Ramsay Hunt Syndrome presenting as gait imbalance without facial paralysis: A case report
Ramsay Hunt Syndrome (RHS) is the reactivation of a Varicella Zoster Virus (VZV) infection affecting the geniculate ganglion and is also known as Herpes Zoster Oticus. It is clinically diagnosed with a classical triad of ipsilateral facial paralysis, otalgia, and vesicular rash near the ear and auditory canal. It is not always necessary to have the classical triad, and it can also present atypically without facial nerve palsy, with variants such as Zoster sine herpete. We are presenting a case of Ramsay hunt syndrome with no facial paralysis but with an atypical presentation of gait imbalance, who had a vesicular rash around the ear a week before presentation. He was started on steroids and valacyclovir after confirmation of diagnosis, with which his symptoms improved drastically. Maintaining a high index of clinical suspicion is crucial for diagnosing the syndrome, particularly when it presents without the classic triad of symptoms. The potential involvement of adjacent cranial nerves should also be considered, and a low threshold for suspicion facilitates early diagnosis and treatment, helping to prevent long-term, irreversible complications.
Copyright (c) 2025 Kamatam S https://creativecommons.org/licenses/by/4.0
Unveiling Hidden Culprits: An Observational Study of Upper Gastrointestinal Endoscopy Findings in Symptomatic Cholelithiasis Patients
Background: Cholelithiasis, commonly known as gallstone disease, is often managed surgically through cholecystectomy. However, many patients continue to experience persistent gastrointestinal symptoms post-surgery, raising questions about hidden upper GI pathologies that may mimic gallstone-related discomfort. Could these overlooked conditions be the true culprits behind lingering symptoms? Aim & Objectives: 1. to analyze the role of upper gastrointestinal endoscopy (UGIE) as a routine pre-operative investigation in cholelithiasis patients with typical biliary colic or atypical upper abdominal symptoms undergoing elective cholecystectomy.2.to find out co existing pathologies in symptomatic cholelithiasis patients. Methods: An observational study was conducted on 80 patients diagnosed with symptomatic cholelithiasis. All patients un derwent preoperative UGIE to assess for associated GI abnormalities. The findings were analyzed and correlated with symp tom presentation, demographic factors, and postoperative outcomes. Statistical Analysis: Descriptive statistics were used to analyze the prevalence of pathological upper gastrointestinal endos copy (UGIE) findings, including gastritis, hiatus hernia, peptic ulcer disease, polyps, and malignancy, expressed as percentages. Data were recorded and processed using Microsoft Excel for preliminary analysis. The Chi-square test was applied to assess the association between the type of pain (typical vs. atypical) and endoscopic findings. Statistical analysis was conducted us ing IBM SPSS Statistics (Version 27), with significance level set at 0.05 for all tests. Results: This prospective study was conducted at a tertiary care medical college hospital in Mangalore, Karnataka, India. It in cluded 80 patients diagnosed with gallbladder stones via ultrasound, who subsequently underwent upper gastrointestinal en doscopy (UGIE) to evaluate coexisting GI pathology. UGIE detected abnormalities in a significant proportion of patients, with gastritis being the most prevalent finding, followed by reflux esophagitis and peptic ulcer disease. A subset of patients tested positive for Helicobacter pylori infection. Notably, patients with abnormal UGIE findings had a higher incidence of persistent postoperative symptoms compared to those with normal UGIE results. The study observed a higher prevalence of gallstones in females compared to males, with a female-to-male ratio of 1:0.45. Gallstones were more commonly found in individuals over 40 years of age, with the majority of female patients being above 60 years. A subset of patients with inflammatory GI pathology tested positive on the rapid urease test and were treated with an H. pylori eradication regimen, leading to symptom improve ment. Furthermore, upper GI abnormalities were more frequently observed in patients with a single gallstone compared to those with multiple calculi. Additionally, all patients with a normal UGIE had a normal gallbladder wall thickness. This study highlights the importance of evaluating upper GI pathology in patients with gallstones to optimize management and improve postoperative outcomes. Conclusion: This study highlights the critical role of upper gastrointestinal endoscopy (UGIE) in the preoperative evaluation of symptomatic cholelithiasis. Findings suggest that gastrointestinal inflammatory conditions, rather than gallstones, are of ten the primary cause of symptoms. Laparoscopic cholecystectomy should be deferred until after GI treatment; if symptoms resolve, surgery may not be needed.
