Vol 3, No 2 (2025): Current Issue (Volume 3, Issue 2), 2025

Introduction

Human immunodeficiency virus (HIV) and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) surface glycoproteins, including shared epitope motifs, show similarities. This may lead to false-positive HIV results due to cross-reactivity between the two viruses. This study presents a systematic review of the published studies on their cross-reactivity.

Methods

A systematic review of the published studies of HIV and SARS-CoV2 cross-reactivity was conducted, the studies that met the following criteria were included: 1) Studies in the English language. 2) Studies in which the title included the required keywords. 3) Studies in which false positive results were achieved and confirmed. 4) Studies investigating the possibility of cross-reactivity between HIV and SARS-CoV2.

Results

A total of 11 studies and 466,140 patients were analyzed. Of the specified sexes, 363,786 (82.1%) of the participants were males. A total of 707 false-positive HIV results were recorded, of which 122 (17.3%) had detectable Coronavirus disease 2019 (COVID-19) antibodies. The remaining 585 (82.7%) false positives were either healthy patients or patients recovered from COVID-19 with no detectable COVID-19 antibodies. Twenty-five distinct tests were used as initial and confirmatory tests for both COVID-19 and HIV. Six (24%) unique fourth-generation HIV antigen/antibody combination tests, six (24%) HIV-specific molecular tests, and four (16%) HIV immunoassays were used.

Conclusion

COVID-19 should be considered a potential cause of false-positive results in HIV tests, due to the cross-reactivity between the antibodies or antigens from both viruses.

Thoracic outlet syndrome (TOS) is a complex and often overlooked condition caused by the compression of neurovascular structures as they pass through the thoracic outlet. This compression can result in pain, numbness, tingling, muscle weakness, and vascular complications, with severe cases leading to thrombosis or embolism.

TOS is classified into three types based on the affected structure: neurogenic, venous, and arterial. Neurogenic TOS is the most prevalent, accounting for over 90% of cases, and is more commonly seen in females. Venous TOS represents 3–5% of cases, while arterial TOS is the rarest, comprising only 1%. Diagnosing TOS is challenging due to its symptom overlap with various musculoskeletal and neurological disorders, often leading to misdiagnosis. The absence of universally accepted diagnostic criteria further complicates identification, relying primarily on clinical evaluations and inconsistent diagnostic methods.

Neurogenic TOS, in particular, is difficult to distinguish from other conditions with similar presentations. This study provides a comprehensive review of the differential diagnosis of neurogenic TOS, comparing it with musculoskeletal and neurological disorders that share overlapping clinical features.

Introduction

Osteonecrosis, also known as avascular necrosis, aseptic necrosis, or ischemic necrosis, results from a temporary or permanent halt in blood flow to a portion of bone. This lack of blood supply can eventually cause the affected bone to collapse. Osteonecrosis around the elbow is not frequently observed. However, its occurrence in the trochlea known as Hegemann's disease is even rarer. Incidence rates of trochlear osteonecrosis have been reported to vary from 0.27% to less than 0.001% across different studies.

Case presentation

A 14-year-old male presented with severe right shoulder pain and swelling, along with mild right lateral-sided elbow pain due to a fall to the ground. The radiograph of the right shoulder revealed a proximal humeral metaphyseal greenstick fracture. Additionally, the radiograph of the right elbow incidentally revealed osteonecrosis of the distal humeral trochlea. The affected shoulder was immobilized and Conservative management was selected for treating the trochlear osteonecrosis.

Conclusion

Trochlear avascular necrosis is a rare condition that might cause mild discomfort or even be asymptomatic, potentially being diagnosed incidentally through radiographs. Typically, it can be managed with conservative treatment methods.

In the face of mounting healthcare challenges, developing countries grapple with resource constraints, underfunded health systems, and a growing burden of infectious and non-communicable diseases. The question is no longer whether healthcare systems can sustain themselves under these pressures—the evidence says they cannot—but how they can adapt and evolve to meet these needs. One promising approach lies in establishing and strengthening public-private partnerships (PPPs) [1].

PPPs are collaborations in which governments and private entities collaborate to achieve common health goals, leveraging the strengths of both sectors. The public sector offers reach, regulatory frameworks, and an understanding of population health needs, while the private sector contributes innovation, efficiency, and financial resources. Together, they can address healthcare access, quality, and affordability gaps [1].

