauma group (group 2) were with the age range of 20-40-year (58.8% of patients) P value was significant (<0.001). In COVID19 infected patients' group (group 1) the age range was 40-60 year (50%of patients). P Value (<0.001) was significant too. Male was the dominant gender in group 2 (96.1% of patients were male), while in groupl (78% of patients were male), P Value was significant (0.007). No comorbidities (diabetes, hypertension, ischemic heart disease, Asthma and dyslipidemia) were detected in group 2 (0.0%). Co-morbidity were detected in 76% of patients in group 1, P Value was significant (<0.001). Hemothorax occurred in 37.3% of patients in group 2, and no cases of hemothorax was detected in group 1. P Value was significant (<0.001). Complications of chest tube insertion took place in group 2 as follows; tube malposition in 13.7% of patients, tube blockade in 3.9% of patients. The percentage in group 1 was as follows tube malposition in 16% of patients, tube blockade in 18%. The difference between the two was not significant for tube malposition (P value 0.748) and significant for tube blockade (P value 0.023). Subcutaneous emphysema occurred in 15.7% of patients in group 2 and in 15.7% of patients in group 1. The difference was not significant (P value was 0.118). Acquired bronchopleural fistula occurred 2.0% of group 1 cases. No cases of this fistula were documented in group 2. Number of chest tubes needed to be inserted in group 2 patients was as follows (one chest tube in: 74.5% of patients, two chest tubes in: 23.5% of patients. Three chest tubes or more in 2% of patients). While in group1 patients' number of chest tubes needed to be inserted was (one in 56% of patients, two in 30% of patients. Three or more in 14% of patients). The difference was significant only in those who required insertion of three chest tubes or more (P value was 0.028). The median duration needed to keep a chest tube was 3 days in group 2, and 7 days in group 1. The difference between the two was significant (P value was 0.000). Death was the fate of 3.9% of patients in group 2 and in 64% of patients in group 1. The difference was significant (P value was< 0.001) Conclusion: Therapeutic effect of tube thoracostomy in treating Adult COVID19 patients who had pneumothorax or pleural effusion is less than that used...

In asymptomatic patients or those with mild infection with those with severe COVID-19 infection undergoing elective or and emergency surgery. Materials and methods: This is a retrospective study of 37 COVID19 patients who had the infection 7 days prior to and 30 days after emergency or elective surgery. Patients were divided to two groups. Group1: the asymptomatic or those with mild infection that is diagnosed just before surgery (14 patients). Group 2: those who were admitted to the hospital because of severe COVID-19 and were operated for COVID-19 related complications (23 patients). Morbidity and mortality of both groups was studied. Results: There was no significant difference in gender between the two groups. There were 5 females (2 in group 1, and 3 in group 2) and 32 males (12 in group 1, and 20 in group 2). Mean age for all patients was 49.8years (38 for group 1 and 57 for group2). Median age for all patients was 50 years (37.5 for group 1 and 57 years for group 2). Sepsis developed in 7 patients (1 patient in group 1 and in 6 patients in group 2). Statistically there was no significant difference in occurrence of sepsis between the two groups. There was a significant difference in the intensive care stay between the two groups (higher in group 2). Four deaths were reported in group 1 and fourteen in group 2. Eighteen out of thirty-seven patients died. Conclusion: Severity of COVID-19 infection will prolong the hospitalization and ICU stay in surgical patients with no significant effect on mortality....

Acute appendicitis is a common abdominal surgical emergency, typically characterised by classical signs and symptoms such as right lower quadrant abdominal pain, and tenderness, along with laboratory findings of leucocytosis and elevated inflammatory markers. However, this condition can present with atypical signs, creating diagnostic challenges for clinicians. We report an unusual case of acute appendicitis in a 53-year-old male, who exhibited the incidental finding of Grey Turner's sign on the right flank. Grey Turner's sign in the context of acute appendicitis initially raised suspicion of other conditions causing retroperitoneal haemorrhage, such as acute pancreatitis, as the primary differential diagnosis. This case underscores the importance of maintaining a broad differential diagnosis when faced with atypical clinical signs. Keywords: Acute abdomen- retrocaecal appendicitis – Grey turner sign.

