Case Of Ulcer Research Articles

Pancreaticogastrostomy: A Safe and Effective Reconstruction Method After Pancreaticoduodenectomy: A Short Observational Study

Background: Pancreaticoduodenal resection is usually performed in patients with a localised small carcinoma in the head of the pancreas, at the lower end of the common bile duct or at the ampulla and occasionally for chronic pancreatitis.The mortality following pancreaticoduodenal resection has fallen and is now below 5% 1-6 .However, leakage from the anastomosis between pancreas and the jejunum has been and remains, one of the most worrying complications of the operation. The data from papers published in the last 8 years show that the incidence of pancreatic leak is 14% and the mortality of this complication 24%3,4,6-16 .Pancreaticogastrostomy is a potentially safer alternative to pancreaticojejunostomy in the reconstruction following Whipple's operation. Aim: The aim of the study was to observe pancreaticogastrostomy is a potentially safer alternative to pancreaticojejunostomy after pancreaticoduodenectomy. Methods: This prospective observational study was conducted at the Department of Surgery in Shaheed Suhrawardy Medical College Hospital, for One year (August 2021 to July 2022). Patients with a localised small carcinoma in the head of the pancreas, at the lower end of the common bile duct or at the ampulla, and occasionally for chronic pancreatitis admitted in the department of surgery were approached for inclusion in the study. Total 41 patients were selected according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients underwent pancreaticogastrostomy. Detail clinical and demographic history was taken along with thorough physical examination relevant investigations. All patients were evaluated preoperatively and post operatively at discharge, 1 month and 3 months. Outcome was assessed post operatively. Collected data were checked and analysed in SPSS 23. Results: Two patients died within 30 days of the operation (mortality 4.9%), one from perioperative haemorrhage and another from septicaemia due to a biliary infection, which may have resulted from preoperative transhepatic biliary drainage. Both operations were carried out for carcinoma of the head of the pancreas. One patient developed a biliary leak which closed in 6 days. A postoperative pancreatic leak occurred in one patient with carcinoma of the ampulla; the fistula closed after 5 mdays, and did not delay his discharge from hospital. This patient remains well 36 months after operation, although he has now developed mild diabetes.One other patient developed diabetes mellitus postoperatively. This woman had evidence of obstructive pancreatitis at operation. She died 6 months later of recurrent carcinoma of the head of the pancreas. One patient with chronic pancreatitis has uncontrolled steatorrhoea, with up to four bowel movements a day. Four other patients take regular pancreatic supplements together with H2 receptor antagonists in order to maintain normal defaecation. There has been no case of stomal ulceration. None of the patients were lost to follow-up. The median survival for patients operated on for carcinoma of the head of the pancreas was 13 months, and for patients with carcinoma of the bile duct, 14 months. Median survival of patients with ampullary carcinoma was 38 months. Conclusion: Seventy two percent of patients had good outcome after Pancreaticogastrostomy(PG). Significant relief in symptoms of pain were noted after PG. Further larger study is recommended to validate this findings. J Shaheed Suhrawardy Med Coll 2023; 15(1): 66-72

Molecular detection of Epstein-Barr virus in paraffin-embedded tissue samples of patients suffering gastric cancer in Ahvaz, Iran: a case-control study

Background and Objectives: Gastric cancer (GC) is the third most common cause of cancer-related mortality. Epstein-Barr virus (EBV) is associated with several human tumors. The present research was performed to investigate the prevalence of EBV-associated gastric cancer (EBVaGC) among Iranian patients. Materials and Methods: Seventy cases of gastric cancer and 30 cases of gastric ulcer, all preserved in formalin-fixed paraf- fin-embedded (FFPE), were examined in a case-control study conducted between 2011 and 2018. The specimens underwent analysis to detect the presence of the EBV genome using a Nested-PCR method targeting EBNA1. Subsequently, samples testing positive for the EBNA1 underwent further testing for the presence of the EBER gene using PCR. Finally, Positive samples were subjected to sequencing. Results: Five out of 70 cases (7%) were found to be positive for EBV based on EBNA1 testing, while all EBNA1 positive samples were negative for EBER. Notably, EBV was not detected in patients with gastric ulcer. The mean age of EBV-posi- tive gastric carcinomas pateints was 64.5 years. Within this group, 60% were male and 40% were female. A higher prevalence of EBV association was observed in diffuse-type cases, with 60% (3 out of 24) testing positive, compared to intestinal-type cases where 40% (2 out of 46) were EBV-positive. Most cases of EBVaGC belonged to grade Ⅰ. Conclusion: This research demonstrates a low prevalence of EBVaGC in Iran. Discrepancies in EBVaGC occurrence among countries could be attributed to epidemiological variables and dietary practices. A comprehensive studies will provide signif- icant contributions to understanding of its etiology

Lipschütz ulcer following first dose of COVID-19 tozinameran vaccine: Report of a case and review of a World Health Organization pharmacovigilance database.

