BackgroundPersistent cortical deafness in the pediatric population is rarely reported, and there is limited information on its implications for early intervention.ObjectivesThis study aims to (1) conduct a scoping review on pediatric cortical deafness and (2) present a case report of a 7-year-old girl with left unilateral spastic cerebral palsy and cortical deafness resulting from presumed perinatal bilateral stroke.MethodsA search of PubMed, Scopus, and Web of Science identified 407 manuscripts. After the screening, 5 studies met the inclusion criteria for analysis. The case report details clinical characteristics, diagnostic challenges, and intervention strategies for pediatric cortical deafness.ResultsThe scoping review highlighted the limited literature on pediatric cortical deafness, emphasizing its association with extensive bilateral lesions and heterogeneous etiology. The case report underscored the need for comprehensive auditory function measurements, early diagnosis, and tailored interventions.ConclusionsEarly and tailored interventions are crucial for improving prognosis in pediatric cortical deafness, particularly in cases associated with bilateral perinatal stroke.

Persistent hypoglycemia is a life-threatening complication in insulinoma patients. When tumor excision is not possible, medical treatments are the main option. Pasireotide has shown promise in managing refractory hypoglycemia, but its use has been reported only in case series and reports.

This work aimed to assess the efficacy and safety of pasireotide in treating insulinoma-associated hypoglycemia.

We conducted a systematic review on using pasireotide to treat insulinoma-associated hypoglycemia, following a predeveloped protocol. We searched MEDLINE, Scopus, Google Scholar, and references forward and backward from database inception to March 30, 2024.

Of 490 identified studies, 137 were reviewed, and 17 cases from 13 studies met the inclusion criteria. Patients' ages ranged from 52 to 71 years (9 women). Five patients (30%) underwent surgical tumor resection. Pasireotide was never the initial treatment. The most common doses were 40 to 60 mg/month for pasireotide long-acting release and 0.6 mg/12 h for short-acting pasireotide. Six patients (35%) showed no improvement, 4 (23%) had partial improvement, and 7 (41%) had complete resolution. Patients with aggressive insulinomas had a lower response rate, with 55% showing no improvement compared to 16% in indolent cases. Larger tumors were significantly associated with poorer response (P = .043). Hyperglycemia was the most common side effect (n = 3).

Pasireotide effectively restored glucose levels in insulinoma patients who failed prior treatments. However, its efficacy was lower in aggressive insulinomas, emphasizing the need for alternative or combinatory strategies in metastatic cases. Given that pasireotide was never used as a first-line therapy in the reviewed cases, earlier administration in selected patients may improve outcomes.

The purpose of this case report is to describe chiropractic management of acute low back pain for a patient with a unilateral transtibial amputation.

A 39-year-old male veteran presented to the VA Puget Sound chiropractic clinic with acute low back pain. The patient had a history of a left transtibial amputation secondary to a blast injury sustained during combat. He presented wearing a prosthesis, walking with a left trunk antalgia, and utilizing a cane for ambulation assistance due to low back pain severity. The PEG patient-reported outcome was scored 7.3/10. Lumbar range of motion produced severe pain with flexion and mild pain with extension and right lateral flexion. Repetitive lumbar extension reduced the low back pain intensity without peripheralization of symptoms. Orthopedic testing was provocative for low back pain, but not radicular symptoms.

A trial of care was completed with six visits over six weeks and included high-velocity, low-amplitude spinal manipulative therapy spinal manipulative therapy, spinal end-range loading, and exercise prescription. Following the first visit, there was an immediate reduction in pain, and the patient was able to ambulate without the use of his cane. A resolution of the complaint was achieved by the sixth visit, with a final PEG mean score of 1/10, and he was released from care to self-management.

This is only the third case report to describe the chiropractic management of a patient with comorbid transtibial amputation. Our case highlights the necessary modification of the examination and a positive outcome following a trial of care. There is currently limited guidance available for clinicians to aid the management of individuals with spinal complaints and lower limb amputations, suggesting a gap in the literature.

Infantile myofibromatosis is a well-recognized soft tissue tumor that is usually seen in infants and younger populations. These benign lesions mostly arise in the skin and soft tissues of the head and neck but may also involve visceral organs such as the lung, liver, and gastrointestinal tract. After a clinical diagnosis is made, a histological and immunological workup is performed to identify characteristic features like spindle-shaped cells and positive markers such as alpha-smooth muscle actin and vimentin. In most cases, since the mass is expected to spontaneously resolve, a wait-and-watch approach is adopted, especially in the pediatric age group. However, if the tumor advances to involve the organs, a complete surgical resection is carried out. In line with this, we present the case of a 1-month-old male who was diagnosed with infantile myofibromatosis after presenting with a congenital mass on the right thigh. He was born at 36 weeks of gestation to a healthy mother with an uneventful prenatal history. Imaging and histopathology confirmed the diagnosis, revealing a spindle cell neoplasm positive for alpha-smooth muscle actin and vimentin. Given the absence of visceral involvement, a conservative management approach was chosen, and the patient was scheduled for follow-up. However, the patient was lost to follow-up, which limited further assessment of disease progression. This case underscores the importance of early recognition and diagnosis of infantile myofibromatosis as a differential diagnosis for pediatric soft tissue masses. It also highlights the challenges posed by loss to follow-up in rare pediatric conditions.

BackgroundFacial arteriovenous malformations (AVMs) can pose a risk of hemorrhage, bone erosion, and cosmetic deformity. Our objective is to evaluate treatment strategies and outcomes of patients with AVMs of the mandible and maxilla at our institution.MethodsA retrospective, consecutive series of patients with AVMs involving the mandible, maxilla and adjacent tissues was identified. Endovascular treatments included trans-arterial, trans-venous and/or direct venous access embolization. Staged procedures were performed until arteriovenous (AV) shunting was minimized or eliminated. Dental extraction was utilized in patients with residual AV shunting of an affected alveolar ridge with refractory bleeding and loose dentition. Follow-up angiography was evaluated.ResultsNine patients presented with AVMs of the mandible or maxilla to our institution in 1993-2023 (6 females; age range 7-38 years). Seven patients presented with a history of hemorrhage: two spontaneously and five at the time of biopsy or dental extraction. Embolization was performed in eight patients. Angiographic closure of the AVM was achieved in five patients. Six patients underwent surgery for debridement, resection or dental extraction. One lesion had complete spontaneous regression. No further bleeding episodes occurred in all patients. Seven patients had follow-up angiography (range 1-17 years) which showed significantly decreased or no residual AV shunting in all patients.ConclusionsMultidisciplinary treatment involving embolization and/or surgery can be accomplished safely and effectively for high-flow AVMs of the mandible and maxilla. Embolization with focused surgery may be a reasonable algorithm of clinical care and can result in significant reduction or durable closure of these lesions.

Gingival recession (GR) poses esthetic and functional challenges for patients, particularly in cases of multiple adjacent defects. Traditional surgical approaches, such as the modified coronally advanced flap (MCAF) with connective tissue grafts (CTG), demand high levels of precision and skill, making outcomes reliant on clinician expertize. The integration of digital technologies, including cone-beam computed tomography (CBCT) and computer-aided design and manufacturing (CAD-CAM), offers a novel, standardized approach to enhance procedural accuracy and predictability.