Copyright (c) 2025 Anand Bhandary Panambur https://creativecommons.org/licenses/by/4.0
Assessing Health Care Providers’ Proficiency in International Patient Safety Goals: A Study to Assess the Knowledge &Practice on Patient Safety in a Tertiary Care Teaching Hospital in Gujarat
Background: Patient safety is a paramount concern in healthcare systems worldwide, remaining a significant challenge de spite advancements in medical technology and clinical practices. To address these issues, the Joint Commission International (JCI) introduced the International Patient Safety Goals (IPSG) framework, aimed at promoting patient safety and minimizing risks across various healthcare settings. This study seeks to evaluate the knowledge and practices of healthcare providers in a tertiary care teaching hospital in Gujarat. The insights obtained will help identify areas for improvement and enhance patient safety initiatives within the hospital. Aim: To assess the knowledge and practice of healthcare providers on International Patient Safety Goals. Methodology: This observational descriptive study was conducted among 100 healthcare workers at the All India Institute of Medical Sciences, Rajkot. The participants included Senior Residents, Junior Residents, Senior Nursing Officers, and Nurs ing Officers. Prior to commencing the study, approval for an expedited review was obtained from the Institutional Ethical Committee. Data collection involved gathering sociodemographic information and assessing knowledge, while practices were evaluated using a structured checklist. Results: A total of 100 healthcare workers (HCWs) participated in the study. The participants comprised Senior Residents (SRs) (15%), Junior Residents (JRs) (35%), Senior Nursing Officers (SNOs) (10%), and Nursing Officers (NOs) (40%). All HCWs had less than 10 years of experience, with a majority being female (55%). Knowledge assessment results from a 20-question questionnaire indicated that SRs scored 58%, JRs 54.71%, SNOs 62%, and NOs 65.63%. Compliance in practice, observed across 1200 practices, revealed rates of 46.34% for SRs, 39.05% for JRs, 47.20% for SNOs, and 68.75% for NOs. Conclusion: Overall, the knowledge and practice compliance rates among healthcare workers in our institute are moder ate. Nursing Officers (NOs) demonstrate higher compliance rates in both IPSG practices and knowledge compared to Senior Residents (SRs), Junior Residents (JRs), and Senior Nursing Officers (SNOs). Compliance rates are notably lower among JRs, indicating a significant area for improvement. Gap analysis revealed a positive gap of 12%, 15%, and 16% among SRs, JRs, and SNOs, respectively, suggesting barriers that prevent effective translation of knowledge into practice. Conversely, a negative gap of -3% among NOs indicates their practice compliance slightly surpasses their knowledge, likely due to practical experience.
Copyright (c) 2025 Bhise M https://creativecommons.org/licenses/by/4.0
Challenges in Diagnosing Child Language Disorders
Diagnosing language disorders in children imposes constraints and a significant challenge. This challenge is imposed due to the intricate interplay of numerous factors or variables. These factors or variables include age, gender, cultural diversity, symptom variability, and trait variation. The aetiology causing the development disorder determines the trait manifestation. For instance, a developmental language disorder may be caused due to neurological factors and/ or environmental factors such as socio-economic factors, or stimulation-related factors. The disease manifestation can vary based on the cause. Demographic factors such as age also can influence the disease traits. The critical age is one of such factors which influence disease traits. The age of intervention sought is regarded as yet another factor. Additionally, the stigma surrounding language disorders may impede or stop parents from seeking intervention pertaining to communication disorders, leading to further delays in diagnosis and treatment. However, it is noteworthy that a significant impact of technology and advances in public education can neutralize the factors based on the age of intervention and its influence on disease manifestation. Bilingualism is yet another factor that can exert a potential influence on the disease trait. This review aims to collate challenges in diagnosing child language disorders and discusses the role of such factors in diagnosis. Understanding these factors can enable a better understanding of such factors and counteract their influences.
Copyright (c) 2025 Abhishek BP https://creativecommons.org/licenses/by/4.0
Stunting Service Management Model in the South-Central Timor Region, East Nusa Tenggara, Indonesia
South Central Timor is one of the regions with a high prevalence of stunting in Indonesia. The programs and policies that have been carried out have been unable to reduce these health problems effectively. This study resulted in an innovative service model based on intelligent Governance. The design of this study is a sequential explanatory model using the mixed method. The research subjects were 226 respondents and 527 midwives in 27 South Central Timor region health centres. The results of the analysis found that there are factors that inhibit the management of stunting management services in community health centres in South Central Timor Regency, including (a) tractability of the stunting problems, (b) diversity of group behaviour, (c) clarity of policy content, (d) accuracy of allocation of funding sources, (e) socioeconomic conditions of the community and the level of technological advancement, (f) official support for stunting prevention policies. The analysis results have an adjusted R2 (Adjusted R Square) value of 0.436. Service implementation needs to be carried out collaboratively and participatory, es pecially related to data, policies, budgets, coordination, socialization, and implementation.