In many developing countries, healthcare access remains unequal. Rural and underserved populations often lack essential services, while urban areas face overcrowded and overburdened public hospitals. By pooling resources and expertise, PPPs can deliver sustainable solutions, such as building health facilities in remote areas, funding community health programs, or providing cutting-edge technology and training to public hospitals.  Initiatives like the African Access Initiative have brought affordable medicines and diagnostic tools to low-income countries by fostering collaborations between governments and pharmaceutical companies. These partnerships ensure the availability of life-saving medications for conditions like cancer and diabetes [2].  In countries like India, PPPs have been instrumental in building state-of-the-art hospitals in rural areas, combining public funding with private expertise. For example, the Karnataka state government’s partnership with private hospitals expanded tertiary healthcare access to previously underserved populations [3]. Partnerships with multinational corporations and NGOs have facilitated training for healthcare professionals, enabling them to provide higher-quality care. In Kenya, PPPs have focused on improving maternal and child health outcomes through community-based education programs [4], in 2010, the Kurdistan Regional Government (KRI) asked for assistance from the RAND Corporation, a U.S.-based nonprofit policy think tank specializing in research and development across various fields, to support the reform of the healthcare system in the Kurdistan Region of Iraq. The primary goal of the reform was to establish a health system that could efficiently provide high-quality services to all individuals, with the support of Public-Private Partnerships (PPPs) [5].

Despite their promise, PPPs are not without challenges. Critics argue that these arrangements can lead to the privatization of public health assets or create inequities in service delivery. For instance, poorly regulated PPPs may prioritize profitability over the needs of vulnerable populations, leaving rural or low-income communities underserved.  Transparency, accountability, and robust legal frameworks are essential to mitigate these risks. Governments must ensure that PPP agreements prioritize public health outcomes with clear success metrics and oversight mechanisms.

As the global health landscape evolves, developing countries have an opportunity to harness PPPs as a tool for resilience and equity. By fostering inclusive partnerships that align public and private incentives, countries can mobilize resources, improve service delivery, and ensure sustainable healthcare financing.

The need for innovation and collaboration in healthcare has never been more urgent. Governments, private entities, and civil society must work together to create partnerships that prioritize the well-being of all citizens, particularly the most vulnerable. With the right frameworks, public-private partnerships can move beyond being a stopgap solution and become a cornerstone of sustainable health systems.

Let us embrace the potential of PPPs and work toward a future where healthcare is a right, not a privilege, for everyone, everywhere.

Introduction

Thoracic outlet syndrome is a group of disorders arising from compressive forces on the neurovascular bundle in that region due to different etiologies. This study aims to present a case with an intractable cough as a complication of the surgery and its management.

Case presentation

A 41-year-old woman had a 15-year history of bilateral upper limb pain and numbness. The pain worsened over the last two months. Tests and imaging confirmed thoracic outlet syndrome. Physiotherapy had no effect. She underwent thoracic outlet decompression (TOD) under general anesthesia via a supraclavicular incision. Post-surgery, she developed uncontrollable cough that didn't respond to medication. Two days after the operation, a bupivacaine (5%) injection near the phrenic nerve resolved the cough.

Literature review

The literature review identified several cases of TOD complications, including right phrenic nerve paralysis resolving in 3-6 months, unilateral right diaphragm dysfunction, and lung herniation successfully treated with thoracoscopic reduction. These cases underscore the diverse presentations and outcomes of TOD complications, highlighting the importance of early diagnosis and tailored management strategies.

Conclusion

A possible complication of surgical decompression for thoracic outlet syndrome is an intractable cough that can be relieved by the injection of local anesthesia into the area of the phrenic nerve.

Introduction

Sacrococcygeal teratoma (SCT) is a rare embryonal tumor that occurs in the sacrococcygeal region, with an incidence of about 1 in 35,000 to 40,000 live births. This study presents a systematic review of giant SCT greater than 10 cm.

Methods

A systematic review of published studies regarding giant SCT in infants was conducted. The studies included met the following criteria: 1) the teratoma was situated in the sacrococcygeal region; 2) all case reports involved infants with a teratoma larger than 10 cm, and 3) the size of the teratoma was verified to exceed 10 cm through diagnostic methods.

Results

The current study included 31 studies that met the inclusion criteria. The studies included patients aged 6.1 to 9.3 months, with a median age of 7.6 months, predominantly female (72.7%). Diagnoses were primarily made in the first and second trimesters (39%) or after birth (33.3%), with cesarean delivery being the most common method (66.7%). Tumors weighed between 1.5 and 5 kg, with an average diameter of 15.6 cm. Surgical resection was performed in 93.9% of cases. The most common complication was respiratory failure (30.3%), and histopathology revealed that 39.4% of tumors were immature teratomas, while 33.3% were mature teratomas. The overall survival rate was 66.7%, with 18.2% of survivors experiencing tumor recurrence. Most complications occurred in the second trimester; however, no significant associations were found concerning the timing of diagnosis. Additionally, tumor size did not significantly impact outcomes.