Lipschütz ulcer (LU) is a condition known for painful vulvar ulcers, typically affecting young women and often linked to infectious agents. Recent reports have indicated a potential connection between LU and COVID-19 vaccination, particularly after the second or booster doses. This study presents a case of LU following the first dose of tozinameran in a young woman who had a previous SARS-CoV-2 infection and investigates similar cases globally. An 18-year-old woman experienced vulvar pain and ulcers 2-days after her initial COVID-19 vaccine dose. After ruling out infections through serological tests, a diagnosis of LU was made, and her symptoms resolved after 10 days. A literature search and VigiBase® analysis revealed 11 cases of LU following COVID-19 vaccination, and 519 vulvovaginal ulcer cases associated with these vaccines were identified in Vigibase®, with a median onset of 2 days. Most LU cases occurred after the second dose or booster shots. The primary hypothesis for this association is a type 3 hypersensitivity reaction mediated by immune complexes, possibly triggered by prior exposure, as many cases occurred after the second dose. Interestingly, the presented case suggests that prior COVID-19 infection could serve as sensitization. In conclusion, this study highlights the potential occurrence of LU after the initial COVID-19 vaccine dose in young patients with prior COVID-19 infection. While the risk of recurrence after subsequent vaccinations or infections remains uncertain, the benefits of vaccination outweigh the risks. Clinicians and patients should be aware of this potential issue to make informed decisions regarding vaccination.

S4027 Challenges in Managing Hemobilia Post-ERCP: A Case of Ulceration and Successful Intervention

S4027 Challenges in Managing Hemobilia Post-ERCP: A Case of Ulceration and Successful Intervention

S4740 A Case of Small and Large Bowel Ischemic Ulcerations in a Patient With Atypical Hemolytic Uremic Syndrome

S4740 A Case of Small and Large Bowel Ischemic Ulcerations in a Patient With Atypical Hemolytic Uremic Syndrome

A Rare Case of Uvulitis Following Endotracheal Intubation Using C- Mac Videolaryngoscope and How To Avoid It

Uvular injuries are uncommon after general anesthesia and can result from direct trauma to the posterior part of the soft palate or compression and restriction of blood flow to the uvula caused by the inadvertent placement of the airway or suction devices in the oral cavity. There have been cases of inflammation and ulceration occurring in the midline oropharyngeal structures such as the uvula after general anesthesia with a tube or laryngeal mask airway, even in the absence of direct trauma or infection, presumably due to compression ischemia. While sore throat following general anesthesia is a common symptom, it is important to evaluate any severe or persistent pain to exclude uvulitis. Here we present a case of uvulitis that developed after the insertion of a flexometallic endotracheal tube using the midline technique during C-Mac video laryngoscopy. We also emphasize the measures that can be implemented to prevent such a complication. The entrapment of the uvula during intubation often goes unnoticed due to limited oral space after insertion of the video laryngoscope blade, with the intubating anesthetist staying focused on the monitor. This complication following the use of a C-Mac video laryngoscope has not been previously documented.

S4773 Diagnostic Challenges in Abdominal Pain: A Case of Toothpick-Induced Duodenal Ulcer

S4773 Diagnostic Challenges in Abdominal Pain: A Case of Toothpick-Induced Duodenal Ulcer

When the Crystals Do Not Align: A Rare Case of Sevelamer-Induced Colonic Ulceration and Crystal Deposition

When the Crystals Do Not Align: A Rare Case of Sevelamer-Induced Colonic Ulceration and Crystal Deposition

A Case of Anal Mucosal Ulcer due to Cytomegalovirus Infection During Bullous Pemphigoid

A Case of Anal Mucosal Ulcer due to Cytomegalovirus Infection During Bullous Pemphigoid

Effective Treatment of Refractory Oral Ulcers Using a Compound Chinese Herbal Mouthwash: A Report of Two Cases

