Present Case Report Research Articles

Case Report of Concomitant Presentation of Ovarian Torsion and Acute Appendicitis in a Patient Post-Hysterectomy

Case Report of Concomitant Presentation of Ovarian Torsion and Acute Appendicitis in a Patient Post-Hysterectomy

Non-surgical management of gingival cleft.

The aims of the present case report are to describe the non-surgical management in addition to hyaluronic acid application of two gingival recessions with cleft and to perform a narrative review on the newest evidence of non-surgical treatment of gingival recessions. A 47-year-old female patient with dentine hypersensitivity and pain during brushing has type 1 gingival recession with red Stillman's cleft on 1.4 and 1.5. The gingival defects have been treated with a Gracey curette n° 7/8 to cause bleeding. Sodium hyaluronate gel has been applied in the gingival sulcus of both elements affected. Three months after treatment the gingival tissue on 1.5 and 1.4 revealed complete healing of the Stillman's cleft and the mean value of REC depth reduced by 0.50 mm. Furthermore, four articles about this topic were selected for a narrative review. Based on the recent literature, the non-surgical treatment of Stillman's clefts and gingival recessions is not highly rated. The clinical result of this case report suggests a non-surgical method to treat Stillman's cleft. However, the evidence from a single case report is weak and more clinical trials are required to deepen the knowledge on the topic.

Treatment of excessive growth of granulation tissue in horses by topical application of resveratrol

AbstractExcessive growth of granulation tissue (EGT) is a common complication during wound healing in horses. Wounds involving lower limbs are especially prone to the development of EGT. Often increased expression of transforming growth factor‐β (TGF‐β) is found in the EGT. In the present report, resveratrol was used as TGF‐β modifier. Topical application of an aqueous solution of resveratrol at 0.01 mg/mL once daily for 5‒7 weeks depending on EGT size, successfully suppressed the EGT growth in all seven horses in the present case report.

Visceral and Vascular Imaging Findings of Hypovolemic Shock in Contrast-enhanced Computed Tomography: A Case Report

Shock, a medical emergency condition secondary to an underlying cause, requires urgent diagnosis for timely management. Imaging can play an important role in this process. Certain identifiable features on Contrast-enhanced Computed Tomography (CECT) may alert radiologists to the presence of Hypovolemic Shock (HS). A spectrum of visceral and vascular CT signs has been documented to represent the underlying shock condition. Authors, hereby present a case of 78-year-old male patient, depicting visceral and vascular imaging findings of HS, as observed on a CECT of the abdomen and pelvis. The visceral findings included hypoenhancement of the liver and spleen, heterogenous hyperenhancement of the kidneys and adrenal glands and abnormal dilation of small bowel loops. The vascular findings were characterised by the flattening of the Inferior Vena Cava (IVC). The present case report was aimed to help radiologists increase their awareness of the CT signs of HS and assist physicians in taking early measures for adequate management.

Synovial Sarcoma: A Case Report of first presentation at penoscrotal junction

Synovial Sarcoma: A Case Report of first presentation at penoscrotal junction

Osteoid Osteoma of the Body of Cervical Vertebra—A Case Report of an Unusual Presentation

Osteoid Osteoma of the Body of Cervical Vertebra—A Case Report of an Unusual Presentation

Computed Tomographical Characterisation of Dyke-Davidoff-Masson Syndrome: A Case Series

Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurological disorder that primarily manifests through various neurological symptoms, with a significant focus on contralateral hemiparesis and convulsive disorders that often show resistance to standard treatments. It is mainly characterised by hemicerebral atrophy, bony calvarial thickening and hyperpneumatisation of the ipsilateral paranasal sinuses on imaging. Computed Tomography (CT) is a crucial diagnostic tool in settings with limited resources, offering an effective means to identify and diagnose this syndrome. In the present paper, the authors present case reports of three patients (2 females, 1 male) with seizure disorders and hemiparesis who were admitted to the Medicine Department and had CT brain imaging performed within six months. The objective to highlight the diagnostic process and discuss the clinical presentation of this syndrome in a limited-resource setting, emphasising the role of CT in aiding diagnosis and further medical management.

