Search

Patients with angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema (ACEIIA) may visit family physicians. The aim of this article was to describe a case of delayed-onset ACEIIA and to present a concise scoping review. Using a case report and a scoping review study design, we report a case of ACEIIA, with clinically confirmed diagnosis. The symptoms resolved after replacing the offending ACEI with another antihypertensive agent. After excluding other causes of perioral swelling and discontinuation of ACEI, the patient was symptom-free within a few days thereafter. Based on this case presentation, we performed a meta-narrative scoping review including up-todate diagnosis and management of ACEIIA, based on published data in English, French, and German from inception to April 1, 2021. Patients with angioedema of unknown origin should be cautiously examined to rule out oral diseases, including allergy to dental materials and drug-induced angioedema. Clinicopathological aspects and current treatment guidelines for ACEI-associated angioedema are also presented.

Objective Intra-procedural WEB device migration is a scarcely reported complication that necessitates prompt intervention. Case Presentation Endovascular treatment of two broad necked flow-related aneurysms was planned aided by WEB-SL (Woven EndoBridge-single layer) devices in a 71-year-old female with known left temporal arteriovenous malformation. Inadvertent distal migration occurred while performing a control angiogram with an automated iodine injector. Immediate retrieval was successfully performed using a Solitaire stent-retriever. Conclusion To our knowledge, we report for the first time the successful retrieval of a distally migrated WEB using a stent-retriever device.

Solitary fibrous tumours (SFTs) are a rare mesenchymal neoplasm with an incidence of 2.8 per 100 000 of which only 1% occur in the female genital tract. Doege-Potter syndrome is a paraneoplastic phenomenon associated with approximately 5%–10% of SFTs and is characterised by non-islet cell hypoglycaemia due to tumour production of low molecular weight insulin-like growth factor-II. We present the fourth confirmed case of female pelvic SFT with Doege-Potter syndrome and a literature review.

Purpose To present a surgical technique and case presentation of internal chandelier-assisted macular buckling for myopic foveoschisis. Methods Review of patient clinical features, visual-acuity and optical coherence tomography (OCT) results following internal chandelier-assisted macular buckling for myopic foveoschisis. Results A 48-year-old highly myopic female (axial length 29.85mm) underwent internal chandelier-assisted macular buckling for myopic foveoschisis with macular detachment. The best-corrected visual acuity improved from 20/150 to 20/40. Post-operative OCT confirmed central buckle positioning and demonstrated resolved foveoschisis and macular detachment. There were no complications. Conclusions Internal chandelier-assisted macular buckling is a valuable tool to optimize buckle position and patient outcomes.

Background: Dealing with the COVID-19 pandemic has been one of the most important objectives of many countries.Intently observing the growth dynamics of the cases is one way to accomplish the solution for the pandemic. Introduction: Infectious diseases are caused by a micro-organism/virus from another person or an animal. It causes difficulty at both the individual and collective levels. The ongoing episode of COVID-19 ailment, brought about by the new coronavirus first detected in Wuhan, China, and its quick spread far and wide revived the consideration of the world towards the impact of such plagues on an individual’s everyday existence. We suggested that a basic structure be developed to work with the progressive examination of the development rate (cases/day) and development speed (cases/day2) of COVID-19 cases. Methods: We attempt to exploit the effectiveness of advanced deep learning algorithms to predict the growth of infectious diseases based on time series data and classification based on symptoms text data and X-ray image data. The goal is to identify the nature of the phenomenon represented by the sequence of observations and forecasting. Results: We concluded that our good habits and healthy lifestyle prevent the risk of COVID-19. We observed that by simply using masks in our daily lives, we could flatten the curve of increasing cases.Limiting human mobility resulted in a significant decrease in the development speed within a few days, a deceleration within two weeks, and a close to fixed development within six weeks. Conclusion: These outcomes authenticate that mass social isolation is a profoundly viable measure against the spread of SARS-CoV-2, as recently recommended. Aside from the research of country- by-country predominance, the proposed structure is useful for city, state, district, and discretionary region information, serving as a resource for screening COVID-19 cases in the area.

Background: We report a case of a 23-year-old man with a solitary fibrous tumor of the great omentum who presented clinically as a case of dull abdominal pain. Case Presentation: Solitary fibrous tumor normally occurs in the visceral pleura. Extrathoracic solitary fibrous tumor is rare, especially those from the great omentum, with approximately 31 cases reported in the literature. Conclusion: After reviewing and summarizing the imaging findings of 31 cases of solitary fibrous tumor of the greater omentum, we considered that the characteristic findings can provide a reliable basis for preoperative diagnosis.