Copyright (c) 2025 Salesman F https://creativecommons.org/licenses/by/4.0
Acute Small Bowel Obstruction Presenting as Gangrenous Jejunal Loop Secondary to Intestinal Endometriosis – A Rare Case Report
Acute intestinal obstruction is one of the few gastrointestinal symptomatology that intestinal endometriosis frequently manifests as in the reproductive age group of females. The majority of diagnosis is still laparoscopy or laparotomy with removal of affected areas for biopsy. Endometriosis affects up to 15% of menstrual women. In 3%-37% of women, endometriosis causes gastrointestinal involvement in the sigmoid colon, rectum, and terminal ileum. Proliferation and infiltration of the intestinal wall with endometriotic tissue may result in a fibrotic response with the development of strictures and adhesions, most likely as a result of the cyclical hormonal impact of menstruation. This can eventually lead to acute to recurrent abdominal pain and bowel obstruction. When it comes to identifying endometriosis, magnetic resonance imaging offers a good sensitivity (77- 93%). On immunohistochemistry (IHC) the stromal and epithelial cells are estrogen receptor (ER) positive and the stromal cells positive for CD10. This also helps in ruling out other differentials like crohn’s disease especially involving ileum with fistulae formation, acute appendicitis with phlegmon formation and in rare instance ischemic bowel disease. We hereby present a case of a 41-year-old nulliparous female with past history of ectopic pregnancy (aborted) with small bowel endometriosis who experienced severe colicky diffuse abdominal pain. Her imaging study revealed that she had multiple edematous dilated bowel loops with no peristalsis. She was hemodynamically unstable and underwent an emergency exploratory laparotomy, which revealed gangrenous jejunal loops and histopathology confirmed gangrenous small bowel with endometriosis. Post operative period was uneventful and smooth and she is on regular follow-up.
A Single-Center, Prospective Study Focused on Quality Indicators, Success Rate, Features, Outcomes, and Indications of Endoscopic Retrograde Cholangiopancreatography (ECRP) Practice at a Tertiary Care Hospital
Objective: To assess, in a single center-based study, the indications, results, success rates, incidence, and risk factors for complications linked to endoscopic retrograde cholangiopancreatography (ERCP) procedure and validate the ASGE/American College of Gastroenterology Task Force recommendations. Methods: We conducted a prospective analysis of all patients who underwent ERCP at tertiary care center in Mangalore, India between October 2018 and September 2023, a span of five years. ERCP was performed under sedation/ general anesthesia. Review of the patient's demographics, ERCP indications, outcomes, quality indicators, and related complications of the procedure was analyzed. Potentially relevant patient and procedure related risk factors for overall post ERCP complications were analyzed. To determine the likelihood of post-ERCP problems and post-ERCP pancreatitis (PEP) in patients with specific risk factors, such as demographic characteristics, variations in procedural procedures, pancreatic duct modifications, and others, two multivariate logistic regression models were performed. Results: A total of 948 patients were included in this study. 76.2% of naïve papilla cannulation was achieved successfully; 68% of procedures include women, 32% involve men, 84% involve benign pathology, and 26% involve suspected or confirmed malignancy. (42% women and 58% men). Suspected or confirmed choledocholithiasis was the commonest indication for an ERCP. Success rates, operative outcomes, and post-procedural complications such as hemorrhage, pancreatitis, Cholangitis, perforation were the primary outcomes of interest in our study. We also discussed the management of the failed procedures. This was followed by suspected ascending cholangitis, acute biliary pancreatitis, dysfunction of the sphincter of Oddi, and suspected malignancy. The most prevalent findings among all patients was choledocholithiasis in 43.6%, dilated duct in 35.8% and biliary stricture in 10.1%. The most common intervention was sphincterotomy, which was performed in 851 (96.8%) patients who underwent first-ever ERCP, followed by dilatation and stenting. 10.9% of the patients had post-ERCP complications, with post-ERCP pancreatitis being the commonest, followed by bleeding and cholangitis. Conclusions: In our center's ERCP procedures are carried out by experienced surgeons wellversed with endoscopic procedures who achieve good procedural outcomes, meeting the quality standards and good procedural success. Even ERCP has some morbidity and mortality risk, it is a valuable tool for addressing pancreatobiliary disease. The technical success rates met or beyond the ASGE/American College of Gastroenterology Task Force recommendations which was the main objective of this study. When compared to other centers across the country and the western world, cannulation success rates are adequate and comparable to the set norms. Since ERCP seldom results in mortality and has low rates of peri-operative complications, it is regarded as a safe interventional biliary procedure.
Endoscopic Retrograde Cholangiopancreatography
Copyright (c) 2025 Anand Bhandary P https://creativecommons.org/licenses/by/4.0
Fever Unmasking Brugada‐Like Electrocardiographic Pattern Induced by Fever: ICD or NOT?
We report a case report of 71-year-old man was admitted for syncope during a febrile state. The electrocardiogram revealed a right bundle branch block and pattern of elevated ST segment in the anterior leads similar to the Brugada syndrome. These electrocardiographic anomalies disappeared when the temperature returned to normal. An electrophysiological study using aggressive protocol did not triggered ventricular arrythmia. An automatic defibrillator (ICD) was proposed due to the highrisk arrhythmic events but refused by the patient to get implanted.
