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Background: In an ageing population, dementia has become an imminent healthcare emergency. Capgras syndrome, the most common delusion of misidentification (DMS), is frequently found alongside dementia. Previous research showed that Capgras syndrome has significant negative effects on people living with dementia and their carers due to its complex presentation and impact on their lives. This qualitative systematic review explores the evidence base of the effective management and treatment of Capgras syndrome in dementia., Aims: As per our knowledge, this is the first systematic review exploring the symptomatology of Capgras syndrome across different types of dementia. Additionally, it aims to identify the treatments used and their efficacy., Methods: Four databases (EMBASE, MEDLINE, PsycINFO, and CINHAL) were screened in March, 2023. Twenty-six studies met the inclusion criteria and were included in the review. Thematic analysis was performed to explore and synthesise the qualitative findings of the studies., Results: Three conceptual themes were identified: diagnostic tools, Capgras syndrome symptomatology, and Capgras syndrome treatment. Results showed that Capgras syndrome in dementia is not diagnosed and treated in a standardised manner. Following the pharmacological intervention, 28% of cases showed resolution of symptoms, and another 28% experienced improvement. However, 7% of cases reported worsening symptoms, and 10.7% experienced no change. While some patients had positive outcomes with specific medications, others either did not respond or experienced a deterioration of their condition., Conclusion: The results highlight that there is no single treatment approach for Capgras syndrome in people living with dementia. This underscores the need for person-centred care, where treatment is tailored to individual needs. The review also reveals a heavy reliance on antipsychotic medications and a noticeable lack of psychosocial interventions. Given the limited benefits and significant risks associated with antipsychotics, future research should prioritise developing and testing psychosocial approaches. Additionally, establishing standardised diagnostic criteria and consistent outcome measures for Capgras syndrome in dementia is crucial for evaluating treatment effectiveness and improving care., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Imipenem-cilastatin, a carbapenem antibiotic, is commonly used for severe bacterial infections. While generally well-tolerated, it can rarely cause central nervous system toxicity, including seizures. We have, herein, reported a case of imipenem-cilastatin-induced seizure in a 20-year-old patient., Case Presentation: A 20-year-old male was admitted to the intensive care unit for febrile status epilepticus and acute respiratory distress syndrome. Initial evaluations ruled out underlying causes and anti-epileptic treatment has been initiated. Despite having an effective anti-epileptic treatment for three months of hospitalization, seizure recurrence occurred, leading to antibiotic regimen adjustment as the imputability of imipenem-cilastatin was suspected. After discontinuation of the involved drug, the patient remained neurologically stable. Previous literature has reported cases of imipenem-cilastatin-induced seizures, particularly in elderly patients or at higher dosages. The causality assessment was conducted using the updated French method, which rated the chronological criterion as C2 and the semiological criterion as S2. The intrinsic imputability score was I3, indicating plausible causality, and the extrinsic bibliographic score was B3., Conclusion: Our case has highlighted the importance of promptly recognizing imipenem-cilastatin- induced epileptic seizures in order to treat them more effectively and thus optimize the patient's care. Therefore, we emphasize that clinicians be vigilant about the side effects of its use, particularly in patients with neurological susceptibilities. We also advocate a personalized choice of antibiotics, taking into account both antimicrobial efficacy and potential adverse effects, for better outcomes with fewer risks., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

COVID pandemic has been a cause of extensive morbidity and mortality worldwide. Patients with severe COVID have been observed to suffer from remnant lung damage, fibrosis and oxygen dependency. These patients have still an unpredictable course and outcome. The outcome of these patients is not clearly defined yet. The signs and symptoms in such patients persisting even 4 weeks after acute COVID-19 has been recently named as "Long COVID". In the present case series, we present the course and outcome of two such ‘Long COVID’ patients who presented with severe hypoxemic respiratory failure. These patients were managed with a prolonged application of Non-invasive ventilation with high flow oxygen and alongwith glycaemic control, steroids and antibiotics. The patients showed tremendous response to the treatment and could be weaned from NIV after about three weeks of therapy. These cases demonstrate the utility of NIV, even in severe hypoxemic respiratory failure, in Long COVID.

Typical radiological findings in patients with SARS-CoV-2 pneumonia consist of the presence of bilateral pulmonary opacities (both ground-glass attenuations and consolidations) with a peripheral or subpleural distribution, often involving the posterior regions of both lungs specifically. Although interstitial pneumonia represents the hallmark of COVID-19, the clinician should remember that sudden worsening gas exchange may have different aetiology. Pneumothorax and pneumomediastinum are well-known complications of invasive mechanical ventilation. However, since the beginning, the development of spontaneous pneumothorax and pneumomediastinum was reported in COVID-19 patients, without risk factors. The exact mechanism for the development of spontaneous pneumothorax and pneumomediastinum in COVID-19 patients is still unclear, and findings suggest that these clinical manifestations can be interpreted as an index of lung disease severity associated with complicated hospital courses, worst prognosis and increase in mortality rate. We report a case of a SARS-CoV-2 infected obese male patient, in quarantine and without risk factors, presenting to the emergency department for severe dyspnea due to COVID-19 pneumonia complicated by spontaneous pneumothorax and pneumomediastinum.