Background: Ritual circumcision is a custom. But, when it is done by inexperienced person, it may cause painful situation for parents. Case Presentation: We are presenting a case of ritual circumcision done by inexperienced person. Complete amputation of glans was occurred during circumcision. That was very painful situation for parents. Conclusion: To avoid such complication circumcision should be done by experienced medical practitioner or training should be provided to the persons who are doing ritual circumcision. Keywords: Circumcision, Glans penis, Ritual circumcision, Penile amputation

Objective At present, neither the American College of Surgeons (ACS) nor the Society for Vascular Surgery (SVS) provides curriculum recommendations for medical students rotating on a vascular surgery service. We sent a targeted needs assessment to vascular surgeons across the country in order to investigate the need for a structured curriculum for medical students participating in a vascular surgery rotation during their clinical clerkships. Methods The survey was developed with input from medical students, vascular surgeons, and medical educators. Respondents were identified from the Fellowship and Residency Electronic Interactive Database (FREIDA). The needs assessment was sent to program directors of vascular residencies and fellowships and to other vascular surgery educators. The survey collected data regarding the existing vascular surgery curriculum at the respondent's institution, the need for a standardized curriculum, desired experiences for medical students, and important vascular topics for medical students to cover while on rotation. Results Responses were obtained from 50 of the 146 surveyed individuals (response rate = 34.2%). Forty-eight respondents (96%) worked in an academic hospital or academic affiliated hospital. With regard to the existing vascular surgery curriculum, only twenty-eight respondents (61%) indicated that they had a curriculum approved by the surgery clerkship director. Thirty-seven respondents (77.1%) said there were at least goals and objectives for students on the vascular surgery service, and 29 respondents (60.4%) indicated that there was dedicated time for didactic sessions. Only 17 respondents (35.4%) indicated students gave a case presentation on the service. Twenty-nine respondents (63%) agreed or strongly agreed that there should be a standardized vascular curriculum for medical students. When asked to rank nine topics from most important to least important for students to learn, respondents ranked peripheral arterial disease, aortic disease, and carotid disease highest. Simulation experience was most frequently indicated as a desired addition to the curriculum, and only 16 respondents (33.3%) reported opportunities for vascular surgery specific simulation experiences. Conclusions This study identified the lack of an existing structured curriculum for medical students, the desire for a standardized curriculum, and key topics and experiences that are felt to be important for students to cover. With this information in hand, vascular educators have the potential to enhance the learning experience of medical students rotating through the service by developing a standardized curriculum.

Carnitine palmitoyltransferase-II deficiency, an autosomal recessive disorder, is the most common cause of recurrent rhabdomyolysis in adults. Recognition and avoidance of triggers, such as heavy exercise and stress, is key in prevention of further episodes; however, even with preventative measures, many patients will continue to experience periodic symptoms, including rhabdomyolysis. Avoidance of renal failure, correction of electrolyte disturbances and halting further muscle breakdown are the goals of treatment. It is essential for clinicians to recognize the signs and symptoms of acute disease in CPT-II deficiency. We present a case of recurrent rhabdomyolysis requiring hospitalization in a patient with CPT-II deficiency and review the literature for common clinical manifestations, diagnostics, and treatment strategies.

Objectives Plaque psoriasis is very embarrassing condition of skin as it produces itchy rashes and scaly lesions which may not respond well to the treatment. It can be correlated with Kitibhakushta which is one among the 18 types of Kushta (skin diseases). Several corticosteroids for skin applications are used now a day’s which gives only temporary relief. Case presentation A 36 years old moderate built male patient complains of blackish skin rashes with itching, pain and scaling all over the body for three months. Based on the symptoms, Dosha (Biological humors) involved were assessed as Kapha (binding factors) and Vata (vital force of life) and suggestive of Kitibhakushta. Diagnosis of the Plaque psoriasis was further confirmed by biopsy. Classical Kushta treatment was adopted here. As Poorvakarma (pre-operative procedures), Rukshana (Dehydrating therapy) was done and then Snehapana (intake of medicated ghee) was administered. Then classical Vamana (emetic therapy) and Virechana (purgative therapy) were performed. This took almost one month. After Samsarjana (special diet) patient was administered Manibhadragula as Shodhana Rasayana for a period of one month. At the end of Manibhadragula intake, remarkable changes were observed in all the symptoms. There were significant changes seen in PASI, DLQI and photographs taken before and after treatment. Conclusions Here the special mode of administration of Manibhadragula as mentioned in Ashtanga Hridaya helps for Shodhana and the Shodhana itself has Rasayana action. Drugs also have Rasayana property. This made the authors to propose a new concept called Shodhana Rasayana. Classical treatment by considering the condition of Roga (disease) and Rogi (patient) helps for management of Kushta.

Background. Mucormycosis is a rare and invasive fungal infection, affecting almost exclusively immunocompromised individuals. Immunosuppressive effects of corticosteroids which are widely prescribed in COVID-19 patients might be a predisposing factor for opportunistic infections even though the other factors should also be considered. Case Presentation. A middle-aged man without any significant past medical history was admitted to the hospital due to a severe COVID-19 infection. He received a high dose of corticosteroids as a part of the treatment. Five days after discharge, he presents with a headache and fever. Eventually, orbital mucormycosis was diagnosed for him and he was treated with antifungal medications. Conclusion. Opportunistic infections should be considered during the current pandemic of COVID-19, during which corticosteroids are widely prescribed.