Appendicitis in Pregnancy - A Multidisciplinary Approach and optimal Management from the perspective of Gynecology and Obstetrics: A Case Report

Appendectomy for acute appendicitis is the most common surgical procedure performed during pregnancy. The primary treatment for acute appendicitis is emergency surgery, which can be particularly challenging due to altered anatomical conditions. Preoperative and postoperative care may require certain examinations due to pregnancy that are not standard within surgical practice or may be overlooked by the attending gynecologist. In the presented case report, we demonstrate an example of the appropriate multidisciplinary approach in a patient at 33 weeks of pregnancy, with an analysis of the specific steps that should be taken to maximize the benefit for both the fetus and the mother, as well as the surgical team. In the discussion, we outline the steps that should be followed for patient benefit and forensic reasons.

Novel treatment of Paroxysmal Nocturnal Haemoglobinuria with wheat grass oral therapy

I will start with William Osler’s Famous Quote “Always notice unusual, Publish it, Place it on Permanent Record”. This has really motivated me to publish the present case report. A 28 year old lady was diagnosed with Paroxysmal Nocturnal Haemoglobinuria at the age of 28 years. She initiated on wheat grass juice on her own after three years of diagnosis and is continuing since. She is presently 58 years of age, leading a fruitful life and her latest report shows remission of gene. I will close by Dr Dean Ornish’s( an American Doctor) remarks that if special type of diet is taken honestly religiously, it gets incorporated in DNA of individual, thus changing DNA, This has happened probably in our case.

Quercetin Phospholipids Supplementation as a Natural Relief in Osteomuscular Health

Quercetin, a polyphenol substance, was found in several foods, including apples, grapes, onions, berries, broccoli, citrus fruits, green tea, coffee and red wine. The properties of quercetin are well known, including antioxidant/antiinflammatory, vasodilator, anti-allergic, anti-fatigue and senolytic. In the present case reports in joint health, one month quercetin phospholipid supplementation significantly reduced both NRS and FIHOA scores in erosive hand osteoarthritis subjects. No side effects related to the supplementation was detected, thus quercetin phospholipid supplementation would represent a valid safe support in joint health and pain management as add-on natural support.

Computer-assisted total bilateral knee arthroplasty for a patient with severe hyperextension in residual poliomyelitis: a case report

Background. Total knee arthroplasty in patients in the residual stage of poliomyelitis is a technically difficult job. The reasons for this are anatomical features and therefore difficulties in an implant choice and conflicting results. In the present case report, we describe a unique method of a computer-navigated installation of a rotating-hinge implant in a non-standard position for a patient with residual poliomyelitis. The aim of the study is to demonstrate a method of a computer-navigated installation of rotating-hinge knee implants in a patient with severe hyperextension and valgus deformity in the residual stage of poliomyelitis. Case description. The clinical case presents a 55-year-old man with lower peripheral paraparesis as a consequence of poliomyelitis and bilateral valgus knee arthritis with severe hyperextension. The patient moved on crutches at a distance no more than 300 meters. Two-stage total knee arthroplasty was performed using a navigation system and second-generation rotating-hinge implants. At the 4-year follow-up period, we note a good clinical result, and the patient is satisfied with the total knee arthroplasty outcomes. Conclusion. The clinical case demonstrates good results of performing total knee arthroplasty in a patient with bilateral severe hyperextension and knee valgus deformity in residual poliomyelitis. Having analyzed available topic-related literature, we developed an original method of a computer-navigated installation of a second-generation rotating-hinge implant. The method can be an effective treatment solution for patients with knee arthritis deformity in the residual stage of poliomyelitis.