Chronic kidney disease (CKD) is characterized by loss of kidney function and generally it is associated with several alterations in pulmonary functions, including restriction, obstruction, and impaired diffusion capacity. It became challenging to maintain oxygenation in a CKD patient associated with COVID 19 on non-invasive ventilation (NIV). In patients with end stage renal disease (ESRD), several factors likes, fluid overload, anaemia, immune suppression, extraosseous calcification, malnutrition, electrolyte imbalance, and acid-base disorder affecting the lungs indirectly. Here we are reporting NIV failure in two COVID 19 patients during dialysis. Both patients were stable on NIV before starting dialysis and underwent oxygen desaturation and shifted to invasive mechanical ventilation during hemodialysis. The possible mechanism of the oxygen desaturation is alveolar hypoventilation in the absence of hypercapnia, which may be due to the removal of CO2 from the body by some route (dialysate) other than the lungs.

Central giant cell granuloma (CGCG) is a relatively uncommon benign osseous lesion with sometimes aggressive nature. The nature of this lesion is unknown and although the exact cause is unclear, the three theories about possibility of its nature are: developmental anomaly, reactive lesion or benign neoplasm. Histologically by presence of multinucleated giant cells within a stroma of spindle-shaped mesenchymal and fibro vascular connective tissue along with containing of hemorrhagic areas is characterized. This case report presents the diagnosis and management of a CGCG in a 50 years-old man with biopsy and surgical treatments. The lesion involve the left side of mandibular. Diagnosis plan was designed based on the combination of pathology and imaging. Finally after en bloc resection of involved regions of mandible, a titanium plate prosthesis was used for the jaw reconstruction. Since some of CGCG lesions can be highly invasive and inclinically and radiographic features can mimic as malignancy lesions. Keywords: Central giant cell granuloma; Malignant lesion; Case report.

The location and the size of intracranial haemorrhage play an important role in determining the time for the hematoma resolution. Without surgical intervention, it takes at least a few weeks for the whole hematoma to resolve spontaneously. Despite that the rapid and spontaneous resolution of intracranial haemorrhage is well described in the literature, it is considered rare. Moreover, we could identify only one case of rapid spontaneous resolution of isolated traumatic intraventricular haemorrhage (ITIVH) in the literature. Herein, we report a rare case of ITIVH that disappeared rapidly without surgical intervention. Our case supported the hypothesis that the cerebrospinal fluid (CSF) and its circulation are major players in the rapid resolution of ITIVH.

Kounis syndrome (KS) is an acute coronary syndrome developing as a consequence of an anaphylactic or allergic reaction. Multiple mediators (especially histamine) released by mast cells, platelets, and some immune cells may lead to coronary vasospasm or thrombosis and cause an acute coronary syndrome. A clinical case of the KS in a hospitalized patient being treated for the COVID-19-associated pneumonia is presented. A 62-year-old woman was treated for COVID-19-associated pneumonia. In 15 min after the beginning of the Moxifloxacin infusion, the patient complained of severe headache, crushing chest pain, abdominal pain, severe general weakness, shortness of breath. Hypotension and decrease in SpO2 developed. Immediately performed ECG showed the ST-segment elevation in leads I and aVL. There were reciprocal changes in leads III, aVF, V3-V6. Troponin I was slightly elevated. Coronary angiography showed no hemodynamically significant coronary artery lesions. The KS type 1 was diagnosed. Repeated ECG in 2 hours showed isoelectric ST segments in all leads. It may be difficult to diagnose KS. Clinical signs of an allergic or anaphylactic reaction should raise the suspicion of KS. Moxifloxacin as well as other fluoroquinolones may be associated with the development of KS. We suggest a possible association of COVID-19 with KS. However, this issue requires further observation.

Background: Primary localized mediastinal mesothelioma is a rare tumour which accounts for about 0.7% of all mesotheliomas. The mesothelial cells lining of the pericardium are suggested as the most probable cells of origin. Mediastinal pleural mesothelioma are distinctly uncommon, which has only been reported in a single case. Case presentation: We report a case of a 57 years old man with primary mediastinal pleural mesothelioma involving middle and posterior upper mediastinum, one months following surgery, the patient is alive with good performance status. Chest plain scan and contrast-enhanced computer tomography（CT）scan showed a 43 mm×36 mm×36 mm tumor，with a CT value of about 41.5 HU, an arterial phase CT value of about 59.8HU and a venous phase CT value of about 77.5HU during the contrast-contrast-enhanced scan.Patients underwent thoracotomy.The pathological diagnosis was derived from malignant pleural mesothelioma(MPM) growing from the chest wall into the mediastinum. Conclusions Imaging manifestations of tumors have rarely been described in the literature. A short review of literature on MPM is given and summarize the imaging characteristics.