Oral ulcers are a prevalent oral mucosal disorder, characterized by benignancy and self-limiting progression. However, a subset of these ulcers exhibits resistance to conventional therapeutic interventions, necessitating alternative treatment strategies. In this study, we present two cases of refractory oral ulcers that demonstrated limited responsiveness to standard treatments but achieved significant therapeutic benefits following the application of a compound Chinese herbal mouthwash. Case 1 involved a 60-year-old female patient diagnosed with Behçet's syndrome. Initial treatment with glucocorticoids and immunosuppressants yielded limited improvement in her oral ulcers; however, combination therapy involving the Chinese herbal mouthwash resulted in significant improvement and complete healing after a 2-week period. Case 2 presented a 48-year-old female patient with chronic tongue ulceration pain persisting for one year without any detectable systemic etiology. Despite receiving oral vitamin supplementation and local analgesic jelly, her symptoms remained unalleviated. A 3-week treatment regimen involving the administration of the Chinese herbal mouthwash in conjunction with thalidomide led to the complete resolution of her oral ulcers. The findings from this study suggest that the compound Chinese herbal mouthwash may serve as an adjuvant therapeutic approach for managing chronic oral ulcers that are resistant to conventional treatment.

Buruli ulcer: An epidemiological update from Japan.

Japan is one of the rare non-tropical countries with documented cases of Buruli ulcer (BU). Mycobacterium ulcerans subsp. shinshuense has been identified as the causative agent. The first report of BU in Japan dates back to 1982, with sporadic reports thereafter. Recently, the number of cases has been on the increase, and 50 cases (57.7%) are from the past decade alone, out of a total of 87 cases reported to date. Japan's well-developed healthcare facilities play a crucial role in enabling detailed investigations and providing appropriate treatment for patients, contributing to a favorable prognosis. However, the rarity of the disease results in lack of awareness among healthcare professionals, leading to frequent delays in diagnosis. This article aims to offer an updated overview of BU cases in Japan and to raise awareness of BU among dermatologists and other healthcare professionals in a non-endemic setting.

746. ESOPHAGECTOMY, WITH CHOLECYSTECTOMY HAS A HIGH INCIDENCE OF REFLUX ESOPHAGITIS AND GASTRIC TUBE ULCER

Abstract The surgical methods for thoracic esophageal cancer was subtotal esophagectomy, with gastric pull up via retrosternal route, and cervical anastomosis. However, some cases were complicated by acute cholecystitis in the early postoperative period, and cholecystectomy was performed intraoperatively to prevent postoperative cholecystitis in some cases. The disruption of normal anti-reflux mechanisms including the lower esophageal sphincter, angle of His, and diaphragmatic muscle and the denervation of the vagus nerve are generally thought to be the main factors that interfere with gastric motor function. Furthermore, the pressure difference between thoracic (negative) and abdominal cavity (positive) is another factor that promotes reflux across the anastomosis. Due to these factors, postoperative reflux esophagitis is frequently experienced. Furthermore, after cholecystectomy, due to loss of gallbladder reservoir function after cholecystectomy and decrease in antroduodenal motility, bile is not excreted by food intermittently but continuously, resulting in duodenogastric reflux. We investigated postoperative reflux esophagitis and gastric tube ulcers in cases with and without intraoperative cholecystectomy for the past three years. We investigated cholecystectomy with esophagectomy (n=65) and non-cholecystectomy with esophagectomy (n=101) in 166 cases of radical surgery for esophageal cancer in which 2-3 regions had been dissected in the past 3 years. As shown in Fig. 1, there are no differences in location, TNM, gender, and PPI administration .reflux esophagitis of the cervical esophagus is A:0 B:2 (3%), C:5 (8%), D:3 (5%) for chole(+), A:2 (2%), B:2 (2%), C:2 (2%), and D:2 (2%) for chole(-). Gastritis was Chole(+) superficial gastritis 14 (21%), metaplasia 4 (6%), chole(-) superficial gastritis 25 (25%), metaplasia 3 (2%). However, gastric tube ulcers occurred in 5 cases (7%) of Chole(+) and 1 case of perforation, while only 1 case (1%) of gastric tube ulcers occurred in Chole(-).. (Conclusion) Esophagectomy, gastric pull up with cholecystectomy has a high incidence of reflux esophagitis in the neck and can also cause ulcers in the gastric tube. Therefore, care should be taken in postoperative follow-up.

Clinical features and outcome of dogs and cats with gastrointestinal pneumatosis: 30 cases (2010-2021).