Introduction: The infection caused by the COVID-19 virus is associated with thromboembolic events and severe inflammatory reactions, significantly impacting the prognosis of infected patients. Numerous studies have indicated that COVID-19 patients often exhibit a hypercoagulable state, disseminated intravascular coagulation, and overwhelming inflammation, particularly in critically ill patients with multiple comorbidities requiring admission to the ICU. This study aims to assess the prognostic significance of alterations in coagulation, inflammatory, and blood chemistry markers in COVID-19 patients both before and during admission to the ICU. Methods: Study design and population: This retrospective observational cohort study was conducted from March 2020 to July 2021 at a single center, including 90 adult patients with confirmed COVID-19 infection requiring ICU admission. Patients were divided into two groups: survivors (n = 42) and non-survivors (n = 48). The median age of non-survivors was 48.5 years (BMI 26–40), while survivors had a median age of 54 years (BMI 23–35). All participants received uniform supportive therapy comprising endotracheal intubation, anticoagulation (low molecular weight heparin or unfractionated heparin), aspirin, and steroids. No antiviral therapy was administered. Inclusion criteria encompassed adult COVID-19-positive patients requiring ICU admission. Exclusion criteria included pediatric patients, adult COVID-19 patients not admitted to the ICU, and Intensive Care Unit (ICU) patients without COVID-19 infection. Data collection: Demographic data (age, gender, comorbidities) and laboratory parameters (D-dimer, lactate dehydrogenase [LDH], procalcitonin, prothrombin time, platelet count, ferritin, C-reactive protein [CRP], glucose, and creatinine) were extracted from electronic medical records at three time points: ICU admission, shortly after treatment initiation, and at discharge or death. Statistical analysis: A total of 94 patients were initially assessed; three were excluded due to incomplete data, yielding a final cohort of 91 patients. Missing data for certain variables were imputed using the median of respective variables. Given the non-normal distribution of most laboratory markers, non-parametric statistical tests were applied. Paired Wilcoxon signed-rank tests were used to compare biomarker medians between admission and subsequent time points. Mann–Whitney U tests were employed to evaluate differences between survivors and non-survivors. All tests were two-tailed with a significance threshold set at P ≤ 0.05. Analyses were performed using Jamovi software. Results: Baseline characteristics: A total of 91 patients were included in the final analysis, comprising 42 survivors (36 males [83.7%], 6 females [16.3%]; median age 54 years [Interquartile Range (IQR): 49–59]; Body Mass Index (BMI) range 23–35) and 48 non-survivors (40 males [83.3%], 8 females [16.7%]; median age 48.5 years [IQR: 45–53]; BMI range 26–40). Overall, the cohort was predominantly male (83.5%) and had a wide range of body mass index. At ICU admission, survivors had slightly higher median platelet counts (257 vs 254 × 10⁹/L) and ferritin levels (1491 vs 1212 ng/mL), whereas non-survivors had higher median D-dimer (3.33 vs 2.28 mg/L), CRP (185 vs 131 mg/L), and procalcitonin (0.825 vs 0.51 ng/mL) levels. Creatinine, LDH, and glucose levels were similar between the groups at admission. Baseline demographic and clinical characteristics, along with initial laboratory values, are summarized in Table 1. Temporal changes in biomarker levels: Serial measurements revealed significant biomarker changes across the ICU stay. In the overall cohort, the Wilcoxon signed-rank test identified significant increases in platelet count (median 256 to 294 × 10⁹/L, P < 0.001) and procalcitonin levels (median 0.6–0.93 ng/mL, P = 0.016) shortly after treatment initiation (Table 2). From admission to discharge or death, significant increases were observed in prothrombin time (median 14.5–15.2 s, p<0.001), procalcitonin (median 0.6–1.01 ng/mL, P < 0.001), and creatinine (median 78–92 µmol/L, P < 0.001), whereas CRP (median 172.5–61.2 mg/L, P < 0.001) and LDH (median 581–472 U/L, P = 0.001) significantly decreased (Table 3). These temporal dynamics are visually summarized in Figure 1 (panels A–E), displaying median and mean values with 95% confidence intervals for each biomarker. Comparisons between survivors and non-survivors: Mann–Whitney U test comparisons (Table 4) revealed significant differences between survivors and non-survivors. At admission, survivors had significantly lower glucose levels (median 10.8 vs 8.2 mmol/L, P = 0.006). Shortly after treatment, survivors exhibited lower D-dimer (P = 0.013), prothrombin time (P = 0.022), ferritin (P = 0.022), CRP (P = 0.028), and LDH (P = 0.003) levels compared to non-survivors. At discharge or death, survivors demonstrated significantly higher platelet counts (median 331 vs 211 × 10⁹/L, P < 0.001) and significantly lower D-dimer, prothrombin time, ferritin, CRP, procalcitonin, creatinine, and LDH levels (all P < 0.001). Subgroup analyses: Among non-survivors, significant increases in prothrombin time, ferritin, procalcitonin, and creatinine levels were observed between admission and shortly before death, alongside a decrease in platelet count (all P < 0.001). Conversely, survivors showed significant reductions in CRP, ferritin, procalcitonin, and glucose at discharge (all P < 0.001), accompanied by increased platelet counts (median 257–331 × 10⁹/L, P < 0.001) and decreased LDH (median 570–472 U/L, P = 0.001). Conclusion: This study identifies key biomarkers that predict COVID-19 outcomes, emphasizing the association between platelet count and the final fate of COVID-19 patients admitted to the ICU. Elevated ferritin levels predict disease deterioration and poor prognosis, whereas lower glucose levels indicate a better prognosis.

This case report describes a rare and severe complication of extracorporeal shock wave lithotripsy (ESWL): necrotising fasciitis in a woman in her early 20s following treatment for a ureteric stone. The patient presented with escalating abdominal pain and signs of soft tissue infection, which advanced to involve the retroperitoneum and abdominal wall. Prompt imaging and diagnostic laparoscopy confirmed necrotising fasciitis. She underwent more than 10 surgical debridements, skin grafting and received prolonged antibiotic therapy. A multidisciplinary team approach was essential in achieving recovery. This case emphasises the need for high clinical suspicion for necrotising fasciitis post-ESWL, even in low-risk individuals. Key learning points include early recognition, aggressive surgical management and collaborative care to reduce morbidity and mortality associated with this life-threatening infection.