BACKGROUND: Drowning is one type of asphyxia caused by the entry of fluid into the airway. Death due to drowning is one of the hardest things that are difficult to diagnose in the field of forensic medicine, primarily if the victim found to be in a decomposed state. The state of decomposed examination often does not show typical signs. The diagnosis of drowning can be reached after considering all the results of the forensic examination including external, internal, and laboratory examinations. CASE PRESENTATION: A body has been found in the residential area on the east side of the beach, Tambaksarioso Village, Asemrowo District, on Tuesday, May 18, 2021, at 13.30 West Indonesian Time and reported to the police for investigation. The body was then identified at Dr. Soetomo General Hospital by a forensic expert. External, internal, and laboratory investigations were conducted. On external examination, the corpse was not intact, with signs of decay, saponification, and violation. In an internal examination, sand in the airways and other signs of drowning were identified. In the acid destruction test using the right femur, a positive diatom result was obtained. CONCLUSION: A complete autopsy is vital to determine the cause and mechanism of death, reconstruct the events before death, and identify the victim. It is also essential to determine whether the deceased died by drowning was alive before entering the water. All injuries suffered by the victims should be described.

Introduction Vertical ridge augmentation (VRA) is one of the most challenging procedures. This is the first case report to show 2-5 mm VRA after two unsuccessful GBRs around previously placed dental implants, with the use of an exposed d-PTFE membrane. Case presentation A 79-year-old ASA II Caucasian male presented after two previous GBR procedures on the LLQ. The second attempt left the site with two exposed implants, scar tissue, no keratinized tissue and lack of vestibular depth. VRA was attempted with the use of cortical perforations, tenting screws, dense PTFE membrane and a 50:50 mixture of anorganic bovine bone matrix and mineralized allograft. The site was left to heal in a secondary intention, leaving the d-PTFE membrane exposed. The membrane was removed 4 weeks postoperatively. The healing abutments were placed, the tenting screws were removed, and the site was allowed to heal for more than seven months. Radiographically, VRA was achieved ranging from 2 to 5 mm. A vestibuloplasty was performed using a diode laser and subsequent flap dissection. Four months after the vestibuloplasty, the tissue surrounding the implants showed adequate keratinization, and an elongated vestibular depth. In addition, in both implants, the emergence profile buccal and lingual was more than 3 mm and the patient was referred to his prosthodontist for the fabrication of the final restorations. Conclusions VRA around dental implants was achieved with the use of a nonresorbable dense PTFE membrane, which was left exposed to heal in a secondary intention, tenting screws and a combination grafting technique to correct two previously failed GBRs.

Introduction: Patellar injuries are usually caused while a person slips or falls on a flexed knee and when the forces from the extensors surpass the inherent strength of patella. As the bony failure advances, it concurs or follows injury to medial and lateral extensions of quadriceps mechanism. This happens by pulling mechanism of the muscles. The patient is unable to extend the affected knee actively. This is indicative of disruption of the extensor mechanism and a torn retinaculum. This requires repair or reconstruction through operative means. Case Presentation: To find out complications of comminuted fracture of patella and open reduction after 15 years of surgery. Case Report: A 32-year-old man had a history of fall on ground due to slipping of the wheelchair over wet floor while taking a patient on wheelchair which led to comminuted fracture of left patella with shift knee and had undergone Open reduction and Tension band Osteosynthesis. After this surgical intervention, the patient presented with knee stiffness and pain (rated 6 on numerical pain rating scale) and was referred to physiotherapy. Conclusion: This case study concluded that there is evident stiffness and muscle wasting observed after 15 years of post-fracture surgery of patella, which was managed with the physiotherapeutic rehabilitations.

Introduction Pain and instability following an anterior cruciate ligament (ACL) reconstruction remain a significant issue. Common causes include infection and inflammation, and mechanical issues such as graft failure. Case Presentation A 36-year-old male with an ACL reconstruction six years prior was admitted due to pain and swelling. The ACL graft that had ruptured was found arthroscopically. Numerous gout crystals and tophus were observed inside. This finding is suggested as a cause of this kind of complication. Discussion Biological failure is one of the causes of graft failure. Gout arthritis is associated with internal derangement of the joint structures, which is reported in advanced case. Conclusion Severe gouty arthritis, even though rare, could be an etiology of graft failure following ACL reconstruction and cause significant morbidity.

Case Presentation A 51-year-old White male never-smoker presented with intermittent cough and progressive dyspnea. His symptoms started after an exposure to bat guano while cleaning his attic approximately 9 months earlier. He has received several courses of antibiotic and corticosteroid for these symptoms, with short-term relief.