BACKGROUND AND OBJECTIVE: Cerclage surgeries for the treatment of cervical insufficiency are performed transvaginally. However, in some patients, due to anatomical changes of the cervix caused by congenital factors or previous surgery, they cannot be performed transvaginally. Transabdominal cervicoisthmic cerclage (TCIC) is considered in these cases. The aim of the present study was to report the results of three successful cases of transabdominal cerclage. CASE REPORT: The first patient was a 34-year-old woman with a history of failed curettage and transvaginal cerclage. By the seventh week of pregnancy, the patient underwent transabdominal cerclage via laparotomy due to the possibility of preterm delivery and cervical insufficiency. The next patient was a 40-year-old woman with a history of performing six IVF sessions and having two live fetuses, underwent TCIC laparotomy at 13th week of pregnancy due to the possibility of preterm delivery and cervical insufficiency. Another patient was a 24-year-old woman with a history of transvaginal curettage and cerclage and 2 miscarriages. This patient also underwent laparoscopic TCIC surgery due to the possibility of preterm delivery and cervical insufficiency. All three patients underwent cesarean section at 38th week of gestation and gave birth to healthy babies. CONCLUSION: According to the present study, transabdominal cerclage via laparoscopy or laparotomy in patients with preterm delivery or cervical insufficiency has favorable results in women with unsuccessful transvaginal cerclage.

Nicolas Dufour,1 Fouad Fadel,1 Bruno Gelée,1 Jean-Louis Dubost,1 Sophie Ardiot,2 Pascal Di Donato,2 Jean-Damien Ricard3,4 1Medical and Surgical Intensive Care Unit, Centre Hospitalier René Dubos, Pontoise 95300, France; 2Agence Nationale de Sécurité du Médicament et des Produits de Santé, Direction des Dispositifs Médicaux, des Cosmétiques et des Dispositifs de Diagnostic in vitro, Saint-Denis Cedex 93285, France; 3Medical and Surgical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, 92700 Colombes, France; 4Infection, Antimicrobials, Modelling and Evolution, Université de Paris, IAME UMR 1137 Institut National de la Santé et de la Recherche Médicale, Paris 75018, FranceCorrespondence: Nicolas DufourCentre Hospitalier René Dubos, 6, Avenue de l’île de France, Pontoise 95300, FranceTel +33 130754341Email nicolas.dufour@ght-novo.frBackground: Complexity and functions of automated medical devices used to support life (eg, ventilators, dialysis machines, monitors, insulin pump with continuous blood glucose monitoring system, etc.) increase over time. Until recently, devices were partially automated by very simple feedback loops, with no or few software dependence (such as the simplest home thermostat). For the last two decades, devices have been increasingly driven by complex algorithms devoted to improve patient’s treatment and monitoring as well as users experience.Methods: We report the unexpected and inappropriate operation of two recent ventilators, associated to potential harmful consequences. We provide both a description of the clinical situations (five ICU patients, archetypal situations) and a test bench analysis.Results: While set in volume mode, these ventilators activated an algorithm dedicated to limit airway pressure when an increase in airway resistance occurred. In such situations, a pressure-like mode was activated (with decelerating inspiratory flow and set pressure, with target of volume). The main consequences observed were that the tidal volume was no longer guaranteed or delivered and that the pressure limitation operated by the algorithm prevented the airway pressure from reaching the high-pressure alarm threshold.Conclusion: This led to the silent takeover of commands by the ventilator without clinicians or nurses being aware of it and without any warnings or alarms emission adapted to the severity of the event. Generally speaking, such an algorithm questions the place of automation and its limit when users are not aware of its presence as well as the need for regulation and additional tests before its implementation. Intensivists and respiratory care specialists should remain vigilant regarding the risk of rare but critical events related to unexpected functioning or insufficiently tested equipment during the pre-clinical development phases. They should not neglect misunderstood critical events without having performed sufficient investigations.Keywords: mechanical ventilation, algorithm, dual mode, automation, material vigilance, case report

BACKGROUND AND OBJECTIVE: Giant hemangiomas are less likely to be present at birth. This syndrome is caused by obstruction of the portal veins of the liver and requires surgical intervention. Treatment of hepatic hemangiomas varies depending on the symptoms, location and size. In this study, giant hepatic hemangioma in a patient with Budd-Chiari syndrome was reported. CASE REPORT: The patient is a 57-year-old woman with a giant hemangioma in the liver who has referred to Montaserieh Hospital in Mashhad with symptoms of liver failure, anorexia and early satiety and obstruction of hepatic portal veins. She did not mention any specific drug or food allergies. Except for the heartbeat, all other vital signs were in the normal range. Initial examinations diagnosed giant liver hemangiomas and ascites. After performing the required diagnostic tests, the liver weighing about 10 kg was removed and a liver transplant was performed. After 13 days, the patient was discharged in good general condition. CONCLUSION: One of the rare indications for liver transplantation is giant hepatic hemangioma, which causes liver dysfunction and Budd-Chiari syndrome. Liver transplantation in these patients improves their life and shows good results.