This case study describes the use of the guided-modified coronally advanced flap (g-MCAF) for the treatment of multiple GR defects. A patient whose main concern was the esthetic appearance of her teeth was treated. Using an intraoral scanner, CBCT data, and CAD-CAM software, surgical guides were designed and 3D printed using a dedicated resin, assuring precise adaptation to the patients' teeth. The guides delineated MCAF oblique incisions and free gingival graft dimensions tailored to fit into the area, facilitating flap design, and graft harvesting.

The guided MCAF (g-MCAF) procedure successfully achieved complete root coverage. At the 6-month follow-up, recession reduction was observed, measuring 2.22 mm for tooth #5, 2.59 mm for tooth #6, and 2.26 mm for tooth #7. Gingival thickness also increased, reaching 1.23, 1.16, and 1.45 mm, respectively. Additionally, the patient reported improved esthetics and reduced hypersensitivity.

The g-MCAF technique may have the potential to serve as a reliable aid to execute MCAF in the management of multiple GR defects.

A guided surgical approach (g-MCAF) using digital technologies allows for precise flap design and graft harvesting, which may help control variability and minimize errors during root coverage procedures. The integration of CBCT, intraoral scanning, and CAD-CAM technologies supports preoperative planning, potentially contributing to safer and more predictable outcomes, particularly in cases requiring connective tissue grafts. This innovative approach may assist in simplifying complex surgical techniques, improving clinician confidence, and serving as both a clinical and an educational tool for periodontal plastic surgery.

Double-inlet right ventricle is an extremely rare and complex cardiac malformation characterized by the opening of both atria into the right ventricle and is usually associated with other major cardiac malformations. In this case report, we have discussed an isolated case of double-inlet right ventricle without other malformations and conducted a literature review to compare our case, which is the third in the medical literature, with previously published papers on double-inlet right ventricle.

A 2-month-old Syrian male infant was admitted to the cardiology department due to symptoms of central cyanosis and failure to thrive. Echocardiography revealed double-inlet right ventricle with a hypoplastic left ventricle from which the hypoplastic aorta emerged, while the pulmonary trunk emerged from the dilated right ventricle. The child was sent abroad for the Norwood procedure.

Although double-inlet right ventricle is a very rare malformation, it can be encountered in clinical practice and should be taken into consideration by practitioners. Clinical researchers should document and publish cases of double-inlet right ventricle diagnosed to draw attention to this malformation and study it in greater depth.

The inferior alveolar nerve block (IANB) is commonly used in dentistry for pain management before and after dental procedures. Traditional nerve block techniques can sometimes be associated with complications such as anesthetic failure and nerve damage. Ultrasound-guided (USG) nerve blocks have emerged as a promising alternative. This systematic review aimed to evaluate the effectiveness of USG mandibular nerve blocks in pain control in adults.

A systematic search of English literature was conducted using the PubMed, Web of Science, Scopus, Google Scholar, and Cochrane Library databases. Articles published between 2020 and September 2024 were selected based on a set of preestablished inclusion criteria. These articles were analyzed according to the PRISMA-2020 guidelines to seek evidence of effective pain management following USG IANB.

Seven articles including 193 patients and 176 ultrasound scans met the eligibility criteria. The included studies reported the effectiveness of USG mandibular nerve blocks by using various pain measurement scales. In addition, other indirect measures of pain control, such as maximum mouth opening, were used.

This systematic review showed that USG IANB can effectively manage pain in adult patients undergoing specific dental surgical procedures including third molar extraction. Furthermore, it can provide relief for those suffering from chronic orofacial pain associated with conditions, such as temporomandibular disorders.

Hepatitis E virus (HEV) typically induces self-limiting infection but can establish persistent infection, particularly in patients with compromised immune systems. However, the literature on HEV infection in patients undergoing chemotherapy is limited.

A 46-year-old Chinese male patient with rectal cancer underwent ten cycles of chemotherapy and targeted therapy. Routine blood tests revealed grade 4 bone marrow suppression necessitating emergency admission. On the second day following admission, the patient presented with high fever that was determined to be chemotherapy-induced febrile neutropenia (FN). However, despite the recovery of white blood cell counts, the fever persisted, and the levels of aminotransferases and bilirubin continued to rise. Two weeks after admission, next generation sequencing of blood samples revealed evidence of HEV. The patient underwent symptomatic and supportive treatment and was discharged after a 30-day hospitalization. One month after discharge, the transaminase and bilirubin levels were within the normal range.

The fatality rate of FN is alarmingly high. To prevent progression to sepsis syndrome and potential mortality, it is imperative to initiate empirical treatment with broad-spectrum antibiotics. As the differential diagnosis of elevated liver enzymes in immunocompromised patients encompasses a wide range of possibilities, the exclusion of HEV infection is crucial when diagnosing drug-induced liver injury (DILI).

This case highlights the importance of healthcare providers being vigilant in identifying HEV infection in patients with solid tumors who experience FN and DILI. Early implementation of comprehensive supportive treatment is crucial for reducing the duration of disease and enhancing patient prognosis.

The treatment of stubborn tibial nonunion remains a significant challenge. This case report describes a patient who underwent six surgeries and was treated using a stepwise surgical approach based on the diamond theory. The application of platelet-rich plasma (PRP) enhanced autologous iliac bone grafting combined with locked compression plate fixation ultimately achieved successful healing. This study also reviews relevant literature to explore the treatment experiences and outcomes of similar cases.

A middle-aged Asian male with severe heart disease underwent five failed surgeries, including two autologous bone graft procedures. Clinically, he presented with right calf pain, poor soft tissue condition on the anterior medial tibia, and signs of nonunion. During the sixth surgery, we applied a stepwise surgical procedure based on the diamond theory, achieving excellent clinical and bone healing, as well as satisfactory limb function at a follow-up of 11.3 months post-operation.

We utilized a stepwise surgical procedure based on the diamond theory: locked compression plate internal fixation, PRP-enhanced structural autologous iliac bone grafting, and bioactive center creation techniques, providing a strong and stable mechanical and superior biological environment for the nonunion site.

Upadacitinib is a Janus kinase (JAK) inhibitor approved for the treatment of different rheumatic diseases, including axial spondyloarthritis (axSpA). In phase III clinical trials, upadacitinib was associated with rapid and significant improvement in disease parameters, including scores for pain, function and mobility, signs of structural damage, and patient-reported outcomes, and had an overall incidence of adverse events similar to that in the placebo group. Improvement in axSpA disease severity was observed in both biologic-naive patients and those with prior biologic exposure, and this improvement was sustained during open-label treatment. Indirect comparisons with other agents suggest that upadacitinib is more effective than biologics and other JAK inhibitors in patients with axSpA and is associated with the lowest number-needed-to-treat. Long-term safety data indicate that upadacitinib is well tolerated in patients with axSpA, with a low rate of infections, malignancies, major adverse cardiovascular events and thromboembolism. Four case studies described here illustrate the effectiveness of upadacitinib in a range of real-world patients with axSpA, including patients with early disease and those who have been pre-treated with biologics.