Optic neuritis presents as an acute or subacute inflammatory episode. Objective: Describe the clinical-epidemiological characteristics in 7 cases with unilateral optic neuritis and evaluate the therapeutic results obtained. Material and method: A series of cases with a diagnosis of unilateral optic neuritis who attended the Neurophthalmology consultation at the Hermanos Ameijeiras Hospital in Havana, Cuba, from August 6 to November 16, 2018, from Havana and Matanzas, were studied. An unusual increase in the incidence of NO was recorded in the period analyzed. Results: An unusual increase in the incidence of unilateral optic neuritis was recorded. The average age was 33.5 years. All reported unilateral painless visual loss. Four patients reported general signs and symptoms suggestive of having suffered a respiratory disease of viral origin, between 7 and 15 days before optic neuritis. In the examination carried out, great impairment of visual acuity (≤0.05) and colors (0/21) was found. The centro-caecal scotoma was the most frequent campimetric defect. Optical Coherence Tomography (OCT) in the affected eye showed increased neuroretinal thickness, decreased nerve fiber layer, and ganglion cell damage. Treatment was with intravenous methylprednisolone and B vitamins. Conclusions: An unusual increase in patients with unilateral optic neuritis was observed. The OCT revealed damage to the structures at the level of the retina and the optic nerve. The therapeutic effectiveness was conditioned by the time of evolution of the neuritis.

CASE PRESENTATION We report three cases of vitamin B12 and/or folic acid deficiencies presenting with non-immune hemolytic anemia and thrombocytopenia. This presentation, with features of a thrombotic microangiopathy (TMA), has earlier been described as 'pseudo-TMA'.

Introduction: The most severe autoimmune subepidermal blistering condition of the skin and mucous membranes is bullous pemphigoid (BP). In Europe, it is estimated to affect 1 in every 4,000 people. Currently incidence range between 2-22/1,000,000 worldwide. It primarily affects the elderly and is diagnosed using clinical, histologic, and immunologic criteria. Clinically, it appears as diffuse eczematous, pruritic, urticaria-like lesions with the later emergence of tense bullae or blistering lesions filled with clear fluid. Case Presentation: Here, we report a case of a 50- years old female patient with a complaint of itchy lesions with wounds all over the body present with an 8-month of history. A subepidermal blister with eosinophils and neutrophils infiltration was discovered on histopathological evaluation. Salt-split indirect immunofluorescence revealed linear deposition of IgG at the dermo-epidermal junction. On further investigation, using diagnostic and Interventional aids a final diagnosis of Bullous pemphigoid.

SWYER-JAMES-MACLEOD SYNDROME (SJMS) is a rare pulmonary disorder that manifests as unilateral hyperlucent lung. HRCT is a novel imaging modality to diagnose SJMS since Chest radiographs underestimate this condition. We report a case presentation of SJMS in a 54-year-old male and treated with bronchodilators and i.v antibiotics. In conclusion, only a few with SJMS in adulthood has been reported worldwide.

OBTURATOR HERNIA is a rare condition of pelvic hernia in which abdominal contents protrude through the obturator canal. This condition can lead to bowel obstruction with relatively high mortality and morbidity due to bowel ischemia/gangrene. Most commonly presents in elderly thin females. It is primarily asymptomatic unless there is compression of the obturator nerve. Therefore, obturator hernia in the differential diagnosis of intestinal obstruction of unknown origin. Computed tomography is the modality of choice for preoperative diagnosis as obturator hernia. Sometimes mistakenly diagnosed as femoral or inguinal hernia on Ultrasonography. Its early diagnosis is challenging since the signs and symptoms are non-specific make a preoperative diagnosis difficult. We present a case of obturator hernia in an 81-year-old male with a known prostate carcinoma who presented with a painless soft swelling in the medial aspect of the right upper thigh and a negative Howship-Romberg sign.

Hemiballism is a rare hyperkinetic movement disorder characterized by repetitive, uncontrolled movements unilateral /or bilateral extremities, develops as a result of insult to the contralateral basal ganglia. The leading source for this disorder is ischemia, followed by non-ketotic hyperglycemia with poorly controlled diabetes. Non-ketotic hyperglycemic induced hemichorea-hemiballism is an uncommon but unique etiology of unilateral neuro-parenchymal findings restricted to corpus striatum (caudate nucleus and putamen). Nonketotic hyperglycemia-induced hemichorea-hemiballism diagnosed by Cross-sectional imaging modalities (Computed tomography and Magnetic resonance imaging), Clinical results (hemichorea-hemiballism), Laboratory tests (elevated blood glucose and hemoglobin A1c levels).

Pott's puffy tumor is considered as a rare clinical entity. It is developed as a rare complication of frontal sinusitis. In addition, the trauma to the frontal area is another suggested cause. The Pott's puffy tumor is presented as a forehead swelling due to sub-periosteal collection. Although, the Pott's puffy tumor is a rare condition but at the same time, it can be serious because it may lead to life threatening complications namely, extradural abscess, subdural abscess, meningitis, encephalitis, and brain abscess. Thus, the Pott's puffy tumor is classified as a very significant surgical emergency.