To describe the presentation, etiology, and outcome of dogs and cats diagnosed with gastrointestinal pneumatosis (GP). Retrospective study. Three referral institutions. Twenty-six dogs and 4 cats. None. The most common sites of GP were the stomach (n=19), followed by the colon (n=8) and small intestine (n=2). One case had pneumatosis of both the stomach and the colon. GP was most commonly associated with gastrointestinal disease in dogs (18/26 [69%]) and cats (3/4 [75%]), with common diagnoses including gastric dilatation and volvulus (n=5), acute hemorrhagic diarrhea syndrome (n=4), and gastrointestinal ulceration (n=4). Of the 4 cases of gastrointestinal ulceration, 3 were dogs with a history of glucocorticosteroid or nonsteroidal anti-inflammatory drug administration and vomiting and diarrhea. Six of 30 cases (20%), all of which were dogs, were determined to have a surgical indication for exploratory celiotomy, although not solely on the basis of diagnosis of GP. Five cases underwent exploratory celiotomy, of which 1 (20%) survived to hospital discharge. Of the medically managed cases, 13 of 24 (54%) survived to hospital discharge. Overall, 14 of 30 cases (47%) survived to hospital discharge. GP is an uncommon diagnostic imaging finding that is associated with a variety of disease processes. Its development is often related to primary gastrointestinal diseases. In the absence of other surgical disease, exploratory celiotomy based solely on the diagnosis of GP is unlikely to be indicated.

Monkeypox-related ophthalmic disease (MPXROD): Monitoring the antiviral effect of tecovirimat with monkeypox virus detection in tear samples.

Although monkeypox-related ophthalmic disease (MPXROD) is rare, visual impairing complications have been reported. At present, tecovirimat is the standard-of-care antiviral treatment. In this MPXROD case, the effect of tecovirimat was assessed with PCR analysis of tear samples and concurrent monitoring of inflammation with laser flare photometry (LFP). The patient presented with a palpebral lesion and a corneal ulcer in his right eye, with complete absence of the corneal epithelium, high intraocular pressure and anterior uveitis. MPXV-DNA was detected in tear samples with real-time PCR (RT-PCR). A total volume of 0.5 ml tear-wash was aspirated from the inferior fornix, following instillation of saline onto the ocular surface. In addition, LFP was used to quantify inflammation in both eyes. Viral load in tear samples was detected prior to treatment initiation. In the left eye, tear samples tested negative for MPXV-DNA one week post-treatment while MPXV-DNA was still detected in the right eye, before reaching undetectable levels four weeks post-treatment. Objective quantification of anterior chamber inflammation through LFP demonstrated gradual decrease that was more pronounced in the affected right eye and coincided with the clinical improvement of the corneal ulcer. This case of Mpox related corneal ulcer with associated uveitis manifests the feasibility of monitoring the antiviral effect of tecovirimat with virus detection in tear samples and LFP. Our observations indicate that tecovirimat resulted in viral load reduction in both eyes. RT-PCR MPXV detection in tear samples and LFP represent noninvasive tools that could assist with treatment response monitoring.

Fungal keratitis among inpatients with corneal ulcers in Thai Binh, Vietnam: A retrospective observational study

Background: Infectious keratitis can be caused by bacteria, fungi, and viruses. Fungi are a common pathogen, especially in developing countries like India, Nepal, and Bangladesh where the prevalence ranges from 20% to 60%. In Vietnam, fungal keratitis accounted for the highest number of keratitis cases in a study conducted at the central eye hospital over a 5-year period (57%). Therefore, it is necessary to collect specific background information connected to the types of fungal keratitis in corneal ulcer cases in this region. Aims and Objectives: The aim of this study was to investigate the prevalence of fungal keratitis and the epidemiological features in 216 cases of fungal keratitis out of a total of 240 cases of infectious keratitis. Materials and Methods: This retrospective study collected secondary data from medical records of 240 inpatients with infectious keratitis who were treated at the ophthalmology hospital in Thai Binh, Vietnam, from January 01st, 2021 to June 30th, 2022. Patients with a positive fungal-directed smear were analyzed in detail for the type of fungus isolated, sociodemographic data, predisposing risk factors, prior treatment modalities, and laboratory results for the distribution pattern of fungus species. Results: Among the 240 cases, 126 (52.5%) were diagnosed with fungal keratitis by direct microscopic examination. Culture results showed the highest rate of Fusarium spp. (43.3%). The age group of 41–60 years was most commonly involved (40.5%). Males were more affected by fungal keratitis than females, (53.2% compared to 46.8%), with farmers being the most common occupation correlated with fungal keratitis (55.6%). The rate of fungal keratitis patients due to agricultural injuries was the highest compared to other risks (47.6%) and most patients self-medicated before going to the hospital, with many not knowing or remembering what medications they had taken (52.4%). Conclusion: The study revealed a high rate of fungal keratitis among the total of infectious keratitis cases in Thai Binh, Vietnam. Fusarium spp. was the most commonly isolated fungi. The study also highlighted the impact of agricultural injuries on fungal keratitis, especially in regions like Thai Binh.

