Majd Oweidat

Osteitis fibrosa cystica (OFC) is a rare skeletal complication of primary hyperparathyroidism (PHPT) that may present with multifocal osteolytic lesions mimicking multiple myeloma (MM) or metastatic disease. We report a 79-year-old woman with several years of generalized bone pain, fatigue, anorexia, and weight loss. Imaging revealed disseminated lytic lesions throughout the axial and appendicular skeleton, and MM was initially suspected. However, serum protein electrophoresis was normal, and bone marrow biopsy showed reactive changes with polyclonal plasma cells. She later developed a pathological midshaft femoral fracture. Laboratory testing showed severe hypercalcemia, markedly elevated parathyroid hormone, hypophosphatemia, elevated alkaline phosphatase, and vitamin D deficiency. Fracture fixation with targeted bone biopsy confirmed brown tumor consistent with OFC, and sestamibi scintigraphy localized a right inferior parathyroid adenoma. This case highlights that PHPT should be considered in patients with multifocal lytic bone lesions.

Introduction: Isolated fallopian tube torsion (IFTT) is a rare and often under-recognized cause of acute lower abdominal pain, particularly in adolescents. Clinical features are nonspecific and frequently mimic more common conditions, such as appendicitis or ovarian torsion, leading to delayed diagnosis and an increased risk of tubal necrosis. Association with hydrosalpinx in young patients without traditional risk factors is uncommon. Case presentation: A 15-year-old nulligravid girl with regular menses and no history of sexual activity or prior pelvic surgery presented with a 2-day history of severe, continuous lower abdominal pain, nausea, and vomiting. Examination revealed localized lower abdominal tenderness without peritoneal signs. Laboratory tests showed leukocytosis with neutrophilia; urinalysis was normal. Transabdominal ultrasonography was inconclusive due to body habitus. Contrast-enhanced computed tomography showed a right-sided cystic tubular adnexal structure consistent with hydrosalpinx, a central whirlpool configuration, a normal right ovary, and minimal free fluid, raising suspicion for IFTT. Urgent laparotomy confirmed isolated torsion of the right fallopian tube with necrosis; right salpingectomy was performed. The postoperative course was uneventful. Discussion: This case highlights the diagnostic challenge of IFTT. The coexistence of hydrosalpinx in an adolescent without prior infection or surgery underscores a possible role of tubal pathology in the pathogenesis of torsion. Conclusion: IFTT should be considered in adolescents with unilateral pelvic pain and normal-appearing ovaries to enable timely, fertility-conscious management.

High-flow nasal cannula (HFNC) therapy is increasingly used in pediatric patients with respiratory syncytial virus (RSV)–positive bronchiolitis to ma

Purpose of Review: Pediatric shock remains a leading cause of preventable mortality in low-resource settings, where limited diagnostics, shortages of trained personnel, and constrained critical care infrastructure delay recognition and treatment. The purpose of this narrative is to review studies current evidence and frontline innovations to guide clinicians working in low-middle income countries (LMICs), with particular emphasis on LMIC-specific etiologies such as malaria, dengue, anemia, burns, heat and malnutrition. A comprehensive, non-systematic search of the literature from 1990 to 2025 was conducted regarding clinical practice guidelines and implementation studies related to emergency care delivery in LMICs. Searches were performed in PubMed, Google Scholar, and WHO IRIS and sources included the following: World Health Organization (WHO) guidelines, Surviving Sepsis Campaign pediatric recommendations, Global Burden of Disease (GBD) reports, relevant key trials, studies, and context-specific documents. Due to limited laboratory and invasive monitoring in low-resource settings, early detection of shock relies on clinical signs such as capillary refill time, pulse quality, and mental status. Recent Findings: Recent studies focused on fluid resuscitation strategies, like those established in the African FEAST trial, revealed that early fluid resuscitation in children with shock may increase mortality when compared to children who did not receive fluid boluses. As a result, a cautious stepwise administration of crystalloids with frequent reassessment is the current, predominate fluid resuscitation strategy used in low-resource settings. When fluids alone fail, epinephrine or norepinephrine are preferred over dopamine as first-line vasoactive agents, with peripheral or intraosseous delivery and gravity-drip systems offering feasible alternatives to infusion pumps. Neonates require special consideration: Kangaroo Mother Care sharply reduces hypothermia, and routine glucose screening mitigates occult hypoglycemia. In the context of hemorrhagic shock, whole blood is used rather than its components due to chronic blood shortages, with tranexamic acid and improvised autotransfusion serving as adjuncts. Low-cost technologies, such as telemedicine, task-shifting protocols, solar-powered devices, and AI-assisted triage, demonstrate promising reductions in mortality when integrated into broader health system improvements. Together, these context-adapted approaches form a pragmatic roadmap for improving pediatric shock outcomes in resource-scarce settings. Summary: This review discusses the challenges of pediatric shock management in low-resource settings and outlines practical, evidence-based approaches to improve outcomes. We focus on (1) clinical recognition of shock without advanced diagnostics (2), acute resuscitation strategies, including fluid therapy, vasoactive support, and transfusion alternatives tailored to resource-limited environments, and (3) innovative interventions and research advances that hold promise for the future of pediatric emergency and critical care in LMICs. By synthesizing current evidence and expert recommendations, we aim to provide a framework for clinicians and health systems to strengthen the care of children with shock in settings where resources are constrained.

Isolated fallopian tube torsion (IFTT) is a rare cause of acute abdominal pain. This article reports a case of isolated torsion of the right fallopian tube associated with a paraovarian cyst (POC) in a pre-menarchal 12-year-old girl. The patient presented with 18 hours of progressively worsening right iliac fossa pain and nausea. Laboratory tests showed mild leukocytosis. Ultrasound showed a cystic mass adjacent to a normal right ovary with a thickened tubular structure, while computed tomography confirmed a right POC with features suggestive of torsion. Laparoscopy revealed a markedly edematous fallopian tube twisted twice around its axis with areas of necrosis. The tube was detorsed and the POC was removed. Salpingectomy was declined by the family and the tube was preserved. The postoperative course was uncomplicated. This case highlights the importance of considering IFTT in young patients with acute abdominal pain and a POC.

Amyand’s hernia defined as the presence of the appendix within an inguinal hernia sac, is rare in neonates and can deteriorate quickly. We report a preterm male twin (33 + 6 weeks; 1460 g) presenting at 1 month with 24 hours of progressive right inguinoscrotal swelling, erythema, irritability, and absent stooling. Exam showed a tender, nonreducible, non-transilluminating mass with abdominal distension. X-ray revealed dilated bowel loops; ultrasound suggested an indirect right inguinal hernia containing an inflamed appendix. Urgent inguinal exploration found incarcerated viable cecum and a gangrenous appendix. Appendectomy through the same incision with high sac ligation and posterior wall repair (no mesh) was performed. Recovery was uneventful: feeds resumed, weight gain continued, and the ipsilateral testis remained viable. This Type 2 Amyand’s hernia shows localized vascular compromise of the appendix in preterm infants and supports immediate targeted ultrasound and prompt surgery to avert perforation, sepsis, and gonadal injury.