Acquired thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy, affecting preferentially young women in their fourth decade. Intensive care admission is often required due to organ dysfunction development risk and for specific critical care measures (Plasma Exchange-PEX). In this article, we will discuss our experience with PEX in the treatment of TTP. Case report: A previously healthy 13-year-old female presented with neurological impairment, and suspicion of stroke. The head computed tomography (CT) scan revealed absence of acute intracranian pathology, and biological evaluation displayed severe thrombocytopenia and haemolytic anemia. After 24 hours, the neurological symptoms were remitted and suspicion of thrombotic thrombocytopenic purpura was raised. The presence of ADAMTS-13 antibodies and Moschcowitz’s pentad confirmed the diagnosis. Discussions: The distinctiveness of this case lies in the development of the disease in a 13-year-old person, though TTP usually occurs after the age of 40. The exact cause of ADAMTS-13 low activity could not be established. The use of a high dose of steroids and of plasma exchange is considered to be the first line therapy, with the use of monoclonal antibodies in refractory cases, as it was in our case. Conclusions: The primary end points of our management was to prevent organ damage and to achieve a platelet count greater than 150 000 /µL, as well as a normal or an almost normal lactate dehydrogenase. We achieved this by using high dose corticosteroid therapy, filtration of approximately 50 liters of plasma in 14 PEX session and by administration of monoclonal antibodies.

Background Catatonia is a presenting sign for many primary psychiatric disorders but it can also herald medical and neurological conditions. Increasing research has highlighted co-occurrence catatonia and delirium and how this combination warrants a thorough medical workup. Case presentation We present a case of a middle-aged woman with catatonia and delirium secondary to neurosarcoidosis only involving the brain; we document her 30-day hospitalization and intensive medical work-up that eventually revealed isolated neurosarcoidosis. This is the first reported case to our knowledge in the literature of catatonia occurring due to isolated neurosarcoidosis. Conclusion For this patient, albeit with a history of schizophrenia, the presence of delirium pushed the medical team to pursue a comprehensive work up instead of relying on a psychiatric diagnosis as the explanation for her puzzling clinical presentation. This case report supports a paradigm shift for physicians to think of catatonia similar to delirium: A syndrome that results from an underlying condition that must be treated in order to resolve the catatonia.

Introduction: Pheochromocytoma are tumors arising from the chromaffin tissue located in the adrenal medulla, associated with typical symptoms and signs. Case Presentation: Occasionally, metastasis, defined as the presence of tumor cells at sites other than the original site, secondary to pheochromocytoma have been reported. Pelvic metastatic malignant pheochromocytoma has rarely been reported in English literature. Conclusion: Here, we have reported a very rare case of pelvic metastatic malignant pheochromocytoma, with a particular focus on sonoelastographic features.

Introduction Toxoplasmosis is a life‐threatening complication after hematopoietic stem cell transplantation (HSCT). However, for several reasons, clinicians know little about Toxoplasma infection. Case presentation We report a case of toxoplasmosis that was diagnosed by bone marrow smear and metagenomic next‐generation sequencing (mNGS) after HSCT in a boy. Additionally, we summarize the characteristics of toxoplasmosis after pediatric HSCT reported in the literature published in PubMed. Conclusion Clinicians should increase their awareness of toxoplasmosis in children after HSCT and implement pre‐transplant screening and post‐transplant monitoring and prevention in future according to the national conditions of our country.

Background The most common causative pathogen of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) was reported as HHV-6. Although excitotoxic injury with delayed neuronal death is considered to be a possible pathogenesis of AESD, the detailed pathophysiology remains unclear. Case presentation We present a twelve-month-old girl with AESD due to HHV-6 primary infection. She was successfully treated for AESD including targeted temperature management and the administration of vitamin B1, B6, and L-carnitine. Although the viral load of HHV-6 in her liquor was high (12,000 copies/mL), she fully recovered without antiviral agent use. Discussion There has been no study focusing on the HHV-6 viral load in patients with AESD, and only a few case reports have been published. We reviewed the clinical features and viral load in the liquor of our case and four reported infants with AESD due to HHV-6 primary infection who had real-time PCR tests results. Viral loads in the three patients with a poor prognosis were 31.5, negative, and 3,390 copies/mL, respectively. On the other hand, the copy numbers of HHV-6 DNA in the two patients with no sequelae were 12,000 and 106 copies/mL, respectively, and our case had the highest viral load among the five summarized patients.

Purpose. To report a female with a history of Wilson’s disease who underwent a successful photorefractive keratectomy (PRK) for myopic correction. Case Presentation. A twenty-year-old female with a history of Wilson’s disease and D-penicillamine use was referred to our clinic for myopic refractive surgery. Her best-corrected visual acuity (BCVA) was 20/20 for both eyes with a refraction of ‐ 1.25 ‐ 0.5 ∗ 75 ° and ‐ 1.25 ‐ 0.25 ∗ 55 ° for the right and left eyes. The slit examination showed a prominent Kayser-Fleischer ring (K-F ring) in both eyes. She underwent a successful myopic PRK surgery, and her BCVA became 20/20 with no significant refraction. Conclusions. In this report, we report a successful PRK surgery for myopic correction in a case of Wilson’s disease with prominent K-F rings in both eyes.