This systematic review summarizes the current literature on Warthin-like mucoepidermoid carcinoma (WL-MEC), highlighting its clinicopathological, immunohistochemical and molecular characteristics.

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered by PROSPERO (protocol CRD42024523598). Case reports and case series published in English on WL-MEC of major and minor salivary glands were included. The search was conducted in MEDLINE/PubMed, Scopus, Web of Science, and Embase databases in November 2024, along with a search in grey literature. Twenty-one articles met the eligibility criteria. The extracted information included clinicopathological data, immunohistochemical and molecular tests, treatment, recurrence, metastasis, follow-up, and status. The data analysis was performed descriptively, and presented as absolute and relative frequencies, and means or median for numerical variables.

78 WL-MEC cases were analyzed, with a female predominance observed and a wide age range, peaking in the sixth decade of life. Most cases involved the parotid gland and presented as indolent nodular masses, often asymptomatic. Histologically, the majority were low-grade tumors, with multicystic growth patterns and a lymphocytic infiltrate. Immunohistochemical analysis revealed consistent expression of p63, p40, CK5/6, and exhibited low Ki67 proliferation index (< 5%). MAML2 rearrangement was identified in all molecularly analyzed cases (n = 72/ 100%). Surgical treatment was the most common approach, which typically resulted in low recurrence rates, no distant metastasis, and favorable overall outcomes.

WL-MEC cases typically present as indolent, asymptomatic nodules in the parotid gland, often with a female predominance and a wide age range, peaking in the sixth decade of life. Surgery is the primary treatment and is associated with a favorable prognosis, characterized by low rates of recurrence and metastasis. These tumors commonly exhibit low-grade histopathological features, a multicystic pattern, and lymphocytic inflammatory infiltrate. The detection of MAML2 rearrangement, typically via FISH, is an essential diagnostic tool, emphasizing the molecular similarities between WL-MEC and conventional MEC.

Periapical cysts are the most common odontogenic cysts, often resulting in large bone defects. Guided tissue regeneration techniques support tissue healing by means of membranes and bone grafts. The present case report evaluates for the first time clinical application of a resorbable magnesium membrane in guided bone regeneration (GBR) following cystectomy.

A 35-year-old male patient presented with a large periapical cystic lesion in the maxillary anterior region. Treatment involved marsupialization followed by cyst enucleation and GBR using a resorbable magnesium membrane and bovine xenograft. The magnesium membrane served as a structural support to bridge the bony discontinuity in the palatal bone. Cone-beam computed tomography (CBCT) was used for diagnosis, treatment planning, and follow-up assessments. At 16 months post-treatment, CBCT imaging revealed significant bone regeneration, with restoration of the palatal contour and cortication of the palatal wall. Clinical examination showed asymptomatic teeth with normal mobility and optimal soft tissue healing.

This case demonstrates the potential of resorbable magnesium membranes in managing large periapical defects, offering a promising alternative to traditional GBR materials by combining mechanical strength with complete resorption, therefore eliminating the need for membrane removal surgery. However, future studies on larger patient samples should focus on confirming the long-term outcomes of this approach and investigating patient-specific factors that are important in choosing effective treatment options.

Effective treatment for Complex Regional Pain Syndrome (CRPS), a chronic pain condition, is challenging. Cognitive Multisensory Rehabilitation (CMR) is a cognitive and sensorimotor treatment approach aimed at restoring function that targets cognitive, somatosensory, and multisensory functions through sensory discrimination tasks.

We aimed to apply CMR to treat CRPS within our clinical practice. Clinically, we have found promising results in reducing pain and other common features of CRPS, such as Body Perception Disturbances (BPD).

In this clinical case series, four CRPS patients who participated in a two-week interdisciplinary CRPS rehabilitation program at the National Complex Regional Pain Syndrome Service in Bath, UK received CMR as part of their treatment. A combination of self-reported measures and clinical outcomes were collected pre and post-rehabilitation program.

Functional improvements and a reduction on BPD were observed in all clinical cases.

We demonstrate how CMR may improve several CRPS-related features that often hinder rehabilitation in people living with CRPS.

Research involving larger cohorts are necessary to provide empirical evidence of the application of CMR in treating CRPS.

Segmentectomy is being accepted as a valid operative procedure for small peripheral non-small cell lung cancer. Understanding pulmonary artery (PA) variations is essential to ensure safe and reliable surgeries. Herein, we report a case of left S3 and S8 segmentectomy involving a complete interlobar branch of the left A3, a relatively rare anomaly reported in less than 0.56% of cases in previous studies.

A woman in her sixties was referred to our hospital with two nodules in the left upper lobe anterior segment (S3, 1.1 × 0.8 cm) and the lower lobe anterior basal segment (S8, 1.8 × 1.7 cm), suggestive of double primary lung cancer. Preoperative thin-slice computed tomography (CT) and three-dimensional CT revealed a vascular anomaly in which the entire left A3 branched from the interlobar PA. Left S3 and S8 segmentectomies were performed via thoracotomy. The interlobar A3 branched at nearly the same level as the A6. After cutting the V3b and V3c veins, the intersegmental plane and the interlobar A3 were sequentially divided using staplers. To prevent torsion of the remaining lung, the edges of the apico-posterior segment (S1+2) and the lingular segment were loosely secured with silk sutures. The operative times were 4 h and 8 min with minimal blood loss. Pathological examination revealed that both nodules were squamous cell carcinomas of the lungs (pT1bN0M0, pStage IA2). The patient remained recurrence-free for over 1 year.

Complete interlobar branching of the left A3 is uncommon. During left S3 segmentectomy in cases involving an interlobar A3, the S1+2 and lingular segments may become solitary blocks, necessitating measures to prevent torsion.

Hypereosinophilic syndrome (HES) is an infrequent multisystemic disorder with a serious prognosis, defined by persistent marked eosinophilia (>1500 eosinophils/mm3) associated with organ damage from eosinophil-mediated cytotoxicity. Cardiac involvement is a significant and unpredictable complication of hypereosinophilic syndrome, particularly prevalent in patients carrying the FIP1L1-PDGFRA fusion.

Reported is a case of chronic eosinophilic leukaemia (CEL) with a FIP1L1-PDGFRA rearrangement, diagnosed in a 31-year-old patient presenting with Loeffler endocarditis. Intracardiac thrombi and embolic cerebral infarctions complicated the case. The patient demonstrated haematological remission following chemotherapy, and anticoagulation treatment led to thrombi resolution.

This case highlights that Loeffler endocarditis can present as the primary and sole manifestation of chronic eosinophilic leukaemia. Effective collaboration between cardiologists and internists is crucial for timely diagnosis and comprehensive management, ultimately resulting in enhanced outcomes.

Peer-reviewed medical journals tend to publish fewer case reports. We aimed to describe trends in publishing case reports in peer-reviewed anesthesiology journals over the last 10 years.

We conducted a literature search using PubMed and Web of Science databases. The study identified peer-reviewed case reports published between January 2014 and December 2024 in the 20 highest impact factor anesthesiology journals, according to Journal Citation Reports (Clarivate, June 2024), and included the International Journal of Obstetric Anesthesia. We identified published case reports adhering to "CARE reporting guidelines" for case reports, including the term "case report" or "case study" in their title. Obstetric anesthesia-related case reports were manually identified.