Background: Non-small Cell Lung Cancer (NSCLC) makes up about 85% of lung cancer cases, mainly adenocarcinoma and squamous cell carcinoma. Recently, PD-1 inhibitors have become crucial in NSCLC treatment, significantly enhancing survival for some. However, side effects, like skin reactions and hematotoxicity, limit their use, with drug-induced TEN and immunotherapy-induced agranulocytosis as severe adverse effects., Case Presentation: Herein, we have reported the case of a 75-year-old male diagnosed with metastatic Lung Squamous cell Carcinoma (LUSC) in the left lung. He received first-line treatment with one cycle of tislelizumab in combination with nab-paclitaxel and carboplatin, after which he developed Toxic Epidermal Necrolysis (TEN) and granulocytopenia. To address these two serious immune-related Adverse Events (irAEs), the patient was administered methylprednisolone in combination with gamma globulin for TEN and dexamethasone in combination with G-CSF for agranulocytosis. Antibiotics were also administered according to the patient's medication regimen. After treatment, the patient recovered and was discharged from the hospital. It was also noted that the lung tumor condition improved., Conclusion: Effective management of severe immune-related side effects from tislelizumab, including TEN and agranulocytosis, can be partly achieved through steroids, gamma globulin, GCSF, and antibiotics. This strategy not only alleviates these adverse effects, but also potentially improves tumor conditions, highlighting the crucial role of vigilant monitoring and management in immunotherapy., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases, otolaryngological diseases, central nervous system abnormalities, reproductive system abnormalities, and cardiac function abnormalities. General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease., Case Summary: A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture. Three years prior, he had been diagnosed with PCD. At that time, he had experienced several episodes of pneumonia, sinusitis, and chronic middle ear infections, for which he underwent surgical interventions. At the current admission, he presented with cough and sputum but no other respiratory symptoms. A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe. For the surgical procedure and postoperative pain management, combined spinal-epidural anesthesia was employed. The patient's postoperative pain score was measured by the numerical rating scale (NRS). On the day of surgery, his NRS was 5 points. By the second postoperative day, the NRS score had decreased to 2-3 points. The epidural catheter was removed on the fourth day following the operation. The patient was subsequently discharged no respiratory complications., Conclusion: We performed combined spinal-epidural anesthesia in a patient with PCD. The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Insomnia is a key risk factor for depression and mental disorders, both in general and during peripartum. Covid-19 pandemic outbreak was associated with an alarming increase of insomnia symptoms. This case report aims to describe a digital Cognitive Behavioral Therapy for Insomnia (CBT-I) intervention adapted for pregnancy during the pandemic situation. This article describes the case of a 38 years old woman with significant problems in initiating and maintaining sleep. The intervention was conducted online. The assessment included a clinical psychological interview, semi-structured interview about sleep, sleep diaries and validated questionnaires. Adapted CBT-I protocol was performed including 5 sections lasting 45 minutes each. The case-report description follows CAse REport (CARE) guidelines. The intervention was effective in reducing insomnia symptoms as highlighted by questionnaires and sleep diaries. Furthermore, results showed positive findings with regard to depression symptomatology, stress levels and difficulties in emotion regulation. These positive results were confirmed at post-partum follow ups. Evidence-based CBT-I protocol was applied with relevant benefits for the patient. Furthermore, it was stressed the importance of considering emotions during psychotherapy. High-quality clinical trials evaluating the efficacy of adapted CBT-I in large samples of expecting mothers are suggested to guide changes in gynecological primary care for pregnancy, especially for the post-pandemic time. [ABSTRACT FROM AUTHOR]

Post-partum pubic symphysitis is an exceptional pathology. Its diagnosis is difficult, based on a high clinical semiological finesse complemented by imaging examinations, the most specific of which are CT and pelvic MRI. The earlier the diagnosis, the better the evolution. We report a case of pubic symphysitis occurring in the aftermath of a low-pathway delivery discovered in a septic shock table. Evolution was good under antibiotic and heparin therapy.

Introduction: Our case is unique because the differential diagnosis was a challenge. At first, the patient presented with septic shock and multi-organ failure in the context of a suspected lymphoproliferative syndrome. Once the lymphoproliferative process had been ruled out, hemophagocytic syndrome due to COVID-19 infection was suspected, so he is probably one of the few patients with such an exhaustive study that could contribute to our understanding of COVID-19. We followed therapeutic guidelines that differ from the usual, using adrenalin and levosimendan. Corticosteroids helped to modulate the cytokine storm. Case report: A 16-year-old adolescent was admitted to the intensive care unit with fever, diarrhea, multiorgan failure and septic shock. He was IgG positive for COVID-19 and IgM negative. Thoraco-abdominal computed tomography demonstrated multiple para-aortic and peri-pancreatic lymphadenopathy and acute respiratory distress syndrome. The first suspected diagnosis was a lymphoproliferative syndrome and bacterial infection. The second possibility was a hemophagocytic syndrome in a patient recovering from COVID-19. He was treated with broad spectrum antibiotics because the differential diagnosis was difficult, and we removed them when the microbiological screening was negative. During the course of the disease he presented with severe biventricular dysfunction, probably due to the cytokine storm, so we used inotropic drugs (adrenaline, levosimendan). Infection with Salmonella species group B was diagnosed later, when the patient was in the Internal Medicine ward, although he was asymptomatic. Conclusion: The severity of COVID-19 infection ranges from mild to severe, causing serious disease in some people. Although the pathophysiology is not well known, it seems that in some cases an immune storm is triggered, and it is related to more serious and prolonged disease. In our case, heart failure was important, because it could have worsened the prognosis. Fortunately, the response to levosimendan and corticosteroids was adequate and he recovered favorably until discharge.