Copyright (c) 2024 Lahmouz Y https://creativecommons.org/licenses/by/4.0
Splenic Angle Intussusception – Successful Minimally Invasive Surgery with Intracorporeal Anastomosis
In adults intussusception is rare and accounts for 1% of all bowel obstructions. Colo-colic are less frequent representing less than 25% of all intussusceptions and are more likely to have an underlying malignancy as there is higher prevalence of colonic carcinoma. Less than 10% of intussusceptions in adults are idiopathic. Most of the patients present in the emergency setting with nonspecific symptoms consistent with a partial bowel obstruction. A high index of suspicion is of paramount importance to timely diagnosis and treatment. Although the standard treatment involves surgery, there are controversies regarding reduction of intussusception prior to surgery. Here authors summarize current indications for surgery and describe the first case in the literature of laparoscopic high left colectomy with intracorporeal anastomosis for splenic angle intussusception.
Copyright (c) 2024 Monteiro EV https://creativecommons.org/licenses/by/4.0
Syntactic Judgment in Non-Fluent (Broca’s) Aphasia and Neuro- Typical Participants: A Comparison
Earlier research on persons with non- fluent aphasia especially concentrated on the expression related difficulties, agrammatism component etc. Eventually researchers focused on the comprehension related difficulties in these persons with no- fluent aphasia especially persons with Broca’s aphasia. These persons will have milder comprehension deficits which would reflect as poor performance on meta-linguistic judgment tasks especially syntactic judgment task. The other view in the same line of research attributes poor performance on syntactic judgment to the agrammatic component associated with non-fluent aphasia claiming that the syntactic comprehension difficulty is parallel with agrammatism component associated. The present study aimed at testing grammatical judgment abilities in persons with Broca’s aphasia. 5 persons with Broca’s aphasia and 20 neuro-typical participants were recruited for the study. Syntactic judgment task was carried out on all these participants by using 15 correct, 15 grammatically incorrect and 10 semantically incorrect sentences were used. Persons with Broca’s performed poorly compared to neuro-typical group. The performance of neuro typical participants did not vary much with respect to the three types of stimuli used. While persons with Broca’s aphasia showed more difficulty in judging grammatically incorrect sentences followed by semantically correct sentences.
Copyright (c) 2024 Abhishek BP https://creativecommons.org/licenses/by/4.0
Basic Concepts and Application of Nuclear Medicine
Understanding the scientific and technical concepts related to nuclear medicine is the fundamental approach to ensuring effective and efficient use of radionuclides, either for imaging or treating numerous diseases. Basically, in ancient times, the Greek philosopher Democritus (460–370 B.C.) decreed that all things are composed of small, indivisible bits called atoms [1]. Etymologically, the term atom came from the Greek word “Atomos”, meaning “indivisible.” The idea of small, inseparable particles of substance existed until the 1800s, when renowned chemist John Dalton (17666–1844) introduced the modern atomic hypothesis. Later, the “plum pudding model” of the atom was proposed by J.J. Thomson (1856–1940), who is credited with discovering the electron [2].
Copyright (c) 2024 Nzayikorera J https://creativecommons.org/licenses/by/4.0
Performance on the Variants of Generative Naming Performance in Younger and Middle Aged Adults
Generative naming task is a commonly used task in screening and diagnostic tests and is a part of neuro-psychological test batteries. In this task, the participant is expected to list items belonging to a specific lexical category such as animals the task has been studies in regard to demographic variables such as age, gender, socio-cultural variables. The conventional generative naming task is modified by adapting the concept of switching. The participant is asked to switch between the lexical categories or is asked to switch between the languages L1 and L2) holding the lexical category as a constant, the current studied the performance of young and middle aged adults considering the language switching conditions. A total of 50 participants were considered for the current study and the participants were divided into two groups based on their age. The participants were asked to list lexical items belonging to the category ‘animals’ under three switching conditions: free switching, no switching and conditional switching conditions. The median scores were higher for free switching followed by no switching condition and conditional switching conditions, the same trend was observed across the two groups. Fried man’s test revealed significant difference between the conditions only for the group 2 participants showing that the cognitive substrates may impose challenges to the performance of these participants.