Conclusion

Routine ultrasound and MRI are essential for the antenatal diagnosis of SCT. Due to the high risk of morbidity with larger tumors, cesarean delivery is advised for tumors over 10 cm. Coccygectomy is the most effective approach to prevent recurrence, highlighting the importance of timely surgical intervention and ongoing follow-up.

Introduction

 Microwave ablation (MWA) has emerged as a minimally invasive treatment for patients with inoperable non-small cell lung cancer (NSCLC). However, whether it is more effective as a standalone treatment or in combination with chemotherapy warrants further investigation. This systematic review assesses the efficacy and safety of MWA as a standalone treatment and in combination with chemotherapy in managing NSCLC.

Methods

Studies were included if MWA was used either as a standalone treatment or combined with chemotherapy for managing NSCLC, regardless of whether chemotherapy was administered before or after MWA.

Results

The patient cohort included 928 patients. In 63.8% of the cases, MWA was used alone, and in 36.2% with chemotherapy. Complications from MWA alone were higher (59.29% vs. 32.74%). The tumor stage in 52.36% of the cases who underwent MWA alone was stage I; however, it was the IV stage in 82.44% of the cases who underwent MWA combined with chemotherapy. Patients with available data and treated with MWA alone experienced higher local progression (26% vs. 18.5%), distant recurrence (51.5% vs. 38.5%), and both local and distant recurrence (10.8% vs. 2.6%). Reported complete response was 88.6% among cases that underwent MWA alone. While it was 78.0% in those who underwent combined MWA and chemotherapy. The median overall survival was higher in the MWA alone group (24.9 to 69.6 months vs. 21.3 to 23.90 months).

Conclusion

MWA combined with chemotherapy may represent a more effective option, with a slightly similar treatment response, reducing the risk of recurrence and minimizing complications.

Introduction

Cancer patients face a venous thromboembolism (VTE) risk that is up to 50 times higher compared to individuals without cancer. In 2010, direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, and edoxaban were introduced, consequently becoming the controversial oral anticoagulants for VTE therapy. This study is a meta-analysis of randomized clinical trials (RCTs) evaluating the use of edoxaban for treating VTE in cancer patients over different treatment durations.

Methods

Using Google Scholar, a systematic search for RCTs on edoxaban for cancer-associated VTE was performed. The data extracted covered patient numbers, age, gender, BMI, cancer type, edoxaban dosage, treatment duration, comorbidities, major bleeding, recurrent VTE incidence, and deaths. Statistical significance was set at 0.05.

Results

Out of 52 studies, nine with 3,190 cases met the inclusion criteria. The mean age was 66.68 years, with 1,604 females (50.28%). Major bleeding occurred in 192 patients (7.66%) in the 6- or 12-month group and 57 (8.35%) in the 3-month group (p=0.573). Recurrent VTE was observed in 145 patients (5.78%) in the 6- or 12-month group and 95 (13.91%) in the 3-month group (p<0.001). Deaths from any cause totaled 548 (21.86%) in the 6- or 12-month group and 165 (24.16%) in the 3-month group (p=0.110).

Conclusion

Cancer patients receiving edoxaban for six or 12 months experience a lower recurrence rate of VTE compared to those on a 3-month treatment. The incidence of major bleeding appears to be similar between the two treatment durations.

Introduction

Fibroadenoma is the most common benign breast lesion; however, it carries a potential risk of malignant transformation. This systematic review provides an overview of the presentation, management, and outcome of carcinomas arising within fibroadenomas.

Methods

A systematic search on Google Scholar was conducted for English-language studies on breast carcinoma within fibroadenomas. Studies on fibroadenomas with no malignant components, review articles, pre-prints, incomplete data, and those published in suspicious journals were excluded.

Results

On ultrasonography, 28 masses (36.8%) appeared benign, and 20 (26.3%) were suspicious, with ultrasonographic data unavailable for the remaining tumors (36.8%). Mammography data were available for 50 tumors, revealing 27 benign lesions (54%) and 23 suspicious lesions (46%). Among the 17 lesions with available magnetic resonance imaging data, five were benign lesions (29.4%), and 12 were suspicious (70.6%). Cytology evaluation among 46 tumors revealed that 20 (43.5%) were benign, 24 (52.2%) were malignant, and two (4.3%) were suspicious. The most commonly performed surgery was wide local excision (50.7%), followed by mastectomy (32.9%). On histopathology, 11 tumors exhibited more than one pathology. Ductal carcinoma in situ was the most frequent finding (40.8%), followed by invasive ductal carcinoma (28.9%) and lobular carcinoma in situ (28.4%). Recurrence was observed in one case (1.4%), and metastasis occurred in two cases (2.8%).

Conclusion

Although rare, carcinomas arising within fibroadenomas may present considerable challenges in preoperative diagnosis, whether through imaging or cytology. Therefore, clinicians may find it necessary to approach fibroadenomas with increased caution.