Congenital anatomical anomalies of the lumbosacral nerve root are a rare condition. Various types of anomalies of the lumbosacral nerve roots have been described in the literature. Undiagnosed lumbosacral nerve root anomalies are at risk for iatrogenic injury, may contribute to wrong-site surgery, and contribute to continued postoperative symptoms. Here, we present the case of a 45-year-old female with discogenic back pain and L5 radiculopathy who found to have a duplicated left L5 nerve root intraoperatively.

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Coronary artery disease (CAD) or alternatively called atherosclerosis is the leading cause of death worldwide. There are multiple cardiovascular disease risk factors (CVDRFs), which are the precursors for CAD. A chronic inflammation prompted by cholesterol-rich lipoproteins and other noxious CVDRF is central in the pathogenesis of CAD. Endothelial dysfunction is the first step in the development of CAD. There are many theories in the development of the atherosclerotic process such as the hygiene theory, genetic susceptibility, and the endothelial injury. For the modification and management of CVDRF, the disturbances in lipid and glucose metabolism, hypertension, obesity, and smoking are the most important targets. The main aim of both primordial and primary preventions is to prevent the first cardiovascular event rather than preventing the further myocardial infarction. The prevention should be considered and started early in childhood and not after the first cardiac event. The primary healthcare physicians, obstetricians, neonatologists, and pediatricians need to work together on prevention of CAD early in life and as early as in fetal life.

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Context: During the month of Ramadan, healthy Muslims must fast from dawn until sunset. However, religious rulings dispense the sick from this duty. During the fast, diabetic patients, are predisposed because of their disease, to an increased risk of hypoglycemia, loss of diabetes control, dehydration especially in summer and thromboembolic complications. Objectives: In order to better categorize the indications for the fasting of the month of Ramadan by people with type 2 diabetes mellitus (T2DM), we studied the effects of fasting on clinical; and biological parameters, dietary behavior, and physical activity. Subjects and Methods: We conducted an observational, descriptive, comparative study of patients with T2DM and 16 age- and sex-matched controls. Results: The average age of patients was 52 ± 4 years, and the mean duration of diabetes was 7 ± 4 years. The fasting did not seem to affect the anthropometric parameters and the glycemic control. For the lipid profile, fasting significantly increased high-density lipoprotein-cholesterol (P = 0.004), total cholesterol (P = 0.001) and triglycerides (P = 0.04). Dietary intake decreased from 54% before Ramadan to 47% in Ramadan (P = 0.001), and the intake of lipids increased from 27% to 37% during Ramadan (P = 0.001), in particular, the intake of polyunsaturated fatty acids, which doubled between the two periods (P = 0.009). Physical activity also showed a significant increase in patients and controls combined, essentially represented by the prayer of Tarawih. Conclusions: The Ramadan fast is well tolerated by T2DM patients, treated by diet or oral antidiabetic medications. They can stay free from serious complications, through regular medical support and self-monitoring. However, it is necessary for patients allowed to fast by their physician, to ensure a proper nutrition and obtain diabetes education.

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Background: Ureteropelvic junction obstruction (UPJO) is an obstruction of urine flow from the renal pelvis to the ureter. This condition can be caused by congenital and acquired due to intrinsic or extrinsic factors. UPJO due to acquired conditions such as secondary to inflammation, passage stones, or ureteric folds is less common. In case of suspected UPJO, the critical decision to be made depends on the correlation between the radiologic findings and the physiologic picture. There have been recent and serious trials to perform the surgical repair of UPJO without intubation, with reservation of double J (DJ) stents and nephrostomy tubes for complex cases. The Aim of Study: The aim of the study was a comparison of the time of drain removal, hospital stay, complications, and the end result of surgery in intubated and nonintubated UPJO repair. Patients and Methods: A retrospective case serious study performed in Urological Departments at Benghazi Medical Center and Al-Hawari Urology Center by reviewing 51 files of consecutive patients of UPJO admitted to the department of urology from May 2010 to 2015. All patients were diagnosed using different diagnostic tools. Forty-three cases underwent reconstructive surgeries as follows: 41 (95.3%) patients underwent Anderson-Hynes-dismembered (A-H-D) pyeloplasties and 2 (4.7%) patients underwent VY Foley pyeloplasties. Out of 41 cases underwent A-H-D pyeloplasties, there were six cases underwent concomitant pyelolithotomy. Results: The time of removal percutaneous perinephric tube drain was 7^th to 9^th postoperative days and 7.9 ± 0.5 days. The postoperative hospital stay for all cases range from 7 days to 10 days and the mean was 8.0 ± 0.8 days. Conclusions: Despite both intubated and nonintubated techniques of UPJO repair are comparable regarding the hospital stay postoperative complication, the tubeless surgical repair of UPJO is more suitable for children and superior to the intubated technique regarding the cost of DJ stent and nephrectomy tube.

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Background: The use of central venous catheters is essential in hemodialysis care, but it is associated with infectious and thrombotic complications. The aim of this study is to determine rates and risk factors of hemodialysis catheter-related bacteremia and thrombotic complications from a Moroccan single center to set prevention policies. Materials and Methods: The trial was designed as a prospective observational study including all patients who required a temporary hemodialysis catheter more than 48 h. Baseline demographic and clinical data including age, sex, causes of kidney failure, comorbidities, indication for insertion, catheter insertion sites, and duration of use were collected. Patients were followed up since the insertion of catheter to its removal. Results: A total of 126 hemodialysis catheters were inserted at different sites in 93 patients for the following reasons: the absence of vascular access in patients with end-stage renal disease in 55 cases (43.65%), vascular access dysfunction or infection in 45 cases (35.71%), and acute kidney injury in 26 (20.63%). During follow-up, 15 catheters (11.9%) were complicated by bacteremia, resulting in a rate of 6.68 per 1000 catheter days. Risk factors associated with catheter-related bacteremia were diabetes (odds ratio [OR] =26.018; P = 0.017) and advanced age (OR = 1.105; P = 0.045). Causative microorganisms were dominated by coagulase-negative staphylococci in 46.66%. Twenty-four thrombotic complications (19.04%) were documented with an incidence of 10.69/1000 catheter-days. Among these complications, 18 were dysfunction of catheter (14.28%, 8.01/1000 catheter-days) and 6 were vein thrombosis (4.76%, 2.67/1000 catheter-days). Lower serum albumin levels was the unique risk factor (OR = 0.801; P = 0.042). Conclusions: Early diagnosis of chronic kidney disease and creation of arteriovenous fistula may lower the incidence of catheter use in hemodialysis.

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Pancreatic divisum is a congenital anomaly of the pancreatic ductal system wherein the dorsal duct system fails to fuse with ventral ductal system and results in the major pancreatic drainage through the minor duodenal papilla and minor drainage through the major duodenal papilla. It is a rare cause of recurrent pancreatitis.

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Airway foreign body aspiration is more common in younger children of <3 years of age; it commonly affects the right bronchus and is often characterized by sudden onset of coughing, choking, and difficulty in breathing. We report a case of a 6-year-old girl who presented with fever, cough, and difficulty in breathing who never had any preceding episode or witnessed choking or gagging event, she was diagnosed of pneumonia, and a chest X-ray revealed a left bronchial foreign body. She had bronchoscopy and the foreign body was removed successfully.

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