Primary Anorectal Malignant Melanoma (PARM) with Liver Metastasis: Case Report
Primary Anorectal Malignant Melanoma (PARM) is a rare and aggressive tumor with incidence of 3% of all anorectal cancers. The tumor may seem like adenocarcinomas, small cell carcinomas, or sarcomas histologically, yet it looks like hemorrhoids grossly. It is frequently discovered at an advanced stage due to vague symptoms and its aggressive nature, resulting in a bad prognosis. The prognosis is poor, with a median survival of only 24 months and a 5-year survival rate of &lt; 10%. The majority of patients die as a result of complications related to metastasis. We are reporting a case of 57year old woman with PARM with liver metastasis. The diagnosis of primary anorectal malignant melanoma can be challenging due to its rarity and the overlap of symptoms with other more frequent anorectal diseases. This case study emphasizes the significance of including malignant melanoma in the differential diagnosis of anorectal malignancies. The occurrence of liver metastases highlights the disease's aggressive nature and the importance of a comprehensive diagnostic approach. The treatment options for anorectal melanoma with liver metastases are limited and generally palliative, with the goal of enhancing quality of life and prolonging life expectancy.
Copyright (c) 2024 Panambur AB https://creativecommons.org/licenses/by/4.0
Development of Checklist to Assess Caregivers Perspectives and Preparatory Knowledge about Aphasia
Aphasia has a devastating effect on both the patient and the caregiver. As the onset of this condition is sudden it doesn’t offer time for the caregiver to gain preparatory knowledge about aphasia. If the preparatory knowledge is poor, then the empathy and mutuality would get affected. In order to carry out his/her role effectively a caregiver must have preparatory knowledge about aphasia, its impact on speech and language abilities of a person, co morbid conditions associated, rehabilitation services need for the patient to overcome the constraints induced by aphasia. The study aimed at assessing preparatory knowledge about aphasia in the caregivers. It had three parts part (a) concentrated on questions about impact of aphasia, part (b) tested the knowledge of care givers questionnaire about the rehabilitation service while the last part, part (c) concentrated on testing their knowledge about the responsibilities to be taken up. The questionnaire was circulated among four Caregivers (females) of four patients with aphasia, who were in acute phases. It was found that the caregivers had limited knowledge about the impact of aphasia. They knew that it would take time for the person with aphasia to recover and also the roles to assumed during this phase.
Endoscopic and Colonoscopy Investigation in Anemia: Yield of these Procedures in Identifying a Gastrointestinal Cause
Introduction: Anemia is a common laboratory finding among patients and many inpatients are worked up during their hospital stay with either endoscopy and/or colonoscopy. An evidence-based approach is warranted to determine this course of action is likely to affect treatments and outcomes especially in the inpatient population in other types of anemia as well. Methods: In this retrospective analysis, charts were obtained for inpatients that underwent either endoscopy and/or colonoscopy with anemia during the period of over 5 years at a community hospital. These patient records were reviewed, and data was collected into a standardized collection tool for statistical analysis. Bonferroni method was used to correct for multiple testing parameters. Results: Out of 173 total patients, endoscopic/colonoscopy findings were positive in 6/5 with untyped anemia, 34/20 with anemia of chronic disease (ACD), 49/29 with iron deficiency anemia (IDA), and 34/26 with anemia due to other causes (ADOC) respectively. Positive findings in either endoscopy and/or colonoscopy 75.47%, 91.38%, 72.73%, and 100% with a p value of .026. Conclusion: In cases of anemia without signs of active gastrointestinal bleeding, inpatient examination by either endoscopy and/or colonoscopy found a probable cause in most patients irrespective of the type of anemia.
Copyright (c) 2024 Kamatam S https://creativecommons.org/licenses/by/4.0
Enhancing Lifelong Vaccination: Insights from Spain, France and Italy
Vaccinations are not limited to children and teenagers, as recently reiterated in the Council Conclusions on Vaccination. With the European Union's population continuing to age, there is a growing need to prioritize adult vaccination alongside pediatric vaccinations. In April 2023, the Italian NGO Cittadinanzattiva, through its European branch Active Citizenship Network, launched a new project called 'Civil Society promoting vaccination across the life-course' during the European Immunization Week. The goal was to enhance collaboration and dialogue with all relevant health stakeholders, engaging citizens' and patients' associations across Europe to better understand and implement vaccination policies. This article presents the outcomes of three national focus groups held in the second half of 2023 across Spain, France and Italy. The methodology involved discussions in native languages to gain qualitative insights into life-course immunization, barriers, and strategies. Engaging leaders from civic and patients' associations, healthcare professionals, and policymakers, the collaborative effort explored lessons learned and identified pathways for improving vaccination rates. Positive shifts in stakeholders' perspectives underscore the pivotal role of preventive measures, prompting increased policymakers' awareness. However, challenges arise, including a polarized approach to vaccination and issues in communication causing confusion and distrust, amplified by media influence. Presently, there is an overall stagnation in vaccination rates, with a slight decline, particularly in influenza vaccinations, signaling vaccination “fatigue”. Common suggestions include advocating for effective and personalized communication, leveraging digital tools, endorsing patient and civic organizations as strong vaccine advocates, and recognizing the increased role of different healthcare professionals (pharmacists, nurses, etc.) as invaluable support resources. Additionally, the importance of vaccination campaign evaluation is emphasized.