Introduction. Acute kidney injury (AKI) is a clinical syndrome with high mortality. It is a clinical syndrome consisting in rapid impairment of kidney function. The result is retention of metabolic products in the body and the inability to maintain normal water-electrolyte and acid-base homeostasis. Chronic heart failure is a significant clinical, economic and social problem, and despite the continuous development of medicine, the incidence of this disease is still increasing. A weakened inefficient heart is not able to supply the organs with the right amount of blood, oxygen and nutrients. The effect is fast fatigue, weakness of muscle strength and dizziness. Kidney and cardiovascular diseases affect each other and increase their course, which worsens the patient's condition. Periodic monitoring of renal function in patients with cardiovascular disease is very important because it has been proven that the occurrence of kidney disease in these patients increases the risk of death. Case report. Patient, 78 years old, hospitalized many times in the Geriatrics Clinic, Cardiology Clinic, Nephrology Clinic due to shortness of breath, chronic myocardial insufficiency, edema of the lower limbs. The degree of independence is limited, the patient walks with assistance, lives with a family / significant other. Main ailments of the patient: increasing swelling of the lower limbs, left foot pain, nausea, vomiting, palpitations, effortlessness and rest dyspnea without stenocardial complaints. Comorbidities: Type 2 insulin-dependent diabetes mellitus (with unspecified complications), obesity, generalized atherosclerosis, hypertension, chronic NYHA type II heart failure. Cardiac defect in the form of mitral and tricuspid regurgitation, pulmonary hypertension, paroxysmal atrial fibrillation, myocardial infarction. The patient was qualified for hemodialysis treatment, then returned to conservative treatment, followed a strict diet. The applied treatment improved the general condition of the patient and was discharged from the hospital in a stable general condition. Results. Frequent and regular examination of a patient's condition with cardiac-renal syndrome, disease progression and ability to tolerate treatment can be helpful in treating and prolonging the patient's life. It is important to monitor kidney function in people with cardiovascular disease.

Voriconazole is a fluorinated drug from the triazole group that is widely used in the prophylaxis and treatment of fungal infections in immunosuppressed patients. Chronic use of this medication can generate, as an adverse effect, a multifocal, asymmetric, diffuse and nodular periosteal reaction, associated with severe and disabling skeletal pain and elevated alkaline phosphatase and serum fluoride. Radiography is the imaging technique of choice for periostitis diagnosis. In general, clinical manifestations and radiographic findings disappear, when the drug is discontinued. We report the clinical case of a 44 year-old woman diagnosed with acute myeloid leukemia, who developed an invasive fungal infection treated with voriconazole after a stem cell transplant. Nine months after starting antifungal treatment, she manifested symptoms and radiological signs compatible with periostitis. Due to clinical suspicion, we decided to suspend voriconazole, with consequent resolution of clinical manifestations and radiological findings.

Tracheoesophageal fistula is a challenging anomaly with a rare prevalence with symptoms mainly respiratory, sometimes digestive. We present a rare case of oesophageal atresia with distal Tracheoesophageal fistula in a female child whose mother presented with severe oligohydramnios on ultrasonography with intrauterine growth retardation before cesarean section. After the birth of preterm and very low birth weight neonate, we initially diagnosed as respiratory distress syndrome with a club foot. However, we diagnosed oesophageal atresia with distal Tracheoesophageal fistula on the 2nd day as nasogastric tube insertion was failed beyond 10cm and confirmed by X-ray with a rubber catheter. Right thoracotomy with ligation of the fistula with end to end anastomosis was performed successfully without complications. Breastfeeding initiated and the child discharged after she started gaining weight. Early post-operation complication (anastomotic stricture) was noticed after 2 weeks; however, corrected with endoscopic balloon dilatation. Currently, the child is healthy weighing 10kgs at 18 months of age.