Objectives Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where sympathetic dysfunction and autonomic dysfunction resulting in parasympathetic over activation with some evidence of sympathetic inhibition have been suggested as probable causes. However, cases of hemicrania continua secondary to sympathetic dysfunction due to neurogenic paravertebral tumor impinging on the sympathetic chain has not been previously reported. In this case, the probability of the sympathetic dysfunction was more likely based on the clinical features and management. Case presentation A 23-year-old female presented with a chief complaint of right unilateral pain in the retro-bulbar, head and facial region for the past three years. An initial MRI of the brain was negative, whereas an MRI of the spine was advised to rule out a cervicogenic origin of the pain. The MRI revealed a well-defined mass lesion within right paravertebral region at T3 indicative of a neurogenic tumor. The patient was diagnosed with probable hemicrania continua secondary to neurogenic tumor impinging on adjacent sympathetic chain. A trial of indomethacin 75 mg/day was advised, which provided complete relief of the headache. The patient was referred to a neurologist for management of the neurogenic tumor. Conclusions Headache disorders may be secondary to pathologies and comprehensive evaluation and accurate diagnosis are essential. Knowledge of neuroanatomy is paramount to understand and explain underlying pathophysiological mechanisms. Multidisciplinary management is essential in complex orofacial cases.

Background. Femur fractures in adolescents are rare. Severe vitamin D deficiency has important implications for bone health. We describe the case of a 13-year-old boy with autism spectrum disorder (ASD) who presented with low-impact bilateral femur fractures in the setting of severe vitamin D deficiency. Case Presentation. A 13-year-old boy with ASD presented with bilateral leg pain after an unwitnessed fall. Laboratory investigations revealed severe hypocalcemia (S. calcium 4.9 mg/dL) and severe vitamin D deficiency (25(OH)D

Renal cell carcinoma accounts 2 % of global cancer diagnoses and death. In Malaysia, its occurrence is found in 1.9 in 100,000 patients and more predominantly in male with ratio male to female of 2.75:1 in 2006. Radical nephrectomy has been proven to give the best chance of cure and long term survival. Throughout the years, conventional open surgery has evolved to single port laparoscopic surgery. It has its own advantages, difficulties and cases selections criteria. We report a successful case of Laparoscopic single port surgery in a renal cell carcinoma patient with underlying prostate carcinoma.

Introduction The traditional techniques of maxillary sinus floor elevation via a direct or indirect approach are suitable for the majority of cases. However, in cases of unfavorable anatomy and/or a thick lateral bony wall, we propose here a new approach for sinus floor elevation. Case presentation Forty-two-year-old female presents for sinus floor elevation after a failed attempt due to anatomical limitations and intraoperative complications. During the second surgical procedure, the access to the sinus membrane was performed from the palatal side due to thickness of the buccal wall ranging from 6 to 9 mm and the presence of septa. The sinus augmentation was successful, allowing for future implant placement. Conclusion In selected cases, when the anatomy of the maxillary sinus poses limitations and the lateral wall thickness requires significant bone removal, the palatal approach is a valid alternative to the traditional sinus augmentation techniques.

Objectives We report a case of an infant with nephrogenic diabetes insipidus (NDI) diagnosed by the measurement of serum copeptin. There is only one study that previously evaluated the use of copeptin measurement in a pediatric patient. Case presentation We present a 10-month-old child with polyuria–polydipsia syndrome (PPS) and hypernatremia that could not support water restriction due to increased risk of dehydration and worsening of his condition. Therefore, plasma measurement of copeptin allowed the diagnosis of NDI. Conclusions The water deprivation test (WDT) is considered the gold standard for diagnosis in PPS. However, WDT has serious limitations regarding its interpretation. Furthermore, the WDT can cause dehydration and hypernatremia, especially in young children. Therefore, the measurement of plasma copeptin seems to be a promising method to perform an earlier, safer, and accurate investigation of PPS. Up to now, our study is the second to report the usefulness of copeptin in children.

Introdução: O carcinoma de células escamosas (CCE) constitui a neoplasia maligna mais comum da boca, afetando, principalmente, indivíduos com mais de 50 anos. Clinicamente, apresenta-se, geralmente, como úlcera persistente com bordas endurecidas, podendo a lesão estar ou não associada a vegetações, máculas eritroplásicas ou leucoplásicas. As localizações mais acometidas borda lateral de língua e assoalho oral. Objetivo: relatar um caso clínico de CCE microinvasivo em língua, enfatizando a importância do diagnóstico precoce e acompanhamento do cirurgião-dentista durante e após o tratamento oncológico. Descrição do caso clínico: Paciente do sexo masculino, 42 anos de idade, apresentou-se para avaliação placa leucoplásica em borda lateral de língua, do lado direito, com aproximadamente 2,0 cm em seu maior diâmetro, de superfície rugosa, contornos irregulares e limites bem definidos, o qual tinha aparecido há cerca de dois meses. Sob a hipótese diagnóstica de leucoplasia, realizou-se biópsia incisional, cujo resultado histopatológico foi CCE microinvaisvo. O diagnóstico final de CCE predominantemente in situ foi observado, após remoção cirúrgica radical da lesão. O paciente complementou o tratamento oncológico com radioterapia e foi acompanhado no período trans-operatório pela equipe da odontologia, para prevenir e tratar as complicações consequentes do tratamento radioterápico. O paciente não apresentou sinais de recidiva um ano após a cirurgia e ainda encontra-se em proservação. Considerações finais: O diagnóstico precoce foi de fundamental importância para o bom prognóstico da doença. Além disso, a equipe de odontologia foi de suma importância durante todo o tratamento oncológico.

