The hip joint is one of the most surgically exposed joints in the body. The indications for surgical exposure are numerous ranging from simple procedures such as arthrotomy for joint drainage in infection to complex procedures like revised total hip replacement. Tissue dissections based on sound knowledge of anatomic orientations is essential for best surgical outcomes. In this review, the anatomical basis for the various approaches to the hip is presented. Systematic review of the literature was done by using PubMed, Cochrane, Embase, OVID, and Google databases. Out of the initial 150 articles selected from the the review and selection criteria, only 37 that suited the study were eventually used. Selected articles included case reports, clinical trials, review and research reports. Each of these approaches has various modifications that seek to correct certain difficulties or problems encountered with previous descriptions. An ideal approach for a procedure should be safe and provide satisfactory exposure of the joint. It should avoid bone and soft tissue damage as well as avoid unnecessary devascularization. Among the factors that determine the choice of surgical approach to the hip are the indication for the procedure; the influence of previous surgical incisions as well as the personal preferences and training of the operating surgeon.

Introduction:The incidence of acute mastoiditis, a common complication of otitis media, has significantly decreased with the emergence of antibiotic therapy [1]. Classical symptoms of acute mastoiditis include fever, irritability, otalgia, swelling of the mastoid area, and retroauricular erythema [2]. Delay in appropriate antibiotic treatment of mastoiditis may lead to intracranial and extracranial complications. Facial nerve paralysis is a rare complication of otomastoiditis with different pathophysiologic mechanisms postulated [3]. Extensive literature search showed cases of lower motor neuron involvement of the facial nerve in affected patients. We report an unusual case of mastoiditis without fever complicated by epidural abscess and upper motor neuron facial nerve palsy in a previously healthy adolescent.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 100 million people so far globally with few cases of reinfection reported [1,2]. Most people with coronavirus disease 2019 (COVID-19) develop antibodies after resolution of acute infection, however the exact duration of these antibodies and the extent to which it may indicate a protective immunity to SARS-CoV-2 in humans is unknown [2,3]. We report an unusual case of probable asymptomatic reinfection with SARS-CoV-2 while still having antibodies present.Case Presentation: A 39-year-old healthy female healthcare professional in New York City had severe myalgia, generalized body weakness, cough, and subjective fever (maximum axillary temperature 99.8F) in March of 2020. The patient was not tested for COVID-19 initially because there was no documentation of fever ≥100F and restriction of testing due to limited availability. Conservative management with analgesics and hydration was done and symptoms subsided after 7 days. One week later (April 2020), multiple family members became sick with COVID-like symptoms and tested positive to SARS-CoV-2 by polymerase chain reaction (PCR). Patient was then screened with SARS-CoV-2 RT-PCR (Roche Cobas 6800) due to close household contact and was positive. Routine COVID-19 antibody testing (Roche Cobas Elecsys) offered to hospital staff on a voluntary basis a month later and again 4 months later (September 2020) during annual employee health screening were both positive. In January 2021, the patient was tested due to mandatory return-to-work screening after out-of-state travel and was found to be positive by both PCR and antibody (Table 1). At that time, patient was completely asymptomatic but was required to quarantine. Six days later, she repeated both tests in an urgent care facility at which time SARS-CoV-2 RNA PCR (Roche Cobas) was negative while the IgG antibodies (Abbott Alinity i) remained positive. A respiratory viral panel for SARS-CoV-2 RNA PCR and influenza A and B (Roche Cobas) done three weeks later as part of the prerequisites for clinical rotation in a different hospital was also negative. Conclusion:The asymptomatic index case had antibodies at the time she re-tested positive to SARS-CoV-2 10 months after first testing positive. This may be a case of re-infection in which the presence of antibodies kept the patient symptom-free. Less likely, she may have been carrying viral particles in her nose for 10 months as there JOY EKEZIE

Introduction: Malignant brain tumors in childhood occur less frequently than nonmalignant ones and glioblastoma multiforme has been identified as the most common and aggressive [1]. These tumors usually present with typical neurologic symptoms including signs of raised intracranial pressure [2]. The case study describes an atypical presentation of glioblastoma in a previously healthy adolescent male with several distractors that could have led to a delay in diagnosis. This highlights the need to have a high index of suspicion for serious underlying illness when managing pediatric patients presenting with apparently trivial symptoms.Case Presentation: A 15-year-old previously healthy adolescent male presented with a 2-week history of non-projectile, non-bilious, non-bloody vomiting, usually postprandial, about 4-5 episodes per day. He had associated periumbilical pain, burning sensation during voiding, chills, poor feeding, weakness, and weight loss. Physical examination was significant for dry mouth and generalized abdominal tenderness. He was initially managed with famotidine and polyethylene glycol in the pediatrician's clinic prior to presentation in the ED for persistent symptoms. Results of investigations, including complete blood count, complete metabolic panel, urine analysis, culture, and toxicology were unremarkable. He tested positive for Influenza A and Respiratory Syncytial Virus. Abdominal x-ray was suggestive of constipation. On admission, he received intravenous fluids, pantoprazole, famotidine, and oseltamivir with some improvement in symptoms. On day 2, he complained of throat pain and intermittent low intensity bitemporal headache rated 5/10 which subsided with acetaminophen. On day 3, urinary and fecal incontinence were noted. Additional history of recent travel to Ecuador and prolonged contact with a family member with gastrointestinal tuberculosis was obtained so Quantiferon Gold was sent. Psychiatry was consulted because of his flat affect and poor communication and assessment of adjustment disorder from medical illness was made. On day 4 of admission, neurologic exam revealed significant neck stiffness and suspicion of left abducens nerve palsy. Urgent brain computed tomography scan without contrast showed a large slightly hyperdense mass centered within the left frontal lobe that appeared to cross the anterior corpus callosum and measured roughly 7.6 × 5.8 × 4.3 cm (Figure 1). The patient was transferred to the JOY EKEZIE RASHEEDAT FAWOLE SAVITA MANWANI

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