Daniela Floridia, Francesco Cerra, Giuseppe Guzzo, Silvia Marino, Nunzio Muscarà, Francesco Corallo, Alessia Bramanti, Antonino Chillura, Antonino Naro IRCCS Centro Neurolesi Messina, Messina, Italy Purpose: Brachial plexopathy can sometimes cause severe chronic pain. There are many possible treatments for such neuropathic pain, including neuromodulation. However, rigorous scientific evidence on the usefulness of spinal cord stimulation (SCS) is still scarce. Here, we report the use of high-frequency (10 kHz) SCS (HFSCS) in a patient with brachial plexus injury (root avulsion).Objective: To assess the efficacy of HFSCS in root avulsion and to investigate the putative neurophysiological mechanisms of HFSCS.Methods: A 32-year-old woman visited our center following an iatrogenic brachial plexus injury. She underwent traditional, paresthesia-inducing, tonic SCS with cervical lead placement. She reported that stimulation-induced paresthesia was uncomfortable, without any pain reduction. After the successful trial of HFSCS, the patient was assessed at 1 month (T1) and 6 months (T6) after HFSCS implantation with pain and quality of life (QoL) scales. Moreover, she underwent a neurophysiological assessment (somatosensory evoked potentials [SEPs], reciprocal inhibition [RI], pain-motor integration [PMI], and the habituation of intraepidermal electrical stimulation-induced evoked potentials [IEPs]) with the stimulator switched on and switched off at T6.Results: The patient reported 100% paresthesia-free pain relief, a consistent improvement of QoL, and a complete discontinuation of her previous pain treatment at T1 and T6. Moreover, we found suppression of SEPs, restored habituation of IEPs, and strengthening of RI and PMI.Conclusion: This is the first report to illustrate the usefulness and safety of HFSCS for treating root avulsion in a patient with failed tonic SCS. Our data indicate that HFSCS may either block large-diameter fibers or stimulate medium-/small-diameter fibers, thus inducing analgesia without paresthesia, probably by reducing the activation of the wide-dynamic-range neurons. Moreover, HFSCS seems to modulate spinal inhibitory mechanisms and the descending corticospinal inhibitory output. Thus, HFSCS can be an effective option for treating refractory pain following root avulsion. Keywords: Mechanism, root, avulsion, chronic, pain, neuromodulation

Hydatid cyst is a zoonotic endemic disease in Iraq. It carries considerable complications either related to the disease itself or following its surgical removal. Pleural and pericardial effusion is a rare postoperative complication of hydatid cyst removal. A 65year-old Iraqi female patient complained of right-sided chest heaviness and palpitation one month following surgical removal of 2 large hydatid cysts. There were no other associated symptoms. Physical examination revealed the possibility of pleural and pericardial effusions (poor air entry and stony dullness of the right posterior part of lower zone, difficulty to palpate the apex beat, increase heart dullness, and no pericardial rub). The diagnosis was confirmed by chest X-ray and echocardiogram. She received Albendazole tablet 400 mg twice daily for 6 weeks with a good response. The Early presumption of the disease in an endemic area with a good dose and appropriate course of Albendazole tablets treatment can give very good results. To our best knowledge, this is the first case in the world who presented with hydatid cyst pleural and pericardial effusions and responded completely to the Albendazole tablets. [ABSTRACT FROM AUTHOR]

Wei Wang, Qingbo Li, Lei Cai, Weijun Liu Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China Objectives: Tophaceous gout seldom affects the axial skeleton. Symptoms vary according to the differential localization of urate deposits and the diagnosis is often delayed. Here, we report an unusual case of lumbar spinal stenosis caused by extradural tophaceous deposits.Methods: We retrospectively reviewed a case of a patient with tophaceous gout of the lumbar spine and reviewed the relevant literature.Results: A 62-year-old man with a 2-year history of lower back pain and a 3-month history of lower limb radiation pain and intermittent claudication was admitted. After laboratory and imaging investigations he underwent surgical decompression and stabilization. Histological analysis of the extracted specimen confirmed that it was gouty tophus. The patient’s symptoms improved progressively after the operation. He recovered very well with no complications.Conclusion: The mechanism associated with axial gout is not yet clear. Obesity, inactivity, and previous degenerative disc disease may be the risk factors for spinal tophus. The clinical symptoms are diverse according to the differential localization of urate deposits. It is not easy to diagnose this disease radiographically by routine radiological examination. Analysis of a biopsy specimen is definitely the only way to confirm diagnosis. Surgical treatment should be considered in patients with spinal gout who are experiencing neurological deterioration. Keywords: tophaceous gout, spinal gout, case report

Fahad Al-Saif,1 Ahmed Alhumidi,2 Rama Ayed Alhallaf1 1Dermatology Department, 2Pathology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia Abstract: Dyschromatosis symmetrica hereditaria (DSH) is a rare genodermatosis characterized by various sizes of both hyper- and hypopigmented macules arranged in reticulated patterns on the face and the dorsal aspects of the extremities. There are also cutaneous and extracutaneous abnormalities, but they are rare. As far as we know, DSH associated with immune-mediated conditions has not been reported. We report the first case of DSH, which is associated with cutaneous lupus erythematosus and hyperthyroidism. Keywords: dyschromatosis, genodermatosis, lupus, reticulated, autoimmune

Brunner’s gland adenoma is a rare benign tumor of small bowel, often incidentally discovered during endoscopy or radiological imaging. Mostly they are asymptomatic or often present with nonspecific symptoms such as nausea, vomiting, gastrointestinal hemorrhage, iron deficiency anemia. We reported a 76 years old male case presented with chief complaints of vomiting and black tarry stool. General physical examination was normal except mild tenderness over epigastrium. Esophagogastroduodenoscopy revealed a pedunculated polypoid tubular structure with blind end distally of length approximately 10-12* 3.5*1.5 cm in the second section of the duodenum with multiple skipped ulcers on the exposed surface of it. Additionally, there were few erosions in the duodenum proximally and multiple superficial ulcerations in the antrum, associated with helicobacter pylori confirmed by rapid urease test kit. Keywords: Brunner’s gland adenoma; Brunner’s gland hamartoma; Brunner’s gland hyperplasia; case report.