A total of 502 published case reports were identified over the 10 year period. Half of the top 20 anesthesiology journals do not publish case reports; 5 (25%) published none in the 10 year period. Among all identified published case reports, 11% were obstetric anesthesia related. Three companion journals, not among the 20 highest impact factor journals, were identified as alternative options for publishing case reports. Obstetric anesthesia-related cases represented 5.6% of their case reports. A clear temporal decline in the publication of case reports was observed.

Leading peer-reviewed anesthesiology journals do not currently publish case reports. Nevertheless, the inclusion of case reports in companion journals and other digital platforms highlight their value. Publication of case-reports in peer-reviewed medical journals is crucial for supporting clinical education and practice.

Thoracic paravertebral block (TPVB) is recommended by the Procedure Specific Postoperative Pain Management (PROSPECT) working group for video-assisted thoracoscopic surgery (VATS). Although perineural magnesium and dextran have been used to prolong block duration, combined use is not reported in the literature. In this case report, the author combined dextran and magnesium with levobupivacaine in TPVB as part of multimodal analgesia for a patient with recurrent lung cancer undergoing VATS, which resulted in satisfactory pain control and sensory blockade up to 3 days postoperatively. Nonetheless, the findings of this study are at most exploratory and call for further research to prove the efficacy and safety of this combination.

Attention deficit hyperactivity disorder (ADHD) is a relatively common disorder in clinical psychiatry. Patients often suffer from symptoms long before the diagnosis due to an overlap with other psychiatric differential diagnosis. Importantly, alcohol addiction and other illicit drug dependence and withdrawal symptoms mimicking ADHD symptoms should be ruled out. Here we present a rare case of a young female patient with symptoms of ADHD and an extremely high carbohydrate-deficient transferrin (CDT) of 19,6% (< 1,3%) indicating the presence of a congenital disorder of glycosylation (CDG). A thorough diagnostic workup excluded alcohol addiction as a cause of the constantly high CDT levels. The CDT test was positive due a transferrin mutation affecting the glycosylation site. Nevertheless, psychiatric symptoms can be due to metabolic disorders which should be considered. Further, substance-use disorders (SUD) are a critical and potentially complicated differential diagnosis concerning diagnostic procedures and treatment in ADHD.

Background: Skeletal metastases from carcinoid tumours are extremely rare. Their correct diagnosis is a challenging problem for clinicians and pathologists, with important clinical implications for patients. In most cases, examination for the possible presence of skeletal metastases is initiated only when patients present symptoms suggestive of skeletal metastases. Case presentation: In this paper, the authors present the case of a middle-aged woman suffering from back pain due to a bronchial carcinoid that metastasised to the spine. We managed skeletal metastases with vertebroplasty and achieved excellent results and the complete remission of symptoms six months after the procedure. Conclusions: The relevance of this case report is that it highlights the importance of correctly diagnosing and treating these rare lesions to improve the quality of life of metastatic oncologic patients.

Almost all scientific articles include tables, but there is little guidance on how to prepare tables. Authors should enhance the focus on the tables' data-ink, the essential information, and minimizing the no-data-ink, nonessential elements. The six principles of Gestalt on human perception can also be applied to the table to increase readability. Through this review, we provide a practical guide and an overview of how to prepare readable, informative tables. The five steps for the preparation of tables include (1) tables with a clear purpose; (2) using a universal layout; (3) selecting relevant data for Table 1 versus other tables; (4) simplifying variables by categorizing, standardizing, and reducing; and (5) enhancing the readability of numbers and decimals. This results in informative tables that contain data, serving a specific purpose for the reader and increasing readability.

BackgroundHepatic portal venous gas (HPVG) is an uncommon radiological finding in acute pancreatitis. This systematic review aims to consolidate existing literature on HPVG in acute pancreatitis and assess its clinical significance, particularly regarding surgical intervention. We also report a clinical case from our center.MethodsA systematic search was conducted across Medline, Scopus, Cochrane, and Google Scholar databases to identify studies reporting concurrent HPVG and pancreatitis. Data included demographics, clinical presentation, management, and outcomes. Descriptive statistics were employed for analysis, and methodological quality was assessed using established criteria.ResultsOut of 259 articles screened, 13 met inclusion criteria, yielding data on 17 patients (76.5% male; median age 62 years). Nonoperative management (NOM) was utilized in 75% of cases and was associated with a 54% mortality rate. In contrast, the surgical cohort (n = 4) experienced a similar overall mortality rate of 50%. Importantly, necrotic bowel was implicated in 44% of evaluable cases and was uniformly fatal. However, 2 patients who underwent early surgical resection of nonviable bowel survived the initial phase of their illness, suggesting that prompt operative intervention may confer an early survival advantage in selected patients. Fluid collections and pneumatosis intestinalis were significantly more prevalent in deceased patients (100% vs 17% in survivors; P < 0.0034). All deceased patients had either severe or necrotizing pancreatitis.ConclusionHPVG associated with severe acute pancreatitis appears to have a higher mortality than HPVG alone. It can be managed nonoperatively but when indicative of bowel necrosis, necessitates prompt surgical intervention.

The proposed technique utilizes the osteoconductive regenerative properties of bone-substitute materials (BSMs) and the space-maintaining function of titanium mesh to restore the alveolar ridge at extraction sites with lost labial plates in a single procedure. This approach may reduce the need for extensive ridge augmentation procedures, shorten treatment duration, minimize complications, and potentially lower overall costs for patients.

Both patients presented with hopeless dentition, characterized by chronic infection and loss of the labial plates. To regenerate the alveolar ridge, a titanium mesh was utilized in combination with a layered application of xenograft and allograft BSMs. The success of this technique depended on mesh stabilization, thorough site debridement, and the absence of soft-tissue tension.

The technique effectively restored the lost labial plates and regenerated sufficient bone to accommodate dental implants. Significant bone regeneration was achieved in both cases, with minimal complications. In one case, a minor mesh exposure occurred; however, it did not affect the healing and was managed during the re-entry surgery.

The presented technique effectively regenerated the lost labial plates. It represents a novel alveolar ridge preservation approach to restore the alveolar ridge at extraction sites with lost labial bone plates, even in the presence of chronic infection. However, future studies with sound methodology, larger sample sizes, and long follow-up periods are recommended to validate these findings.

The Mesh-Assisted Regenerated Site (MARS) technique restores the alveolar ridge at sites with lost labial plates by combining the osteoconductive properties of bone substitutes with the space-maintaining function of titanium mesh in a single procedure. This approach may reduce the need for extensive augmentation, shorten treatment duration, minimize complications, and potentially lower long-term treatment costs. The success of this approach depends on minimally traumatic extraction, meticulous socket debridement, careful soft tissue management, and precise placement of titanium mesh and bone substitutes under optimal magnification. Although effective, this technique has limitations, including potential vertical bone loss, time-consuming procedures, possible need for additional augmentation, occasional challenges with mesh retrieval, and infection risk, all of which may compromise regeneration and implant success. Proper case selection and precise application of the technique are essential to mitigate these challenges and optimize clinical outcomes.