Copyright (c) 2024 Quaggia D https://creativecommons.org/licenses/by/4.0
Household Food and Nutrition Security in Nigeria
Achieving food and nutrition security entails ensuring secure access to food alongside a hygienic environment, adequate healthcare services, and informed caregiving, thereby enabling individuals to lead healthy and productive lives. An individual's ability to realize their full personal and economic potential hinges significantly on their level of food and nutrition security. Moreover, the availability of nutrition resources and the degree to which an individual has access to such resources are a function of how society is organized in terms of economic structure, political and ideological expectations, and its institutions. Nigeria grapples with numerous hurdles in attaining food and nutrition security, including widespread poverty, heightened levels of food insecurity, limited access to clean water and sanitation, inadequate healthcare provisions, and suboptimal dietary habits. Among these challenges, poverty stands out as a critical impediment. The World Bank reports that approximately 40% of Nigerians live below the poverty line, rendering many unable to afford a balanced diet. Additionally, restricted access to clean water and sanitation significantly impacts nutrition security, as it contributes to the proliferation of waterborne illnesses and malnutrition, particularly among children. Insecurity also poses a significant barrier to food production in Nigeria's primary agricultural zones. This article provides a thorough examination of the complexities surrounding food and nutrition security in Nigeria, offering practical solutions to address these pressing issues.
Copyright (c) 2024 Olamide O https://creativecommons.org/licenses/by/4.0
Stomach Foreign Body: A Retrospective Study with a Review
Foreign bodies in the stomach may be accidental or voluntary swallowing. Most foreign bodies are due to unintentional ingestion except in insane people or drug peddlers who may be voluntary. Most of the time, coins are accidentally ingested by children. A rare phenomenon is accidental ingestion of a size 16 to 20 cm in length (toothbrush) foreign body in a sane person. Oesophageal foreign bodies are not as risky as airway foreign bodies. These foreign bodies can obstruct and are located at the oesophagus cricopharynx constriction, the crossover of the aortic arch at the mid-oesophagus, and the lower end. After reaching the stomach, most ingested foreign bodies less than 6 cm will pass uneventfully through the gastrointestinal tract, as in 10 patients who consumed one/two rupee coins. Nevertheless, long and rigid foreign bodies like toothbrushes can result in gastrointestinal impaction, perforation and bleeding. Moreover, there have been a few case reports of spontaneous passage of a toothbrush, and promptly removing such ingested foreign objects is recommended before complications develop. Treatment option remains controversial considering the waiting policy or intervention, either endoscopic or surgical. This study describes 11 patients, 10 cases of coin ingestion and one case of the swallowed toothbrush. Ten cases of coin ingestion were managed conservatively. Upper midline laparotomy was done to remove the toothbrush as removal via flexible endoscopy failed. A swallowed toothbrush is a special clinical challenge. Early retrieval of the toothbrush is critical for reducing morbidity.
Copyright (c) 2024 Goyal S https://creativecommons.org/licenses/by/4.0
A Case Study with Six-Week Physiotherapy Rehabilitation Intervention on Intervertebral Disc Prolapse Disorder
This article describes the case of an adolescent female with lumbar disc herniation characterized by chronic low back pain (LBP) and antalgic gait. A 27-year-old woman presented with chronic low back pain and subsequent deterioration in her quality of life and impairment in activities of daily living. The patient was evaluated and diagnosed based on her medical history, clinical examination and imaging. She had shown failure in both her symptomatic and functional improvement in natural history and conservative management due to an injury to the facet joint of her lower lumbar spine. Pain radiating to the lower extremities in a young adolescent should be considered, especially in cases of minor trauma or when her LBP becomes chronic. Further research is needed on the long-term effects of such disc injuries in young adults and how best to conservatively manage these patients. Includes discussion of disc herniation pain associated with adolescent disc injuries.
Copyright (c) 2024 Gurung RK https://creativecommons.org/licenses/by/4.0
Oral Rehabilitation with Removable Partial Denture in a Patient with a Maxillary Defect Caused by a Firearm
The use of Removable Partial Denture (RPD) for the oral rehabilitation of patients who have suffered facial trauma and consequent tooth loss of several elements, serves as an alternative for replacing hard and soft tissues, as well as providing aesthetic and functional support. Facial trauma related to firearm injuries is a challenge for the surgical team, both in planning and during surgery, due to the destruction of anatomical planes and the multifragmentation of soft tissues and bone. The aim of this study is to report on the oral rehabilitation using removable prostheses of a patient who had suffered firearm trauma. Patient F. B. C., 30 years old, male, normosystemic, attended the postgraduate dental prosthesis clinic at Unichristus with the aim of rehabilitation after a firearm trauma. During the clinical assessment, a bone defect was observed in the anterior region of the maxilla, with the loss of several teeth and part of the alveolar bone structure. The plan was designed to rehabilitate the extensive bone loss caused by the trauma, through the use of an RPD, to promote the return of masticatory function, the patient's facial aesthetics and soft tissue support. The prosthesis was designed to use the remaining posterior teeth as a support and means of retention, aided by full coverage of the palate in order to bring more stability and comfort to the patient. At the end of the treatment, the aesthetic and functional aspects were restored, showing that this type of prosthesis is an alternative for rehabilitation in this type of case.