Background: Premature ovarian insufficiency (POI) is extremely rare in the early stage of undifferentiated connective tissue disease. Patients with POI find it difficult to achieve successful pregnancy and delivery., Case Presentation: A 27-year-old female visited an outpatient department for premature ovarian insufficiency (POI) and infertility. She had regular menstrual periods since she was 14 years old and had no history of systemic disease. Laboratory tests showed low estrogen (15 ng/L, range 19.6-144.2 ng/L), elevated follicle-stimulating hormone (34 U/L), low anti-Mullerian hormone (0.1 μg/L), normal prolactin (11.48 ng/mL), and thyroid stimulating hormone (TSH) levels (0.97 mU/L). She demonstrated smaller bilateral ovarian volume and positivity to antinuclear and antiphospholipid antibodies. After the failure of conventional drug therapy and in vitro fertilization, the patient became pregnant naturally after treatment with glucocorticoids., Conclusion: Immunosuppression could help improve ovarian function and pregnancy outcomes in POI patients, but the therapeutic mechanisms are not clear and should be elucidated with more clinical studies., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Managing a newborn with lethal congenital anomalies is challenging but handling a parent's request for doctors under oath to terminate the baby's life is another major ethical dilemma requiring cautious evaluation. We present a term male neonate who presented on the 7 th day of life, with a dark-blue sclera, multiple limb deformities, long bone fractures, beaded ribs, a flattened forehead, a narrow chest, and respiratory distress. A Diagnosis of Type II Osteogenesis imperfecta was made and he was managed by a multidisciplinary team including neonatologists, geneticists/endocrinologists, orthopaedic surgeons, nurses, and medical social workers. Supplemental oxygen, intravenous fluids and antibiotics, analgesia, and bisphosphonates were offered as supportive care. The main concern was the challenges of managing a newborn with lethal OI and balancing the demand for euthanasia by the parents to end the baby's misery. In providing care, the rights of the child to life, the morals of the physician, the best interests of the baby, and the family's role in decision-making in a setting of out-of-pocket expenditures must be weighed. Following extensive multidisciplinary team meetings, it was ultimately decided to allow nature to take her course. Baby subsequently had progressive respiratory distress from pulmonary hypoplasia and died of respiratory failure on the twelfth day of life. In Conclusion, Osteogenesis imperfecta of the perinatal type is usually a lethal disease, with death often occurring within the perinatal period. The physician must, therefore, balance the parental rights, the oath of office, and the existing legal framework to avoid charges of murder or manslaughter., (Copyright © 2023 Nigerian Medical Association.)

Hunter’s syndrome or mucopolysaccharidosis (MPS) type II is an inherited disorder caused by enzyme iduronate-2-sulfatase deficiency. It is characterized by involvement of the nervous, cardiovascular, respiratory, and musculoskeletal systems, along with numerous oral manifestations. This is a case report of an eight year-old girl diagnosed with Hunter’s syndrome, who was referred to the Pediatric Dentistry Department, Faculty of Dentistry, Cairo University with a chief complaint of hard swelling related to the lower left posterior area. Radiographic examination revealed well defined corticated radiolucency surrounding an unerupted lower left first molar. Aspiration was done and cytopathologic examination revealed cystic fluid mixed with blood. The case was diagnosed as a dentigerous cyst. Cyst marsupialization was done under general anaesthesia. From this case report we concluded that in Hunter’s syndrome patients more conservative approaches are more valuable. Regular dental follow up is advised to maintain good oral hygiene, and to detect any complications as early as possible.

We describe a young woman with patent foramen ovale who developed multiple retinal artery occlusion in the right eye after injection of hyaluronic acid into the nasal root. She reported a gradual decline in visual acuity, with visual field defects that had developed in two stages. Multiple retinal artery occlusion was confirmed by slit-lamp examination, dilated fundus examination, optical coherence tomography, visual field examination, and fundus fluorescein angiography. A patent foramen ovale was detected by electrocardiography, transesophageal echocardiography, and transthoracic sonography. The patient was treated with intravenous dexamethasone and cobamamide, as well as extracorporeal counterpulsation therapy; this approach has not been described in previous literature regarding retinal artery occlusion. The patient's visual acuity improved from counting fingers at 30 cm to 20/133 within 3 days. Our report emphasizes the need for better understanding of vascular anatomy to minimize the risk of complications. Moreover, patients undergoing hyaluronic acid injection should receive information regarding the potential for mild and severe complications; relevant tests should be performed before surgery to exclude vulnerable patients. Finally, a nursing system is needed to facilitate the emergency recognition, triage, and management of retinal artery occlusion.