When teeth are removed, the surrounding bone can shrink. Techniques to preserve this area, known as alveolar ridge preservation, help prevent this shrinkage. This novel technique uses specialized bone materials and a titanium mesh to rebuild the bone in areas where the front portion is missing. The author used a combination of bone materials and a titanium mesh to rebuild the lost bone. Key steps included stabilizing the mesh, thoroughly cleaning out any infection, layering the bone materials, and ensuring the gum tissue was not overly tight. The technique successfully reconstructed the missing bone, making it possible to place standard dental implants. Both cases showed significant bone growth with minimal issues. In one case, a small part of the mesh was exposed but did not impact healing and was addressed during follow-up surgery. This technique effectively rebuilt the lost bone, even with the presence of a long-standing infection. It shows promise for preserving and regenerating bone in these areas, but more extensive studies are needed to confirm the results and improve the method.

Mobile spine chordomas demonstrate varied surgical risk profiles compared to their sacral analogs. Often, the limitation to performing an en bloc resection of a mobile spine chordoma is tumor violation of the epidural space. Given these limitations, we propose the utilization of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation in separation surgery to enhance visualization for stereotactic body radiation therapy (SBRT) planning, allowing an ablative radiosurgical dose to be delivered.

We present two illustrative cases highlighting the advantages of hybrid therapy (separation surgery and adjuvant SBRT) with CFR-PEEK instrumentation in the management of mobile spine chordoma.

Case 1 is a 62-year-old female with an L4 chordoma who underwent separation surgery and L3-5 posterior instrumented fusion using CFR-PEEK instrumentation. Case 2 is a 68-year-old female with a L3 chordoma who underwent revision separation surgery encompassing completion of L3 partial corpectomy and CFR-PEEK screw exchange of prior L2-4 titanium instrumentation. Both patients received postoperative ablative SBRT. At 18-month postoperative time points, both patients were clinically stable, with no signs of tumor recurrence or progression.

Mobile spine chordomas present a unique challenge in obtaining a margin negative en bloc resection. Separation surgery allows the ability to decrease surgical morbidity and deliver an ablative radiosurgical dose. Furthermore, the incorporation of CFR-PEEK instrumentation allows the utilization of multiparametric magnetic resonance imaging for long-term disease monitoring. Hybrid therapy, a less morbid alternative to standard en bloc spondylectomy, offers a better surgical morbidity profile by combining effectively with SBRT for optimal tumor control.

Rare disorders often represent a molecular deviation from hi-fidelity genomic integrity networks and are often perceived as too difficult or unimportant for further mechanistic studies. Here, we synthesize evidence demonstrating how valuable knowledge of biochemical pathways related to rare disorders can be for biomedicine. To this end, we describe several rare congenital lipid, protein, organic acid, and glycan metabolism disorders and discuss how rare phenotypes (such as "extreme responders") and case reports (such as the lenalidomide cases) have provided clues for drug discovery or repurposing. We also discuss how rare disorders such as Gaucher disease and ultra-rare genetic syndromes can provide insights into cancer and mTOR-driven metabolism, respectively. Our discussion highlights the continued value of biochemical pathways and studies in understanding human pathophysiology and drug discovery even in the genomics era.

Over the past two decades, dental pulp regeneration has become a major focus in endodontology. The currently applied clinical strategies are referred to as 'revitalisation' procedures. These biology-based treatment strategies aim at regenerating lost pulp tissues in necrotic teeth, in the absence or even more in the presence of periapical bone lesion, clinical signs and symptoms. Such approaches are generally - but not exclusively - used in immature teeth to promote root maturation, both in length and in thickness, ultimately to reduce their risk of fracture. A growing body of evidence has led to increased understanding and reliability of these treatment strategies, which are now considered as a valid alternative treatment option besides conventional ones, mainly the apical plug technique. However, all systematic reviews evaluating clinical outcomes concluded that there is a lack of robust long-term studies on the subject; most published cases of revitalisation having a relatively short-term follow-up, usually under 2 years. In this context, several major challenges remain to be addressed to better understand the promises and limitations of revitalisation procedures as compared to other treatment options, mainly the placement of an apical plug made of hydraulic calcium silicate cement. The purpose of this paper was therefore to identify some of the important remaining challenges related to such procedures, which can be broadly categorised into biological and mechanical ones, affecting treatment success and tooth survival. Meeting these challenges requires close collaboration between both researchers and clinicians, to establish guidelines, evaluate and understand treatment outcomes, and update guidelines accordingly. However, it is not always easy for researchers to understand the clinical reality faced by practitioners. In order to facilitate their mutual understanding, the aforementioned challenges were illustrated by providing clinical context through a series of atypical clinical cases with long-term follow-up (4-8 years).

Crown fracture is a type of traumatic injury that mostly affects the maxillary incisors. Depending on the involvement of the pulp, crown fracture may occur as complicated or uncomplicated and constitutes 26-76% of dental injuries in the permanent teeth. The effective treatment of crown fractures should aim to gain optimal aesthetics and function by preserving the vitality of the tooth. There have been case reports in the literature regarding pulpotomy and reattachment techniques in traumatized teeth. However, there has been no case series presenting different endodontic treatments performed with different current materials along with the reattachment technique. The aim of the current case series is to present treatment approaches of 3 crown fracture cases with different pulp treatments and re-attachment technique.

In all cases the patients were 8 years old boys. In the first and third cases, complicated crown fractures involved upper central incisors. After endodontic treatment with Cvek pulpotomy, the teeth were restored using Biodentine in case 1 and MTA in case 3. In the second case, uncomplicated crown fracture of the lower central incisor was treated with indirect pulp capping. In all cases, the fractured crown parts were re-attached and the patients were scheduled for recall appointments.

Re-attachment technique offers aesthetic, functional and economic treatment option by long-term preserving the anatomic form, color and surface texture. The evaluation of the pulpal status before the reattachment technique and application of the proper pulpal treatment influences the prognosis of the tooth.

Our patient is a woman who developed a subacute amnestic syndrome, followed by cognitive impairment, headache, temporal lobe epilepsy and hyponatraemia. An early-stage asymptomatic breast cancer was identified on positron emission tomography (PET) scan. After treatment with immunotherapy with high-dose corticosteroids, intravenous immunoglobulins, upfront rituximab and excision of the tumour, the patient gradually recovered. Partial retrograde and anterograde amnesia persisted during the initial weeks, followed by slow and steady improvement. Autoimmune encephalitis is a severe neurological disorder associated with antibodies against neuronal cell-surface or intracellular onconeural proteins. Anti-leucine-rich glioma inactivated 1 (LGI1) predominantly affects males in the seventh decade of life, and less than 10% of all cases are associated with cancer. Paraneoplastic cases have been associated with malignant thymoma, neuroendocrine tumours and mesothelioma and usually had Morvan syndrome, in which serum antibodies are more frequently directed against CASPR2 than against LGI1. We report the first well-documented case of anti-LGI1 limbic encephalitis in a woman with newly diagnosed breast cancer.