Split tooth is the type of crack or break in tooth, that has split vertically into two separate parts or in other words, with clinical features like pain, sensitivity, etc. although there are multiple causes for the split tooth but here in this case presentation, we are going to discuss about the split tooth in a diabetic patient due to carious tooth. Also, patient has many dental problems but here we are going to emphasize on the management of split tooth only and its restoration. Keywords: Split tooth, Pain, Caries, Diabetes.

Background/Aim: The aim of the study was to report the case of a 5-month-old boy with a complex prenatal and neonatal symptomatology diagnosed with a “de novo" pathogenic variant of PUF60 gene. Case Report: Our hospital, undertook the antenatal and postnatal care of a 27-year-old pregnant lady. This was her second baby with a previously healthy boy. During her routine first-trimester anomaly scan, increased nuchal translucency was noticed. Multiple anomalies were seen throughout her subsequent antenatal visits. This triggered a sequence of tests, examinations and differential diagnosis. The final diagnosis was made at 5 months postpartum following the result of the whole exome sequence, which described a variant of unknown clinical significance (VUS, class 3 variant) in the PUF60 gene. We are mindful that changing the classification of a variant of unknown significance is challenging and requires supporting and robust criteria. Considering clinical symptomatology produced by the pathogenic mutation in the PUF gene, the identified c.1640A>G variant may be categorized as likely pathogenic. Conclusion: Our case adds new insights on the pathology and the underlying process involved in the PUF60 variant spectrum disorders. It also highlights the limits of current prenatal tests.

Case Presentation A 19-year-old woman presented to pulmonary clinic with recurrent episodes of fevers and productive cough over the last 2 years. She was diagnosed with several episodes of respiratory infection that required antibiotic therapy. Her symptoms improved transiently after antibiotic therapy. However, symptoms continued to recur every 1 to 2 months. She denied any close TB contacts or travel outside the United States. She was a nonsmoker and had no history of immunodeficiency. There was no history of cystic fibrosis or any foreign body aspiration.

Study design Case Report. Background Groin pain in athletes is considered a common condition among males participating in sports that require sprinting, twisting, pivoting and kicking activities. While the condition is considered self-limiting, it often keeps athletes away from sport for a prolonged period of time. Much controversy exists regarding the pathogenesis of groin pain. This conflict translates to disagreement regarding diagnostic criteria, reporting and management strategies. Case presentation a 28-year old recreational soccer player presented with a five-month history of groin pain that was resistant to passive care. With reference to the current conservative management literature, the athlete was progressed through an individualized multimodal program of care. Outcomes Following 10-weeks of care, the athlete was able to return to sport participation pain-free. Conclusion It is suggested that groin pain in athletes is likely multifactorial and therefore the management should reflect its multifactorial nature. Conservative therapy can evidently reduce the time to return to play however the benefits of incorporating plyometrics into the rehabilitation program should be investigated.

Video Video 1 This video case presentation highlights a 65-year-old woman with weight regain after Roux-en-Y gastric bypass and a dilated gastrojejunal anastomosis who presented for endoscopic revision of her gastric bypass involving a plication technique, followed by gastrojejunal anastomosis stenosis dilation.

Angiomatoid fibrous histiocytoma is a rare neoplasm with an intermediate malignant potential, that mostly occurs in the subcutis and features varying proportions of epithelioid, ovoid and spindle cells in a nodular and syncytial growth pattern, with hemorrhagic pseudovascular spaces. Here, we report the clinical case of a 68-year-old man who presented with AFH on the right arm; the disease relapsed a few years after surgical excision. We also conduct a brief review of the literature, focusing on the biological and genetic characteristics and the differential diagnosis from other more or less similar entities.

A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. It is caused by the mutation in KIT and PDGFRα genes. It constitutes

Despite enormous changes in medicine over the last 50 years, the oral presentation of newly admitted patients remains a core activity in academic teaching hospitals. With increased pace and complexity of care, it is time to refresh this tradition, as its efficiency and utility in contemporary practice are open to question. In this paper, we suggest a revised structure to help presenters organize their thoughts before the oral presentation and provide an online tool for doing so. We then offer tips on how to present the facts and inferences to the team in a compelling and memorable fashion; how to tell a story. Organizing information and oral presentation are advanced skills that require repeated practice to learn. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-021-06964-6.