Introduction: Primary extracranial and extraspinal meningioma is a rare tumor which is usually limited to head, neck or paravertebral soft tissues. Case report: This is the report of a 47-year-old man with a swelling on the right side of his face over the mandibular area. On examination a mass with firm consistency and an approximate diameter of 4 cm was found. Panoramic X-ray showed a unilacular well-defined radiolucency with a cortical border at mandibular ramus area. The lesion was then surgically excisedConclusion: Histologically, proliferation of uniform spindle cells in the whorled and fascicular pattern was seen. Immunohistochemicall study revealed tumor cells positive for Epithelial Membrane Antigen and Vimentin, but showing no reaction for cytokeratin, S-100 and ki-67. A diagnosis of ectopic meningioma with transitional pattern predominance was established according to histopathological and immnuohistochemical features of the mass. Key words: Ectopic meningioma, Mandible, Case report.

Amiodarone is an iodine rich agent widely used for the treatment of ventricular arrhythmias, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter. However 14-18% of patients treated with amiodarone develop overt thyroid dysfunction in the form of either amiodarone-induced thyrotoxicosis (AIT) or amiodaroneinduced hypothyroidism (AIH). Two different types of AIT have been recognised and designated as Type 1 and Type 2. Distinguishing between the two is often difficult, but necessary for instituting appropriate treatment. We report a case of a 56 year-old male patient who was started on amiodarone for atrial fibrillation and then developed AIT. The challenges in the diagnosis and management of these patients are discussed.

Central venous catheters (CVP) are frequently used in clinical practice. Occasionally, catheters may become dislodged. If percutaneous retrieval fails, then cardiothoracic surgery is necessary to retrieve the fractured catheter and avoid potential complications. This report describes early experiences of three different modes of broken catheter retrieval: the first by use of a snare catheter; the second by surgery and the third during bypass surgery. We conclude that broken fragments of catheters that lodge in the right side of the heart or pulmonary circulation can be retrieved most of the time percutaneously by snare catheters.

The neuroendocrine tumors are the second most common malignant tumors of the larynx. They originate from the neuroendocrine cells located in the basal and middle layer of the respiratory epithelium of ventricule and subglottis. Atypical carcinoid tumors of the larynx (moderately differentiated neuroendocrine tumors) are the most common type. They have an aggressive clinical course and poor prognosis. A 60-year-old male patient presented to our clinic with painful neck mass which had grown for a month. Laryngeal examination of the patient revealed a vegetative mass involving anterior surface of the right aryepiglottic fold, posterior surface of the ventricle and destructing the epiglottis. There were multiple palpable lymph nodes in the bilateral jugulodigastric, middle jugular, posterior cervical and right jugular lymph nodes in the neck. Lung and bone metastasis was present. The patient was diagnosed as atypic carcinoid tumor of the larynx. The patient was treated with chemotherapy (cisplatin, etaposide and zoledronic acid). The computed tomography which was performed three months after chemotherapy revealed regression of the mass lesion in the aryepiglottic fold and lymph nodes at cervical chain. We intended to present this case since neuroendocrine tumors of the larynx are rare and should be considered in the differential diagnosis of larynx neoplasms

Kimura disease is a chronic idiopathic disease which is usually presented with lymphadenopathy or subcutaneous masses involving head and neck, frequently accompanied by peripheral blood eosinophilia and elevated serum Ig E level. A 52- year-old female presented with recurrent oral cavity lesions for 5 years. There was a 3 cm x 2 cm lesion on the right buccal mucosa which had white patchy areas surrounded by erythematous, vascular tissue. Histopathologically lymphocytes forming follicles surrounded by an inflammatory infiltrate with eosinophilia and fibrosis was observed. We report this case because the diagnosis was made histopathologically and it was seen in a female patient.

The superior transverse scapular ligament (STSL) bridges the suprascapular notch, converting it into a suprascapular foramen. The suprascapular nerves and the vessels traverse through the suprascapular foramen of the scapula. Often the STSL is ossified to produce compression of the suprascapular nerves producing resultant symptoms. The entrapment of the suprascapular nerve by the ossified STSL may result in symptoms like pain in the shoulder region and also result in wasting and weakness of the supraspinatus and infraspinatus muscles. Such a condition has to be differentiated from other conditions like rotator cuff tears. Often asymptomatic cases make the diagnosis difficult. The present study reports the anomalous ossified STSL detected in a bone specimen, discusses its anatomical and radiological aspects and describes its clinical implications.

Blind pouch syndrome is the set of signs and symptoms caused by intestinal content stasis and consequent bacterial hyperproliferation in a segment excluded from the intestinal flow after surgical procedure. This paper reports the case of a 65-year-old male patient complaining of diffuse abdominal pain, poor oral intake, nausea, diarrhea, fever and chills. Surgical history included cecal resection five years before due to a tubulovillous adenoma. On physical examination, the abdomen was tender and distended, without signs of peritonitis. Complete blood cells count showed microcytic anemia. Computed tomography of the abdomen revealed ileocolonic anastomosis (ascending) with blind loop presenting signs of inflammatory process. Exploratory laparotomy was indicated, in which the resection of the blind loop was performed. After gradual improvement of the symptoms, the patient was discharged in12th post-operative day.