People with dementia (PwD) and their carers often consider maintaining good quality of life (QoL) more important than improvements in cognition or other symptoms of dementia. There is a clinical need for identifying interventions that can improve QoL of PwD. There are currently no evidence-based guidelines to help clinicians, patients and policy makers to make informed decisions regarding QoL in dementia.

To conduct the first comprehensive systematic review of all studies that investigated efficacy of any pharmacological or non-pharmacological intervention for improving QoL of PwD.

Our review team identified eligible studies by comprehensively searching nine databases. We completed quality assessment, extracted relevant data and performed GRADE assessment of eligible studies. We conducted meta-analyses when three or more studies investigated an intervention for improving QoL of PwD.

We screened 14 389 abstracts and included 324 eligible studies. Our meta-analysis confirmed level 1 evidence supporting the use of group cognitive stimulation therapy for improving QoL (standardised mean difference 0.25; P = 0.003) of PwD. Our narrative data synthesis revealed level 2 evidence supporting 42 non-pharmacological interventions, including those based on cognitive rehabilitation, reminiscence, occupational therapy, robots, exercise or music therapy. Current evidence supporting the use of any pharmacological intervention for improving QoL in dementia is limited.

Current evidence highlights the importance of non-pharmacological interventions and multidisciplinary care for supporting QoL of PwD. QoL should be prioritised when agreeing care plans. Further research focusing on QoL outcomes and investigating combined pharmacological and non-pharmacological interventions is urgently needed.

Hepatitis A virus is typically an acute infection that is often asymptomatic, especially in children. In Syria, hepatitis A virus infections are not uncommon. However, the emergence of extrahepatic manifestations, such as aplastic anemia, following hepatitis A infection is unpredictable and challenging to manage, with the connection between these conditions remaining poorly understood. This paper aims to highlight this rare manifestation of aplastic anemia linked to hepatitis A infection in children.

We report a rare case of hepatitis-associated aplastic anemia in a 3-year-old Syrian boy who exhibited symptoms of fever, bruising, and mucosal bleeding 1 month after the onset of acute hepatitis. The diagnosis was confirmed via bone marrow examination, and he was treated with immunosuppressives, resulting in full recovery after a year of follow-up with no need for bone marrow transplantation.

Hepatitis A infection associated with aplastic anemia is an extremely rare condition. Its etiology might be related to the immune system, and its diagnosis is always confirmed with bone marrow biopsy. Treatment includes hematopoietic cell transplantation if the immunosuppressive therapy is not effective. Further research is essential to understand the mechanisms and optimize treatment options.

Awareness of the potential association between hepatitis A and aplastic anemia is essential for early diagnosis and effective management. More studies are required to enhance our understanding of the condition and improve therapeutic approaches.

Nitrobenzene poisoning can result in life-threatening methemoglobinemia. Therefore, immediate management is critical.

We report the case of a 45-year-old female, who was brought to our emergency department three hours after ingesting approximately 50 mL of a 35% solution of nitrobenzene. She displayed decreased consciousness, cyanosis, low peripheral oxygen saturation (SpO2) and a saturation gap of 21.9%. Despite high-flow oxygen supplementation, cyanosis persisted, and SpO2 remained low. Nitrobenzene poisoning with methemoglobinemia was diagnosed on the basis of her clinical features. She was treated with manual therapeutic whole blood exchange (TWBE), intravenous vitamin C, and supportive care. The patient underwent manual exchange transfusion of 2365 mL of whole blood (60% of her estimated total blood volume) over 5 days. After treatment, the patient recovered and was discharged from the hospital.

The patient was diagnosed on the basis of clinical features because tests to measure the level of methemoglobin were unavailable. Methylene blue, which is first-line treatment for methemoglobinemia, was not available. Therefore, the patient was treated with manual TWBE and intravenous vitamin C. Several published reports have illustrated the successful use of TWBE in the treatment of methemoglobinemia in settings where methylene blue was unavailable.

A thorough clinical evaluation is key in diagnosing methemoglobinemia in circumstances where specific tests to detect methemoglobin are not available. Treatment with methylene blue can be ineffective, contraindicated or unavailable in some circumstances. In such situations, alternative therapies such as TWBE and intravenous vitamin C should be considered.

To perform a systematic review of all published case reports and compare ectopic pregnancy following total versus supracervical hysterectomy.

Published case reports of patients with ectopic pregnancy following hysterectomy up to July 12, 2024, were searched using PubMed, Google Scholar, Embase, Scopus, and Web of Science databases using the terms "post-hysterectomy ectopic pregnancy," OR "pregnancy after hysterectomy." Manuscripts with case reports of ectopic pregnancy following previous hysterectomy were statistically analyzed. Categorical variables were analyzed using the chi-squared or Fisher's exact test and continuous variables by independent t-test and Wilcoxon rank sum test. A p-value <0.05 determined statistical significance.

One hundred and eight cases reported by 106 authors were eligible for analysis. Of these, 34 underwent supracervical and 74 total hysterectomies. There were no differences between the two groups in the demographic variables, symptoms, and status of patients at presentation. Patients with a history of supracervical, unlike total hysterectomy, were less likely to have their pregnancy associated with the period just before or shortly after hysterectomy (termed the peri-hysterectomy period) (OR 0.18, 95% CI [0.06-0.54], p < 0.001). However, they are more likely to have a diagnosis of possible ectopic pregnancy before surgery (OR 3.56, 95% CI [1.45-8.73], p = 0.007).

Physicians should be aware that ectopic pregnancy following a supracervical, unlike total hysterectomy, occurs more often remote from the peri-hysterectomy period and should include ectopic pregnancy in their differential diagnosis of abdominal and pelvic pain in all previously hysterectomized patients.

Patients with Wilson's disease, an autosomal recessive disorder caused by ATP7B mutations, present with hepatic and neurological symptoms, including tremors, chorea, personality changes, and rare manifestations such as neuropathy, autonomic dysfunction, headache, and epilepsy. This report describes the case of a 14-year-old man born to consanguineous parents who presented with focal seizures and oromandibular dystonia. A neurological exam revealed left upper limb hypotonia. An electroencephalogram showed right hemisphere epileptiform activity, and magnetic resonance imaging indicated bilateral basal ganglia hyperintensities. An ophthalmological exam revealed an incomplete Kayser-Fleischer ring. Laboratory tests confirmed Wilson's disease with low serum ceruloplasmin (3 mg/dL) and elevated urinary copper excretion (1226 mcg/24 h) levels. Treatment included penicillamine (250 mg/day) and zinc (50 mg bi-daily), along with clonazepam for seizures. Routine follow-ups were recommended. This case highlights the importance of recognizing neurological presentations in patients with Wilson's disease for timely diagnosis and management.

