Anterior cervical corpectomy and fusion (ACCF) with anterior plate fixation is a common procedure for cervical spine trauma. Although generally safe, it carries a risk of esophageal perforation—a rare but potentially fatal complication. We report an 18‐year‐old male who developed delayed esophageal perforation 5 weeks after C4–C6 ACCF. Diagnosis was established by computed tomography showing retropharyngeal air and endoscopy confirming a full‐thickness esophageal defect. Surgical removal of the hardware, primary repair with absorbable sutures, drainage, and feeding jejunostomy were performed. The patient achieved complete recovery with no leakage at six‐month follow‐up. This case underscores the importance of clinical vigilance and timely surgical management.

Multiple myeloma (MM), a hematologic malignancy driven by neoplastic plasma cell proliferation, remains insufficiently characterized with respect to occupational and environmental risk factors and their impact on patients’ quality of life (QoL). This study explores modifiable exposures in the West Bank, Palestine, and evaluates their associations with MM risk and disease-specific QoL outcomes. A multicenter, hospital-based case-control study was conducted between 2018 and 2025, including 227 MM patients and 176 matched controls. Matching was based on age, sex, hospital setting, and admission type. Occupational/environmental exposures including ionizing radiation, cosmetics-related agents, pesticides, organic solvents, and farming were assessed via structured interviews and chart reviews. MM diagnosis adhered to International Myeloma Working Group criteria. QoL was evaluated using the validated EORTC QLQ-MY20 instrument. Multivariable logistic and linear regression analyses were performed, adjusting for clinical confounders using LASSO selection. Cosmetics-related chemical exposure was independently associated with higher odds of MM (OR = 2.85; 95% CI: 1.56–5.21) and a mixed QoL profile. Specifically, it predicted increased disease symptoms (Coeff = 11.55; 95% CI: 2.82–20.28; p = 0.010), lower treatment side-effects scores (Coeff = -2.17; 95% CI: -8.57 to -0.23; p = 0.049), and a marked decline in future perspective (Coeff = -13.73; 95% CI: -22.88 to -4.58; p = 0.003). Pesticide exposure was significantly linked to lower disease symptom burden (Coeff = -3.77; 95% CI: -12.61 to -2.06; p = 0.041) and better future outlook (Coeff = 10.05; 95% CI: 0.77–19.34; p = 0.034). Meanwhile, organic solvent exposure (carcinogenic-organic compounds) was associated with a decline in future perspective (Coeff = -3.96; 95% CI: -5.70 to -2.62; p = 0.042). This study highlights cosmetics-related agents, pesticides, and organic solvents as key modifiable risk factors for both MM development and QoL deterioration. Their significant physical and psychological impacts underscore the urgency of integrating preventive occupational health strategies with holistic myeloma care that addresses symptom burden and future outlook.

Background: Non-traumatic bile duct perforation in adults is a rare and often under-recognized surgical emergency. Its non-specific clinical presentation and variable etiologies pose significant diagnostic and therapeutic challenges. This systematic review synthesizes existing data on clinical presentation, diagnostic strategies, management approaches, and outcomes. Methods: This systematic review followed PRISMA 2020 guidelines. Initially prepared as a narrative review and subsequently advanced to systematic methodology, this study was not prospectively registered. A comprehensive search of English-language publications from 1882 to 2024 was performed in PubMed, EMBASE, Cochrane Library, and reference lists. All studies reporting adult cases (≥18 years) of non-traumatic bile duct perforation were included. Exclusion criteria were pediatric cases, traumatic/iatrogenic perforations, non-English language, and unavailable full text. Data extraction included demographics, etiology, presentation, diagnosis, management, and outcomes. Missing data were documented and reported for each variable. ASA classification was retrospectively assigned based on clinical descriptions when not explicitly stated, representing a study limitation. Management approaches were categorized by temporal era to assess the evolution from traditional to minimally invasive techniques. Mortality risk factors were analyzed using chi-square test with P < 0.05 considered significant. Results: From 102 eligible studies containing 223 reports, 124 adult cases of non-traumatic bile duct perforation met inclusion criteria (median age 56 years, IQR 38-68; 71.4% female). Stone-related etiology was identified in 54.0% (n = 67): choledocholithiasis (36.3%, n = 45) and cholelithiasis without choledocholithiasis (21.8%, n = 27). Clinical presentation was characterized by abdominal pain (99.1%, n = 112/113), tenderness (96.5%, n = 109/113), and vomiting (87.6%, n = 99/113). Median time to diagnosis was 3 days (IQR 1-7). Diagnostic modalities evolved significantly across eras: from 0 modalities (1880-1940) to 3.4 modalities (2010-2023). Ultrasonography (42.1%, n = 45/107) and CT (31.8%, n = 34/107) were most frequently used. Paracentesis demonstrated 91% positivity when performed (n = 38/97). Surgical treatment, primarily cholecystectomy with T-tube placement (72.8%, n = 83/114), was performed in 73.7% (n = 84/114). Preoperative ERCP was performed in 23.2% (n = 13/56). Overall mortality was 17.7% (n = 20/113), showing dramatic improvement from 45.7% (1880-1940) to 0% (2011-2023). Preoperative ERCP demonstrated a protective effect (0% vs 17% mortality). Hypotension at presentation ( P = 0.086) and elevated WBC ( P = 0.051) showed trends toward increased mortality. Conclusions: Non-traumatic bile duct perforation carries considerable morbidity and mortality. The evolution from purely surgical to combined endoscopic-surgical approaches has dramatically improved outcomes. A high index of suspicion and prompt use of paracentesis or cholangiographic studies (ERCP, MRCP) are critical for timely diagnosis. Treatment should be tailored to patient stability and perforation characteristics, with ERCP-based interventions favored in stable patients and immediate surgical intervention reserved for unstable or extensive cases. Early recognition and individualized, minimally invasive management strategies are key to improving patient outcomes.