Copyright (c) 2024 Alves do Nascimento J https://creativecommons.org/licenses/by/4.0
Five interesting cases reported between 1992 and 1994 were reviewed. The first case documents successful treatment of chylothorax with balloon angioplasty of baffle obstruction following Mustard operation. The second case illustrates successful relief of supra-valvar pulmonary artery stenosis that developed after arterial switch procedure by balloon dilatation. In the third case, shock-like syndrome developed in an 11-day-old baby with severe aortic coarctation which was relieved by balloon angioplasty; the procedure was performed via the umbilical artery, sparing the femoral artery. The fourth case documents percutaneous occlusion of patent ductus arteriosus with a buttoned device in an adult patient; this was first case of using this device in an adult patient. The final case points to late clinical presentation of the origin of the anomalous circumflex coronary artery from the pulmonary artery several years following repair of aortopulmonary window in infancy. Surgical correction of this anomaly was successfully accomplished. The cases presented successful use of catheter or surgical interventional procedures to address uncommon types of cardiac problems.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
In this report, five different case scenarios were presented. In the first case, successful use of propranolol to relieve severe right ventricular infundibular obstruction was illustrated which facilitated balloon pulmonary valvuloplasty. In the second case, successful percutaneous occlusion of an atrial septal defect with buttoned device in an infant weighing 3.6 kg was documented. In the next case, rare association tricuspid atresia with persistent truncus arteriosus was recorded. The fourth case illustrates first successful transcatheter closure of patent ductus arteriosus with buttoned device in a child. The final case presents an unusual presentation of coarctation of the aorta in an infant and effective management with balloon angioplasty in the critically ill infant. Each of these cases were unique unto themselves either documenting successful management of these pathologies with innovative techniques or recording rare congenital cardiac abnormalities.
Copyright (c) 2024 P Syamasundar Rao https://creativecommons.org/licenses/by/4.0
Myelolipoma: A Rare Case Presentation and Review
Background: Myelolipomas are rare, benign tumors composed of mature adipose tissue and hematopoietic elements, primarily encountered in the adrenal glands. However, their occurrence in other locations is exceptionally rare. Case report: We present our case of a 63-year-old male, presented with a sub xiphoid myelolipoma. This mass was incidentally discovered during imaging, with the patient reporting no associated pain or symptoms. Imaging studies were concerning for neoplastic etiology like liposarcoma. An interventional radiology (IR) biopsy revealed "unremarkable bone marrow." Subsequent resection confirmed the diagnosis of myelolipoma. Conclusion: The myelolipoma in this unusual location highlights the importance of considering tumor atypical locations in the differential diagnosis when evaluating patients with uncommon mass presentations.
Copyright (c) 2024 Al Hmada Y https://creativecommons.org/licenses/by/4.0
Comparing Olanzapine with Placebo in Patients with Anorexia Nervosa for Increasing BMI and Weight Gain
Anorexia Nervosa is an eating disorder that can be characterized by having exceptionally low body weight with feeling of disgust to food. Commonly known treatment for Anorexia Nervosa is psychological treatment with methods like CBT and MANTRA, but now with the introduction of pharmacological drugs it is the aim of this review to identify whether olanzapine is effective compared with placebo in increasing BMI and weight gain. What was found is that olanzapine showed great increases in BMI [F (1, 20) =6.64, p=0.018] when compared to placebo, and that it noticeably had decreased depression and anxiety. Additional studies found that olanzapine patients gained weight more rapidly and achieved their BMI targets more quickly than those taking a placebo. On the other hand, a contradictory finding was seen, it was that there was no significant difference between olanzapine and placebo in the matter of weight recovery and psychologic, depressive, and anxious symptoms. What is concluded is that to minimize the rely on pharmacologic therapies until new findings emerge, and to depend mostly on psychotherapies such as CBT and MANTRA for increasing BMI in anorexia nervosa patients.
Copyright (c) 2024 Shaabani H https://creativecommons.org/licenses/by/4.0
Ternate and Trine - Spermatocytic Tumour
Spermatocytic Tumour emerges as a polymorphous, tripartite germ cell neoplasm reminiscent of developing spermatogonia, non-concordant to germ cell neoplasia in situ and demonstrates favorable prognostic outcomes. Tumefaction demonstrates aneuploidy and tumour cells characteristically lack anomalies within chromosome 12p. Cytological examination exhibits a cellular neoplastic component of variable magnitude as miniature cells, predominant intermediate cells and enlarged cells. Upon microscopy, pathognomonic tripartite cellular component is constituted of cells of variable magnitude described as miniature cells, intermediate cells and giant cells. Tumour configures nodules, cord-like pattern or peripheral inter-tubular cells enmeshed within a fibrinous perimeter.