A 72-year-old male patient, a diagnosed case of infective spondylodiscitis, was admitted in our hospital for severe pain in the right hip and lower back (in the lumbo-sacral region) in a non-ambulatory mode. Considering the criticality, we administered Kwatha in a Muhurmuhu (frequent administration) schedule. The initial medicines reduced pain, but not the elevated C-reactive protein (CRP). To reduce this elevated CRP, we administered Amruthotharam Kwatha and Guggulu Tiktakam Kwatha (GTK) in the dosage of 30 ml every 2 h for eight times. CRP started reducing, but we encountered an acute urinary retention as an adverse drug reaction. Naranjo Adverse Drug Reaction Probability Scale recording gave a score of eight, which shows that the AE could be probably due to administration of Guggulu Tiktakam Kwatha (GTK) in Muhurmuhu schedule. When the patient did not void urine for more than 6 hours, we did Marma therapy on left Mootthira Kala Marma. The patient voided urine within half an hour of Marma therapy. Clinically, after the medications, pain reduced considerably, CRP came to normal, and the patient came to an ambulatory mode. This case report shows that medicines like GTK should cautiously be administered, as it may complicate. This case report also focusses light on the fact that Marma therapy could be a possible mode of tackling acute conditions.

Pelvic fractures with haemorrhage are associated with high mortality and morbidity. This article describes the case of a 21-year-old man who was admitted to the emergency department of a hospital in India with a pelvic fracture and haemorrhage following a road traffic accident. It highlights the crucial role of nurses in coordinating the initial assessment, diagnostic investigations and treatment as well as the ongoing management of patients presenting with such injuries. Timely interventions by a multidisciplinary team are critical for preventing hypovolaemic shock, reducing mortality and limiting disability.

Mycosis fungoides is a type of cutaneous T-cell malignancy that gives different skin manifestations. Hyperpigmented mycosis fungoides is a very rare type of mycosis fungoides that presents with hyperpigmented patches and macules on the skin, it is reported to affect patients in their 30s, with only few cases reported to date. In this article, we present a unique case of hyperpigmented mycosis fungoides in which histological examination of the skin biopsy showed spongiosis, which is a rare histologic manifestation in mycosis fungoides, which makes the case more exceptional.

A 61-year-old Syrian male presented to the dermatology clinic complaining of a persistent pigmented itchy lesion on the right side of the trunk and right thigh. Histological examination of the skin biopsy showed parakeratosic hyperkeratosic epidermis with spongiosis and deposition of melanophages, immunohistochemistry showed CD3+, CD4-, CD8+, and CD20-, and our patient was diagnosed with hyperpigmented mycosis fungoides, and subsequently treated with psoralen and ultraviolet A therapy, a very good improvement was noted, and the prognosis was excellent.

Although hyperpigmented mycosis fungoides is an extremely rare condition, clinical practitioners should consider it as a diagnosis that may be encountered when approaching a persistent pigmented skin lesion to provide correct clinical orientation and avoid confusion with differential diagnoses. The diagnosis of hyperpigmented mycosis fungoides should not be excluded based only on the age. Skin biopsy and immunohistochemistry are the irreplaceable investigations to diagnose hyperpigmented mycosis fungoides. Spongiosis, although rare in mycosis fungoides, should not rule out the diagnosis of hyperpigmented mycosis fungoides.

Background: This case report describes the rare coexistence of cervical cancer with pregnancy, a challenging scenario requiring careful balance between maternal treatment and fetal safety. In Poland, cervical cancer remains a significant health issue, highlighting the need for effective multidisciplinary strategies. Methods: This case report was prepared based on CARE guidelines for medical case reporting. The patient was observed by a clinical psycho-oncologist-midwife and a psychologist (also specializing in clinical psycho-oncology) from the start of oncological treatment until delivery and early postpartum. During pregnancy, the pregnant woman was asked three times (at the 23rd, 32nd, and 38th weeks of pregnancy) to complete questionnaires: a self-report questionnaire collecting sociodemographic data, clinical information, and perception of causes and effects of fatigue, the Chalder Fatigue Questionnaire (CHFQ-PL), the Fatigue Management Barriers Questionnaire (FMBQ), the Multidimensional Social Support Scale (MSPSS), and the Walsh Family Resilience Questionnaire (WFRQ-PL). Results: The patient, a 37-year-old woman in her second pregnancy, presented with cervical cancer diagnosed in the first trimester. Major concerns included fatigue, emotional distress, and treatment-related uncertainties. Throughout the pregnancy, she underwent four chemotherapy cycles and participated in psycho-oncological assessments to monitor fatigue, which increased as treatment progressed and affected daily functioning and emotional well-being. To enable the early continuation of oncology treatment, the pregnancy was electively terminated by cesarean section at 37+5 weeks, resulting in the good condition of the infant and a stable maternal postpartum condition, though anemia and emotional concerns required further management. Conclusions: As research on fatigue in pregnant oncology patients is limited, this case underscores the value of structured psycho-oncological support to enhance care and outcomes for both mother and child.

Pediatric antiphospholipid syndrome is a rare systemic autoimmune disorder characterized by recurrent thrombotic events in the presence of antiphospholipid antibodies. Isolated right renal vein thrombosis resulting in a nonfunctional kidney is an uncommon manifestation of antiphospholipid syndrome. Here, we present our experience with antiphospholipid syndrome secondary to systemic lupus erythematosus.

A 10 year-old girl from a Hindu family in Sindh, Pakistan, who had previously been healthy, presented in 2020 with a 1-week history of abdominal pain, gross hematuria, vomiting, and fever. On examination, she was anxious, febrile, hypertensive, and had an enlarged, tender right kidney. Other systemic examinations, including skin, locomotor, respiratory, cardiovascular, and nervous systems, were unremarkable. Initial investigations for ureteric colic and acute pyelonephritis were negative, but revealed thrombocytopenia on complete blood count, mild proteinuria, hematuria on urinalysis, and normal kidney and liver function tests, along with normal prothrombin and activated partial thromboplastin times. An abdominal ultrasound showed a diffusely enlarged, echogenic right kidney with a loss of corticomedullary distinction and cortical hypoechoic areas, while the left kidney appeared normal. Color Doppler ultrasound identified a large thrombus in the right renal vein, completely obstructing its lumen and showing no blood flow. The thrombus extended into the inferior vena cava. Computed tomography angiography confirmed an organized thrombus completely blocking the right renal vein and extending into the infrahepatic portion of the inferior vena cava. No prothrombotic risk factors were identified during clinical evaluation, and thrombophilia screening was negative. However, lupus serology and antiphospholipid antibodies were positive, confirming a diagnosis of secondary antiphospholipid syndrome.

The patient was treated with enoxaparin anticoagulation, later transitioned to warfarin sodium, and her hypertension was managed with captopril and amlodipine. She showed gradual improvement over 10-12 days and was discharged on anticoagulants, antihypertensive medications, antiplatelet agents, and hydroxychloroquine. A follow-up Doppler ultrasound revealed persistent blockage of the right renal vein by the thrombus, with no thrombus in the inferior vena cava. A dimercaptosuccinic acid scan indicated a nonfunctioning right kidney. While nephrectomy was recommended, her parents declined the procedure. Anticoagulation therapy was switched to rivaroxaban to avoid frequent international normalized ratio monitoring. Her captopril was replaced after control of blood pressure with losartan. Over the next 4 years, her follow-up was uneventful. She demonstrated normal growth, stable blood pressure (off antihypertensive), and normal kidney function without proteinuria. There were no lupus flares or thrombotic recurrences. Her most recent urinalysis was normal, with a serum creatinine level of 0.6 mg/dL and an estimated glomerular filtration rate > 170 mL/min/1.73 m2.