Upper Gastrointestinal Bleeding in Patients with Chronic Renal Failure: What are the Particularities?

Introduction: Upper Gastrointestinal bleeding (UGIB) is a major cause of mortality in patients with renal failure. The aim of our study is to determine the epidemiological, lesional and prognostic profile of UGIB in chronic kidney disease (CKD) patients. Materials and Methods: This was a single-center study conducted from September 2017 to August 2023, including all patients with CKD admitted to the emergency department for upper GI bleeding who underwent Esogastroduodenoscopy (EGD). The various data were collected from endoscopy registries. Results: Of 662 patients admitted via the emergency department for UGIB, 59 cases of CKD (8.9%) were included, of which 43 cases were at the hemodialysis stage (72.88%). The mean age was 57.17 years, with a male predominance (sex ratio M/F 1.55). Isolated melena was the main reason for admission in 35 cases (59.32%), followed by hematemesis with melena in 9 cases (15.25%), and hematemesis without melena in 10 cases (16.94%), while massive rectal bleeding was present in 5 cases (8.47%). Esogastroduodenoscopy established the etiological diagnosis of UGIB in 40 cases (67.8%) and revealed the following lesions: 25 cases of peptic ulcer (62. 5%):2 cases (8%) of antral gastric ulcer,1 case (4%) of Forrest IIc bulbar ulcer, 12 cases (48%) of Forrest III bulbar ulcer and 10 cases (40%) of ulcerative bulbitis, 12 cases (30%) of gastric and duodenal angiodysplasia, 2 cases (5%) of Los Angelos grade B and C esophagitis and 1 case (2. 5%) of grade II of oesophageal varices ligatured in an unknown patient with portal hypertension. EGD was negative in 32.2% of cases. Conclusion: Upper GI bleeding is common in patients with chronic renal failure and is primarily caused by peptic ulcer disease and angiodysplasia.

Bilateral Aggressive Mooren Ulcer in the Setting of Bilateral Pterygia and Pregnancy: A Unique Case.

To report an unusual case of bilateral aggressive Mooren ulcer that occurred in the setting of bilateral pterygia and showed a relentless course during pregnancy. A 39-year-old woman of Black African ethnicity, 36-week pregnant, presented to the eye casualty with bilateral nasal corneal ulcer and associated melt around preexisting pterygia. A detailed workup including microbial evaluation, culture and sensitivity, polymerase chain reaction for herpes simplex virus, varicella zoster virus, and cytomegalovirus, inflammatory blood profile, autoimmune markers, and human leucocyte antigen (HLA) screening was undertaken. Treatment was initiated in a stepwise approach. Infections and systemic autoimmune and rheumatologic conditions were ruled out. A diagnosis of bilateral Mooren ulcer was made by exclusion. The peripheral blood was positive for HLA DQ2. As the condition seemed refractory to medical management (topical steroids and intravenous pulse methylprednisolone followed by oral prednisolone and topical cyclosporine), urgent bilateral conjunctival resection with multilayered amniotic membrane transplantation was performed to reduce the inflammatory stimulus and keratolysis. Stabilization of the condition warranted the need for systemic immunosuppressive agents. Using a multidisciplinary approach, in liaison with Obstetricians and Rheumatologists, the patient was planned for an earlier elective Cesarean section and commencement of oral mycophenolate mofetil postpartum, which aided in successful control of the disease. Mooren ulcer could follow an aggressive course during pregnancy, especially in the setting of preexisting pterygium. The complex hormonal and immunological changes during pregnancy and the delivery of inflammatory mediators directly onto the cornea by pterygium could contribute to the severity. A well-planned, stepwise, and multidisciplinary management is pivotal for the treatment of this condition.

Retrospective study of 189 cases of acute perforated peptic ulcer: safety and efficacy of over-the-scope-clip based endoscopic closure.