Copyright (c) 2024 Bajaj A https://creativecommons.org/licenses/by/4.0
Intramural and Adapted-Germ Cell Neoplasia In situ
Germ cell neoplasia in situ emerges as a precursor lesion configuring type II germ cell tumours as testicular seminoma or post-pubertal non-seminomatous testicular germ cell tumours. Lesion is comprised of neoplastic gonocyte-like cells, latent totipotent or naive germ cells with developmental potential situated within ‘spermatogonial niche’ of seminiferous tubules. Germ cell neoplasia in situ delineates an increased incidence with conditions as uncorrected cryptorchidism, ambiguous genitalia, infertility or preceding history of post-pubertal germ cell tumour within contralateral testis. Neoplasm demonstrates aneuploidy or polypoid genotype with additional chromosomal gains as is chromosome 12p upon commencement of neoplastic invasion. Neoplastic cells appear enlarged, atypical, gonocyte-like and are incorporated with abundant, clear cytoplasm, enlarged, hyper chromatic nuclei, coarse nuclear chromatin, angulated cellular margins and prominent nucleoli.
In this article five case reports were reviewed and include chylopericardium that developed after performing a Blalock-Taussig shunt, successful surgical repair of syndrome absent pulmonary valve with pulmonary arterioplasty but without replacement of the pulmonary valve, simultaneous occurrence of transient eosinophilic pulmonary infiltration secondary to intestinal schistosomiasis and mitral stenosis and their effective management, description of a rare variant of tricuspid atresia with atrioventricular canal, and successful drug therapy of congestive cardiomyopathy that developed due to chronic tachycardia. Discussion of uniqueness of these findings and management options were reviewed.
Clinical Case Reports 1980 – 84 (Contrast Echocardiography)
In this paper all case reports reviewed demonstrate usefulness of contrast echocardiography in the diagnosis of cardiac abnormalities. The first case illustrates the utility of this technique in diagnosing anomalous connection of the right superior vena cava to the left atrium. This diagnosis was later confirmed on angiographic studies. In the second paper, contrast echocardiography confirmed the successful results of surgery of the anomalous connection seen in the first case. In the third case, contrast echocardiography was helpful in identifying the cause of hypoxemia in a post-open heart patient, leading to successful closure of the residual cardiac defect.
AI Advancements in Diabetic Retinopathy: A Visionary Review of Diagnostic Precision and Therapeutic Insights
The application of artificial intelligence in medicine is a developing field with Potential applications in mass screening and possibly even diagnosis. By constructing intricate associations from incoming data and comparing the results to performance benchmarks, complex computing may recognize patterns. This is a significant advancement. Diabetes-related retinopathy is a growing concern. Retinopathy that poses a risk to vision can be lessened with early detection and prompt treatment. Patients and ophthalmologists will likely benefit from any technology that may facilitate the rapid screening of this illness and reduce the need for skilled human resources for the same. The use of artificial intelligence in diabetic retinopathy is currently being discussed in this review, along with a few other common retinal disorders.
Copyright (c) 2024 Trivedi D https://creativecommons.org/licenses/by/4.0
A Case of Cartagenet's Syndrome Presenting as a Solid Pulmonary Lesion
Background: Cartagena syndrome is a very rare disease with typical clinical manifestations of chronic sinusitis, bronchiectasis, and visceral inversion. Although it is not difficult to diagnose, many physicians do not pay enough attention to it, and it is often misdiagnosed or underdiagnosed. Here, we describe a patient with Cartagena syndrome who presented with solid pulmonary lesions on admission to the hospital. Case Details: A 15-year-old young woman with clinical symptoms such as cough, expectoration, nasal congestion, and runny nose came to the hospital this time due to the aggravation of cough and expectoration symptoms and chest pain. At admission, chest CT showed consolidation of the middle lobe of the left lung and inversion of the whole internal organs. After anti infection and expectorant treatment, the symptoms improved. Reexamination of chest CT showed that inflammation was obviously absorbed, the middle lobe bronchiectasis was obvious, and improved sinus CT showed extensive sinusitis, The final clinical diagnosis was Katane syndrome. Conclusion: It is not difficult to diagnose Cartagene syndrome with typical triad, but it is easy to miss or misdiagnose those with atypical imaging manifestations. For patients with lung consolidation and visceral inversion, we should think of the possibility of Cartagene syndrome, and timely review chest CT and improve relevant examinations to avoid missed diagnosis and misdiagnosis.
Copyright (c) 2024 Wenyong Y https://creativecommons.org/licenses/by/4.0