Isolated renal vein thrombosis is a rare presentation of antiphospholipid syndrome and poses a diagnostic challenge in the absence of preexisting prothrombotic risk factors. Early diagnosis and timely management are crucial to prevent organ damage. In this case, the patient retained a solitary functioning kidney. Long-term follow-up is essential to monitor for lupus flares, thrombus recurrence, hypertension, proteinuria, and progression to chronic kidney disease, as well as to ensure continued thromboprophylaxis.

This report describes the case of a 31-year-old male lumberjack with severe self-inflicted injuries, including the amputation of both auricles and the penis, under the influence of cannabinoids, mitragynine, and 7-hydroxymitragynine. Emergency surgery was performed, and psychiatric evaluation revealed substance-induced psychosis. The patient's motivation for reconstructive penile surgery led to abstinence from the substance use and cooperation with treatment. Five months after hospitalization, successful penile reconstruction was completed. The patient remained abstinent and was engaged in regular psychiatric follow-ups, showing no signs of acute psychopathology. This case underscores the importance of using a multidisciplinary approach to manage severe self-harm behaviors, and highlights the critical role of patient motivation in achieving positive outcomes.

This paper presents a large publicly available benchmark dataset (TCMEval-SDT) for the thought process involved in syndrome differentiation in traditional Chinese medicine (TCM). The dataset consists of 300 TCM syndrome diagnosis cases sourced from the internet, classical Chinese medical texts, and medical records from hospitals, with metadata adhering to the Findable, Accessible, Interoperable, and Reusable (FAIR) principles. Each case has been annotated and curated by TCM experts and includes medical record ID, clinical data, explanatory summary, TCM syndrome, clinical information, and TCM pathogenesis, to support algorithms or models in emulating the diagnostic process of TCM clinicians. To provide a comprehensive description of the TCM syndrome diagnosis process, we summarize the diagnosis into four steps: (1) clinical information extraction, (2) TCM pathogenesis reasoning, (3) TCM syndrome reasoning, and (4) explanatory summary. We have also established validation criteria to evaluate their ability in TCM clinical diagnosis using this dataset. To facilitate research and evaluation in syndrome diagnosis of TCM, the TCMEval-SDT dataset is made publicly available under the CC-BY 4.0 license.

Higher-order pregnancy is considered as a high-risk pregnancy, followed by various maternal and foetal complications. The diagnosis and management of higher order pregnancy have abundant and complex challenges, especially in rural areas where antenatal care (ANC) is often inadequate. Late booking and low awareness of complications necessitates priority management and referral to a tertiary center for fetal medicine expertise. This is our experience managing a spontaneously conceived quadruplet pregnancy delivered prematurely in a low-resource setting.

A 27-years-old primigravida of 7.5 months of gestation presented with preterm labor. Her membrane was intact, and she noted active fetal movements. Her history was notable due to her pregnancy being spontaneously conceived and that her antenatal consultations had mistakenly identified her pregnancy as a triplet pregnancy. At presentation, her fundal height was 49 cm, and her cervix was 5-6 cm dilated. As she was in active labor, she underwent an emergency caesarean section. Four neonates were delivered but only two were transferred to the neonatal intensive care unit due to infrastructure limitations. She made an uneventful recovery and was discharged 2 days later. However, only two of four neonates eventually survived. This quadruplet pregnancy signified the pertinent complications of multifetal pregnancy: misidentification of chorionicity; preterm delivery; and early neonatal deaths due to prematurity.

Higher order pregnancies present their own challenges for diagnosis and treatment. Preterm delivery and its associated neonatal complications are well-known complications, and a multidisciplinary management is crucial.

Leiomyomatosis peritonealis disseminata is a very rare disease that involves the presence of multiple benign tumors of smooth muscle origin all over the peritoneal cavity. Due to its ability to mimic malignant pathologies, it is associated with significant diagnostic and therapeutic challenges. This case highlights a unique case of LPD to further raise awareness and provide useful information on how to manage this condition.

A 28-year-old female was admitted with progressive increase in abdominal distension and discomfort. Imaging studies revealed multiple peritoneal nodules that mimicked metastatic disease. Laparoscopic exploration and histopathological examination subsequently confirmed the diagnosis of LPD. She never had a history of malignancy and hormonal therapy, which are the usual associations with this condition.

Diagnosis of LPD is usually missed because its clinically and radiologically smoky appearance of the belly may mimic peritoneal carcinomatosis. Pathogenesis includes hormonal factors, though rare cases are idiopathic. Symptomatic nodules are usually treated with surgical excision and in recurrent cases, attempts at hormonal manipulation can be done.

This case shows the inclusion of LPD in the differential diagnosis of peritoneal masses is of paramount importance, especially in women of childbearing age. Early and accurate diagnosis will help in avoiding the unnecessary aggressive measures.

To assess the clinical and radiographic outcomes of overdentures and their retaining dental mini-implants, based on a single-arm systematic literature review.

Electronic search was undertaken in three databases, last updated in October 2023, plus manual search of journals. Cumulative implant survival rate (CSR) and the estimated marginal bone loss (MBL) under different follow-up times were calculated.

Thirty-nine studies were included, with 3,787 mini-implants supporting 1,026 overdentures (109 maxilla, 896 mandible) in 1,005 patients, with a mean follow-up of 28.1 ± 19.8 months (min-max 0.3-84.0). 202 mini-implants failed, after a mean of 9.4 ± 11.8 months (7-year CSR 91.4%). The implant survival was lower in the maxilla in comparison to the mandible (p < 0.001), lower for early/delayed-loaded in comparison to immediately-loaded implants (p = 0.005) and lower for 2-mini-implant in comparison to 4-mini-implant-retained mandibular overdenture (p < 0.001; Log-rank test). A high rate of transversal fracture of the prosthesis and wear of the attachment parts was observed. The estimated mean MBL gradually increased from 0.518 (≤ 6 months) to 1.260 mm (58.8-90 months). There was an estimated MBL increase of 0.011 mm per additional month of follow-up.

Although presenting a high 7-year CSR, mini-implant-retained overdentures may require frequent maintenance follow-ups, due to the high rate of technical complications. The estimated MBL of mini-implants over 80 months is low.

The ability to anticipate outcomes is an essential part of risk management in clinical practice. The findings reported herein set some recommendations and potential strategies for minimizing failures and complications commonly associated with this mini-implant-retained overdentures.

Torcular dural sinus malformations (tDSMs) with high-flow fistulas pose complex management challenges due to their vascularity and the delicate neuroanatomy involved. This report presents the case of a child with tDSM and hydrocephalus, who underwent 3 staged embolization procedures but required a redo intervention due to residual malformation and venous hypertension. Utilizing the pressure cooker technique (PCT) in a redo setting allowed for high-pressure, targeted embolic delivery with minimized reflux, achieving near-complete occlusion and significant symptom relief. This case highlights PCT's potential to improve outcomes in multi-stage treatments of high-flow tDSM, reducing reflux and enhancing safety in technically demanding cases.