To compare the clinical outcomes in patients with acute perforated peptic ulcer (PPU) treated with over-the-scope clip (OTSC), non-surgical, and surgical interventions, and to explore the effectiveness and safety of OTSC closure. Hospital stay, antibiotic use, diet resumption time, and mortality rate were analyzed retrospectively. Binary Logistic regression analysis was used to identify the risk factors influencing PPU complicated with sepsis. Patients were divided into three treatment groups: OTSC (n = 62), non-surgical (n = 72), and surgical (n = 55) groups. The median time (IQR) from symptom onset to admission was 9.0 (4-23) h. 88.71% (55/62) of the patients in In the OTSC group underwent OTSC closure within 24h (median [IQR] time: 14.5 [7.00-30.25] h). The perforation diameters in the OTSC and surgical groups were 9.87mm ± 5.97mm and 8.55mm ± 6.17mm, respectively. The median (IQR) hospital stays in the OTSC (9.50 [7.00-12.25] days) and non-surgical group (9.00[7.00-13.00]days) were similar (p > 0.05), but shorter than that in surgical group (12.00[10.00-16.00]days), (p < 0.05). The median duration of antibiotic use was shorter in the OTSC group (7.00[3.00-10.00]) than in the non-surgical group (9.00[7.00-11.00]) and surgical group (11.00[9.00-13.00]) ( p < 0.05); and the time to resume oral feeding was shorter in the OTSC group (4.00[2.00-5.25]) than in the non-surgical group (7.00[6.13-9.00]) and surgical group (8.00[6.53-10.00]), respectively ( p < 0.05). No mortality difference among groups (p = 0.109) was found. Lower albumin level at admission, older age, and elevated creatinine levels were associated with increased sepsis risk, with OR(95%CI) of 0.826 (0.687-0.993), 1.077 (1.005-1.154), and 1.025 (1.006-1.043), respectively (all p < 0.05). OTSC closure improves clinical outcomes of acute PPU patients without sepsis. Age, hypoalbuminemia, and baseline renal dysfunction increase the risk of sepsis, while mortality was associated with sepsis and multiorgan dysfunction.

Phenotypic Screening and Antibiogram of Infectious Ulcerative Keratitis Cases in Tripoli Eye Hospital, Libya

Aims: This study to investigate the most prevalent pathogens that cause corneal ulcer in Tripoli-Libya, and to recognize the antibiogram of the isolated pathogens Study Design: This study was a prospective study performed in eye hospital (Zawyet-Aldahmany eye hospital). Place and Duration of Study: It was conducted at the microbiology laboratory of the hospital over a year from December 2018 to January 2020, The overall size of the sample enrolled in this study was 50 inpatients in the admission department, which was taken according to the incidence of the corneal ulceration cases admitted to the hospital. Methodology: The corneal scrapings and swabs were collected and subjected to microbiological examination. Demographic data and risk factors were collected for each patient. The antibiotic susceptibility of the bacterial microorganisms was determined by the Kirby-Bauer disk diffusion method, to identify the most appropriate antibiotic for each bacterial isolate. Results: 60% of the patients were males, the mean age of the patients was 46.5 years, unilateral right eye keratitis was involved in (54%) of cases, trauma was the major risk factor (24%), followed by systemic disease (14%). Concerning the seasonal distribution of the cases between months, our study revealed that summer and winter seasons in Libya (January, July, August, and September) involved most of the cases, and interestingly, fungal keratitis (Aspergillus) was higher in (July, August), which is the summer season in Libya. The culture positive rate was (80%), of which (36%) were bacterial, and (22%) were fungal pathogens, and the other (22%) were mixed fungal and bacterial cultures. The most common bacterial isolate was (26%) P.aeruginosa and (16%) staphylococcus aureus, while Aspergillus (40%) was the most common fungal isolate, followed by Penicillium and fusarium species. Our results showed that P.aeruginosa was the responsible microorganism for rapid keratitis progression in three cases who were using cosmetic lenses promptly. Concerning antibiotic sensitivity, all gram-negative bacteria and positive isolates were susceptible to old-generation fluoroquinolones such as ciprofloxacin and levofloxacin, while ceftazidime showed resistance to penicillins. Conclusion: In conclusion, with early suspicion and microbiological diagnostic procedures, appropriate therapy can only reduce the incidence of this threatening ocular case.

An unusual case of scalp ulceration

An unusual case of scalp ulceration