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Mycobacteriumchelonae is one of the rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infections have been reported associated with tattoo parlours, pedicures and cosmetic procedures. But disseminated infection is usually associated with individuals who are immunocompromised, predominantly affecting limbs but sparing abdomen and back. We herein present a case where patient was on immunosuppressive therapy and developed locally severe infection around right ankle. A 69-year-old woman known to rheumatology presents in outpatients with severe pain in right ankle, unable to bear weight, oedematous right foot and lower leg. There was extensive erythematous cellulitic skin rash around right ankle and lower leg. She had background history of systemic lupus erythematosus with previous history of cardiac myositis and left foot drop. She had six cycles of cyclophosphamide for flare of lupus and after last cycle developed this presentation. Skin biopsy was arranged with dermatologist, cultures from which grew M.chelonae. She was admitted and started on triple regimen for M.chelonae as per Microbiology guidelines with intention to complete 6–12 months treatment. Patient responded very well to treatment but unfortunately, she died after 5 months on treatment due to other comorbidities and likely cause of death was cardiac arrhythmia.

Background: Postoperative hypocalcaemia, secondary to hypoparathyroidism, is the most common complication observed in patients who undergo bilateral thyroid resection. Although hypocalcaemia is self-limiting in most patients and does not require treatment, symptomatic hypocalcemia is of concern. The aim of this research was to identify PTH-24h post-operatively as a simple predictor of early postoperative hypocalcemia following total thyroidectomy for simple multi-nodular goiter.Methods: Fifty patients undergoing total thyroidectomy for simple multi-nodular goiter were included in a prospective controlled study with follow up of 48 hours postoperatively for the development of hypocalcemia both clinically and biochemically correlating it to the level of serum iPTH thus allocating patients in two groups; those who developed hypocalcemia (whether clinically or biochemically) and those who didn`t.Results: A highly significant difference between PTH percent of decline was noted for the patients who developed biochemical hypocalcaemia and those who did not. Conclusion:Serum PTH 24-h after total thyroidectomy is a reliable early predictor of hypocalcemia.

The emergency intervention for acute malignant left-sided colonic obstruction remains controversial. Conflicting reports exist regarding the efficacy and safety of endoscopic placement of self-expandable metallic stents (SEMS) vs. primary surgery. Most reports focus on SEMS insertion as a bridge to surgery.Methods: An observational nonrandomized study at a single center in Cairo, Egypt included 65 highrisk patients (American Society of Anesthesiologists physical status classification ≥ III, age > 60 years) with acute malignant metastatic (stage IV) colonic obstruction. Twenty-nine patients underwent primary surgery (Hartmann's procedure, HP), and 35 patients underwent SEMS insertion.Results: All cases that underwent SEMS insertion were technically successful. The 2 procedures were comparable in clinical success rates but a statistically significant difference existed between them regarding the duration of postoperative hospital stay in the HP and SEMS group (7.7 ± 3.1 days vs. 3.5 ± 0.6 days, retrospectively; P < 0.001), the interval before regaining oral feeding (41.8 ± 26.8 hours vs. 27.6 ± 18.5 hours, retrospectively; P = 0.015), and the duration of intensive care unit (ICU) admission (5.0 ± 1.7 days vs. 1.5 ± 0.7 days, retrospectively; P = 0.035). Six patients (20.7%) in the HP group and 2 patients (5.7%) in the SEMS group required postoperative ICU admission. Conclusion:SEMS placement provides comparable efficacy and safety to HP in managing acute malignant obstruction of the rectosigmoid region in high-risk individuals, with faster recovery and less hospital and ICU admission time.

Background: Gastroesophageal reflux disease (GERD) is considered to be one of the most prevalent diseases of the gastrointestinal system all over the world. One of the major risk factors of GERD is morbid obesity. During the last decade, the prevalence of obesity has increased significantly around the world. Many studies have suggested the association between obesity and GERD symptoms. The effect of weight loss on decreasing the incidence and severity of GERD symptoms was found to be significant, and weight loss is considered to be one of the most important lines in managing GERD symptoms. Aim:We aim to compare between the use of laparoscopic Sleeve Gastrectomy and Roux-en-Y gastric bypass in the Management of morbid obese patients with Gastroesophageal Reflux Disease GERD) and decide which approach is associated with the best short and long term effects on the prevalence and symptoms of Gastroesophageal reflux disease (GERD). Patients and methods:A retrospective study is conducted in Ain Shams University Surgery Hospital during the period between March 2014 and July 2018. We included patients with Gastroesophageal reflux disease (GERD) to undergo bariatric surgery (RYGB vs Sleeve gastrectomy) in our hospital including a body mass index of more than 35 kg/m 2 , aged between 18 and 65, with one or more co-morbidity and with failure of conservative treatment of obesity over a period of more than 2 years. We excluded patients with general contraindications to abdominal surgery, patients with grade 3 or 4 Gastroesophageal reflux disease (GERD), patients with Large size Hiatal hernias (more than 2 cm), patients with history of previous major abdominal operations and patient with inflammatory bowel disease.Results: A total number of 110 patients have been enrolled in our study. Both groups were similar in terms of age, sex, weight, average BMI and other co-morbidities such as diabetes, hypertension and dyslipidemia. The changes in GERD score were significantly higher in the LRYGB patients (56.5%) compared to (41%) in the LSG group. Patients, mostly in LSG group, experienced worsening of the GERD symptoms. Conclusion:Both the most common bariatric surgery procedures were associated with improved GERD symptoms. We consider the Roux-en-Y gastric bypass to be the superior operation technique in improving GERD symptoms. Sleeve gastrectomy was associated with more de-novo GERD symptoms development. Some recent guidelines consider having a preoperative GERD symptom to be a contraindication to performing sleeve gastrectomy.