Health-related quality of life (HRQoL) is central to the management of inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerativ

Background: Rheumatoid arthritis (RA) is a systemic inflammatory disorder associated with a significantly increased risk of cardiovascular events. This study aims to assess the prevalence of coronary artery disease (CAD) and its associated risk factors among Palestinian patients with RA, a population for which this data has been lacking. Methods: A cross-sectional study was conducted from March to September 2024 at multiple rheumatology clinics in the West Bank, Palestine. The study included 384 patients with a confirmed RA diagnosis based on the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. Data were collected on demographic characteristics, traditional cardiovascular risk factors, and RA-specific factors, including disease activity measured by the Disease Activity Score 28 (DAS28) and C-reactive protein (CRP) levels. Multivariable analysis was used to identify independent predictors of CAD. Results: The prevalence of CAD in this cohort was 25.5%. Multivariable analysis revealed that CAD was independently predicted by increasing age, dyslipidemia, and a first-degree family history of CAD. Markers of systemic inflammation, specifically higher disease activity (DAS28 Prevalence Ratio = 1.309) and elevated CRP levels (PR up to 2.108 for levels > 10 mg/L), also emerged as potent and independent predictors. Furthermore, a paradoxical, non-linear association was observed with anti-CCP antibody status, where low-positive titers conferred the highest risk (PR = 1.811), and a modest inverse association with BMI was noted (PR = 0.992), consistent with the ‘obesity paradox’. Conclusion: This study reveals a high prevalence of CAD among Palestinian patients with RA, driven by both traditional metabolic risk factors and RA-related systemic inflammation. The findings highlight an urgent need to integrate proactive cardiovascular disease prevention into the standard of care for RA in Palestine, recognizing RA as a cardiovascular risk-equivalent condition.

Introduction: Fungal infections in renal transplant recipients are rare but potentially serious complications due to the immunosuppressive therapy required to maintain graft function. Candida glabrata , a less common species that is more resistant to antifungal agents than Candida albicans, is increasingly implicated in post-transplant fungal infections. Case presentation: A 56-year-old female with a history of long-standing insulin-dependent diabetes mellitus complicated by peripheral neuropathy, retinopathy, and diabetic nephropathy underwent a deceased-donor renal transplant. The donor was a 48-year-old brain-dead male with normal renal function; serum creatinine had transiently risen to 1.14 mg/dL during admission but returned to a baseline of 0.79 mg/dL before organ procurement. The donor’s right kidney was transplanted into the recipient’s right iliac fossa using the Lich-Gregoir ureteroneocystostomy technique. A 6 Fr double-J Silastic ureteral stent (ImaJin®, Coloplast, France) was inserted routinely. Discussion: Early detection of C. glabrata fungal balls through urine microscopy and imaging, combined with nephrostomy and local antifungal irrigation, can successfully preserve graft function. The literature shows that management strategies vary widely, highlighting the importance of tailoring therapy to infection severity, patient comorbidities, and procedural considerations. Conclusions: This case highlights the importance of early recognition and individualized management of fungal bezoars in renal transplant recipients, particularly those caused by C. glabrata , a less common and more resistant non-albicans species. While C.