Introduction and importance:Cerebral myiasis is a rare neurosurgical condition with only 21 cases reported globally. Post-traumatic forms are common in low- to middle-income countries, often arising from neglected wounds. We report the first documented case in Ghana, highlighting systemic barriers to timely neurotrauma care.Case presentation:A 7-year-old boy sustained an open comminuted skull fracture as an unhelmeted pillion rider in a tricycle collision. After a 3-day delay in wound care at a peripheral facility, he presented with a foul-smelling, sand-contaminated wound. Neurologic assessment revealed GCS 4/15, anisocoria, flaccid paralysis of all limbs, and absent plantar reflexes. The 12 × 8 cm wound overlaid the right frontal lobe with exposed brain tissue and several maggots were observed around the wound. Ten larvae were removed from wound, extensive debridement was performed, and broad-spectrum antibiotics were initiated. Despite intensive multidisciplinary care, the patient died on day 5 of admission.Clinical Discussion:While head injury of such severity requires immediate multidisciplinary care in an intensive unit, there was a lag in assessing referral centers. This was compounded by a lack of expertise in wound management and the absence of appropriate remote guidance from experts. This case highlights challenges in neurotrauma care in Ghana amidst limited and highly centralized specialist facilities.Conclusion:Post-traumatic cerebral myiasis within a hospital is a testament to weak trauma care. It emphasizes the urgent need to implement measures, such as telemedicine support for peripheral centers, improved trauma referral pathways, and capacity building in emergency stabilization.

Introduction:Carbohydrate antigen 19-9 (CA19-9) is a tumor marker that is primarily linked to gastrointestinal cancer, especially to pancreatic cancer. Lung sequestration is a rare congenital anomaly, The link between them is not well-established.Case presentation:A 62-year-old male was found to have elevated CA19-9 levels, which were increased to 1524.93 U/ml. Despite this significant rise, the patient did not exhibit any notable symptoms. Imaging studies indicated the presence of left lung sequestration accompanied by infection and enlarged retroperitoneal lymph nodes, while further tests pointed towards a benign pancreatic lesion. A multidisciplinary team decided on surgical intervention, opting for a lobectomy. Following the surgery, the patient’s CA19-9 levels decreased significantly, and after 3 months of follow-up, they returned to the normal range.Discussion:This case emphasizes the importance of recognizing elevated CA19-9 as a potential sign of underlying conditions, such as lung sequestration, and illustrates the effectiveness of surgical treatment in these scenarios.Conclusion:The findings highlight the necessity for comprehensive investigations in patients with unexplained elevations in CA19-9 to ensure prompt diagnosis and treatment.

Stroke is a leading cause of disability and mortality worldwide, with survivors frequently experiencing motor and cognitive impairments that hinder their daily functioning and independence. Dual-task training (DTT), an innovative rehabilitation approach, targets simultaneous improvement in motor and cognitive functions by addressing cognitive-motor interference. This narrative review evaluates the efficacy and safety of DTT in poststroke rehabilitation. PubMed, Google Scholar, Cochrane Library, Scopus, and the Directory of Open Access Journals were searched, yielding 31 studies, including randomized controlled trials and observational studies. Articles were identified that evaluated the safety and efficacy of DTT for poststroke rehabilitation in patients who had suffered from hemorrhagic or ischemic stroke. Before extracting variables, the studies were imported into Rayyan software, and thematic analysis was subsequently conducted using Microsoft Excel. The findings indicate that DTT enhances gait parameters, balance, and cognitive functions, particularly attention and executive function. Additionally, it improves functional outcomes, including activities of daily living, and reduces fall risk. While DTT demonstrates promise in fostering neuroplasticity and improving recovery outcomes, questions regarding its long-term efficacy, optimal implementation, and safety warrant further investigation. This review highlights the potential of DTT as a promising approach in stroke rehabilitation, supporting more integrated recovery strategies.

Background:Acute appendicitis is the most common cause of acute abdomen encountered in general surgical practice, with the life time risk of 7–9 %. While early treatment usually prevent complications, perforated appendicitis remains a serious concern leading to higher morbidity, longer hospital stay .Objectives:To determine clinical, demographic, laboratory, and radiological predictors of perforation in adults with acute appendicitis.Methods:This retrospective cohort study included 200 patients diagnosed with acute appendicitis and treated at a major teaching hospital between January 2018 and December 2022. Patients were categorized into perforated and non-perforated based on intra-operative and histopathological findings. Data on demographics, co-morbidities, symptom duration, laboratory markers, imaging results, complications, and hospital stay were collected. Multivariate logistics regression was applied to identify independent predictors of perforation.Results:Acute appendicitis was more prevalent among patients in their second decade of life (44%) and more common in males (56%) than females (44%). Perforation occurred in 20% of cases. Risk factors significantly associated with perforation include old age, delayed presentation (>48 hours; co-morbidities, particularly diabetes). Elevated WBC count (>18.000\\mm3) with negative shift and increased C-reactive protein level. Ultrasound showed modest diagnostic accuracy, while Computed Tomography (cCT) scan outperformed ultrasound in detecting perforation (sensitivity: 92 vs. 65%). Postoperative complications and hospital stay were significantly higher in patients with perforated appendicitis (P-value < 0. 05).Conclusion:Delayed presentation, elevated inflammatory markers, old age, and co-morbidities are strong, independent predictors of appendiceal perforation. Early diagnosis and prompt surgical intervention, especially in patients with known risk factors, are crucial to prevent complications such as perforation and minimize hospital stay.