The process of forming the motivation to learn as the basis for the effectiveness of the educational process continues to be a relevant object of research. The effectiveness of the learning process is largely determined by the students’ attitude to this process. The purpose of our research was to analyze the effectiveness of project methods using authentic materials to increase the motivation of middle school students to learn a foreign language. The study took place in the gymnasium during the on-the-job training. The experimental group consisted of students who were trained by «English» teaching materials by O. Afanasyeva and I. Mikheeva. In the experimental class the curriculum was supplemented with the application of the project method, game technologies and the use of authentic materials. The preparation of methodological materials for the study consisted of creating a technological map of the lesson and preparing additional materials and handouts for students. The article analyzes the results of the application of the project method with the use of game technologies and authentic materials for the formation of motivation to learn a foreign language at the middle stage of training. The article presents the results of a pedagogical study with an example of creating a technological map of a lesson, recommendations for increasing motivation to learn a foreign language at the middle stage of training. Based on the results of the study, the recommendations to increase motivation to learn a foreign language at the middle stage of education have been developed.

Candida guilliermondii is an opportunistic pathogen that rarely causes invasive candidiasis even in immunocompromised humans. We report a case presentation of invasive C. guilliermondii rhinosinusitis causing an orbital and intracranial extension (frontal lobe abscess). An aggressive multidisciplinary team management is a key approach in invasive fungal sinusitis and avoided mortality in this case. When orbital apex syndrome secondary to sinusitis is encountered in an immunocompromised patient, the treating physician should consider fungal infection as a causative agent.

Background: Flavonifractor plautii is a strictly anaerobic rod shaped bacterium belonging to the family of Clostridiales. It is a commensal of the human intestinal microbiota which was seldom isolated from clinical samples, therefore clinical data are scarce. To date, only four cases of F. plautii infections were described, all occurring in immunosuppressed patients. Case presentation: We report a case where F. plautii was isolated from the blood culture of a severe burn victim and identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Discussion: To the best of our knowledge, this is the first case of F. plautii blood stream infection described in a burn patient.

Objectives Familial dysalbuminemic hyperthyroxinemia (FDH) is an autosomal dominant condition caused by heterozygous gain-of-function mutations in the human ALB gene. Case presentation We report, a three-year-old boy with FDH due to p.R242P (or p.R218P without signal peptide) mutation in the ALB gene with a phenotype characterized by extremely high serum total and free thyroxine concentrations. His parents had normal thyroid function tests (TFT), so the mutation detected in this patient is assumed “de novo”. Although the most frequent variant was p.R242H in Caucasians and p.R242P in Japanese, our patient had p.R242P variant. Conclusions Early identification of FDH is fundamental to prevent unnecessary repeats of TFT with different methods. We encourage the ALB gene hot spot sequencing initially and indicate that this molecular diagnosis is a rapid and simple method to diagnose FDH in individuals with euthyroid hyperthyroxinemia.

Objectives Vipadika (Palmo plantar Psoriasis) is a Kshudra Kushta (minor skin disorder) of Vatakapha origin (body humors like vata and kapha) characterized by Sphutana (cracks) and Teevra Vedana (severe pain) in Pani (palm) and Pada (sole). Based on the symptoms it can be correlated to Palmo Plantar Psoriasis which is a variant of psoriasis which affects the skin of the palms and soles with the features of hyperkeratotic, pustular, or mixed morphologies. The treatment methods for Palmo plantor psoriasis causes severe side effects due to which an evident shift from modern treatments to ayurvedic treatment line. Case presentation A 15 year old, female, with complaint of cracks and dryness over sole of both feet with pain for the last 12 and half years. The case was managed with Padanimajjana (immersion of foot). Padanimajjana is a modified form of Avagaha Sweda (switz bath) where the affected part of the foot is dipped in medicated liquid. Here Mahisha Gritha (Buffaloe ghee) is used for Padanimajjana. Conclusions Mahisha Gritha Padanimajjana shows significant improvement in number of cracks, dryness and pain within short period of time. This is a very simple, economical, and effective treatment for Vipadika.

Introduction The purpose of this case report is to document the 8.5 years result of treatment of a mandibular incisor having a buccal Cairo Recession Type 2 (RT2) gingival recession defect (GRD) using a double-layer technique using an acellular dermal matrix (ADM) with a coronally advanced flap (CAF). To the author's knowledge, no long-term results of this treatment modality in the mandibular incisor area have been reported. Case presentation A 65-year-old non-smoking female presented with an RT2 GRD on the buccal aspect of tooth #25 (International Standards Organization, ISO #41). Her overall periodontal status was healthy. This GRD was treated using a double-layer of an ADM with a CAF. Tension-free flap advancement was permitted by eliminating a frenum pull. Improved root coverage and stable gingival margins were found after 8.5 years. Conclusion This report provides evidence to support the use of a double-layer technique using an ADM with a CAF to treat a mandibular incisor with an RT2 GRD.

Case Presentation A 19-year-old pregnant woman at week 32 of gestation was referred to our clinic with progressive shortness of breath for the further evaluation and treatment of high-risk pregnancy. Her complaints had been existing since her childhood. Two years prior to her admission, she had been diagnosed with heart failure with preserved ejection fraction due to cardiomyopathy and associated pulmonary hypertension. The patient had no family history of any cardiac disease. She had never smoked or drunk alcohol. Her clinical condition had deteriorated progressively with the pregnancy.