Background and Objectives:Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide. Nerinetide, a neuroprotective peptide, has shown potential in limiting neuronal damage when administered early after stroke onset. This study aimed to evaluate the efficacy and safety of nerinetide compared with placebo in patients with AIS.Methods:A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in accordance with PRISMA and AMSTAR 2 guidelines. Electronic databases, including PubMed, MEDLINE, Cochrane Library, ScienceDirect, and ClinicalTrials.gov, were searched up to February 2025. The primary outcome assessed was mortality, while secondary outcomes included functional recovery (modified Rankin Scale, Barthel Index), infarct volume, and adverse events.Results:Three RCTs encompassing 2462 patients met the inclusion criteria. Nerinetide treatment demonstrated a modest yet statistically significant reduction in mortality risk (risk ratio = 0.86; P = 0.05). However, no significant improvement was observed in functional recovery or infarct size. The frequency of adverse events was comparable between the nerinetide and placebo groups, with minimal variability.Conclusion:Nerinetide may slightly reduce mortality in AIS, particularly among patients not treated with alteplase. Although functional outcomes did not significantly improve, its favorable safety profile and potential neuroprotective effect support further investigation in larger clinical trials.

Introduction and importance:Renal malrotation is an uncommon congenital anatomical variation presents with various clinical manifestations; renal malrotations types include: incomplete rotation, reverse rotation, hyperrotation, and nonrotation. Renal malrotation along the sagittal plane, with the kidney’s long axis positioned horizontally, represents an exceptionally rare phenomenon, with only three documented cases worldwide.Case presentation:A 45-year-old man with left-sided loin pain arrived at the urology clinic. Non-contrast computed tomography (CT) findings: few calculi in the lower calyx, a massive mid-zonal renal cyst that measured around 8 × 8 × 9 cm, and a sagittally malrotated kidney along its horizontal axis, which was a sign of an acquired ailment rather than a congenital defect.Clinical Discussion:Most cases of renal malrotation are identified incidentally during imaging studies, such as CT scans, which are often performed for unrelated reasons, including low back pain, urinary tract infections, or hematuria.Malrotation is often associated with other renal abnormalities, such as ectopia, horseshoe kidney, or other renal anomalies.Conclusion:Malrotated kidneys are uncommon and frequently discovered by accident, particularly those with a horizontal axis in the retroperitoneal space.

Objective:To synthesize recent advancements in metastatic spinal cord compression (MSCC) treatment, evaluating their efficacy in improving neurological function, pain relief, survival, and quality of life.Background:MSCC is an oncologic emergency caused by the progression of cancer to the spine and is prevalent in approximately 3–5% of all cancer patients, with a relatively higher incidence of breast, prostate, and lung cancers. MSCC can lead to irreversible paralysis due to loss of vital sensory and motor functions, thus requiring an immediate diagnosis and treatment.Methods:A systematic PubMed search identified studies published over the past 5 years focusing on advancements in MSCC treatment. Applying the PICO criteria, 132 articles were retrieved, of which 38 met the inclusion criteria after rigorous screening.Result:Effective care of MSCC includes high-dose corticosteroids, surgery, and radiation therapy. Advancements such as robot-assisted and minimally invasive surgeries enhance surgical outcomes. Emerging technologies, including deep learning models for early detection and automated MRI analysis, improve diagnostic accuracy. Personalized medicine techniques, such as next-generation sequencing, enable the development of customized therapies tailored to individual tumor characteristics. Innovations such as bioengineered implants provide better imaging compatibility and reduce radiation scattering. Proton therapy delivers targeted radiation with minimal harm to adjacent tissues.Conclusion:Prompt, multimodal treatment is necessary, including corticosteroids, surgery, and radiation therapy to reduce symptoms and enhance patient outcomes. Despite advancements, challenges such as delayed diagnosis and limited access to specialized treatments persist. Precision medicine, artificial intelligence–based diagnostics, and easier access to clinical trials should be the main areas of future development. Preventing irreparable neurological impairments and improving patient quality of life requires a focus on palliative care and early intervention. Integrating innovative therapies with comprehensive supportive care in a patient-centered study is essential for enhancing neurological function, pain control, and overall quality of life.

Late-stage leukemias in older adults present a complex interplay of adverse disease biology, age-related vulnerabilities, and health care system challenges. Aging populations face unique clinical and public health burdens, including frailty, comorbidities, and limited access to specialized care, which complicate standard leukemia management. This narrative review synthesizes current evidence on late-stage acute and chronic leukemias in aging populations, highlighting age-specific biological features, therapeutic options, supportive-care considerations, and integrated care strategies. A structured literature search of PubMed, Scopus, Web of Science, and Google Scholar (2000–2025) was conducted using key terms including “late-stage leukemia,” “elderly AML/ALL/CLL/CML,” “geriatric assessment,” and “integrated care.” Eligible publications included clinical trials, observational studies, reviews, and policy documents focusing on adults aged ≥60 years. Evidence was synthesized narratively to provide an integrative perspective. Late-stage leukemias in older adults are characterized by higher prevalence of adverse genetic profiles, increased treatment-related toxicity, and reduced tolerance to intensive regimens. Age-adapted therapeutic strategies – including hypomethylating agents, targeted therapies, immunotherapies, and tyrosine kinase inhibitors – can improve outcomes when combined with comprehensive geriatric assessment and supportive care. Integrated care models incorporating multidisciplinary teams, early palliative interventions, and patient-centered decision-making optimize functional status, quality of life, and health care utilization. Effective management of late-stage leukemia in older adults requires personalized, multidisciplinary approaches informed by disease biology, geriatric assessment, and patient priorities.