The debut of benign recurrent intrahepatic cholestasis in acute hepatitis A

Background. Benign recurrent intrahepatic cholestasis is a rare inherited disorder characterized by recurrent episodes of severe hyperbilirubinemia and pruritus that resolve spontaneously. However, attacks of cholestasis may persist for several months and in some cases be associated with frequent recurrences, which may be grounds for liver transplantation.Objective. To present a clinical case of debut benign recurrent intrahepatic cholestasis following acute hepatitis A.Results. A 30-year-old patient was admitted at the Liver Transplantation Center of Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy for a prolonged episode of intrahepatic cholestasis with severe coagulopathy after acute hepatitis A. Total bilirubin was elevated up to 835 µmol/L and INR was 3.6. The manifestations of vitamin K-associated coagulopathy were controlled after the first dose of parenteral menadione sodium bisulfite. Glucocorticosteroids, ursodeoxycholic acid and plasmapheresis turned ineffective in the treatment of hyperbilirubinemia. Due to long-persisting cholestasis resistant to conservative therapy, the patient was considered for inclusion to the liver transplant waiting list. However, spontaneous resolution of the cholestatic episode was achieved at 5 months after the onset of manifestations. Benign recurrent intrahepatic cholestasis type 2 was diagnosed on the basis of the specific clinical signs, laboratory blood tests and genetic testing.Conclusion. The present Case Report shows a long-lasting episode of cholestasis with severe coagulopathy in acute hepatitis A in a patient with benign recurrent intrahepatic cholestasis with subsequent spontaneous resolution of the clinical symptoms at 5 months after their manifestation onset. Therefore, the differential diagnosis of benign recurrent intrahepatic cholestasis should be considered prior to liver transplantation in patients with intrahepatic cholestasis.

REDISCOVERING RELIEF: A CASE REPORT ON EFFECTIVELY MANAGING SCIATICA WITH AYURVEDIC APPROACHES.

Gridhrasi is a common condition characterized by sequential pain that starts from the (buttock region) of Sphik Pradesh and radiates down to the foot. It can be correlated with Sciatica, radiating pain from the back to the lower limb with paraesthesia. The present case report is of a 43-year-old male patient, unable to walk due to se-vere back pain radiating to his left ankle. As per the previous MRI report, the patient had an established case of prolapse of the intervertebral disc (PIVD) with radiculopathy and took treatment at a private allopathic hospital, and they advised him to have surgery. The patient and his attendant refused surgery and came to our hospital. The patient was treated with Siravedha and oral medications. After improvement, the patient was maintained on back strengthening exercises. Visual Analogue Scale (VAS) score, comfortable walking distance, Straight Leg Raise (SLR) test, and % relief reported by the patient were used as assessment criteria. The patient was relieved from all symptoms with a follow-up period of 1 year. This case report shows that Siravedha and Ayurvedic oral management is very effective in Gridhrasi (PIVD with Radiculopathy). Hence, this treatment can be minimally cost-effective as a day-care procedure and protects the patient from surgical intervention.

Autosomal Recessive Non-Syndromic Hearing Loss: A Case Report with a Novel TRIOBP Gene Variant

In the present case report, we have found a novel variant for TRIOBP in a patient with congenital hearing loss. The patient is an 8-year-old female with hearing loss, the first child of consanguineous parents. To identify the underlying genetic defect, whole genome sequencing was performed. Carrier screening of the parents was also conducted. The results showed a homozygous autosomal recessive missense c.5849C>T (p.Pro1950Leu) variant in exon 16 of the TRIOBP gene. To our knowledge, this variant has not been previously reported as either a pathogenic or a benign variant. The novel TRIOBP variant found in the present study broadens the range of TRIOBP mutations implicated in hearing loss. Accordingly, the results of this study may be important for genetic counseling.

The Winding Road to Dyspnea: A Case Report of an Unusual Presentation of Anomalous Left Coronary Artery from the Pulmonary Artery

The Winding Road to Dyspnea: A Case Report of an Unusual Presentation of Anomalous Left Coronary Artery from the Pulmonary Artery

Nija Shotha - A Clinical Case Report

Shotha is defined as the one which is Shareera Ekadeshe Sthitha involving Tridoshas and having Ashraya is Twak, Mamsa.[1] Nija Shotha is one where the involvement of the Vatadi Doshas is first followed by development of Vedanadi Lakshanas.[2] It has different Nidanas, and a case of Shotha with Sneha Vibrama Nidana is included in the current study. Present case report is of a male patient aged 62 years who is a k/c/o HTN since 3 months, K/C/O Kushta since 18 years, and presented with symptoms of severe pain & swelling in bilateral lower limbs since 1 week. Upon close inspection, it was discovered to have been evolved after Kushta, with Sneha Vibhrama serving as the primary Nidana. He was treated with Bahya Chiktitsa & Shamana Aushadis, resulting in a considerable reduction of Shotha & Vedana and was followed with Virechana after which the symptoms were completely reduced. This case illustrates how Shotha develops due to Vyadhikarshana, wherein Sneha Vibrama functions as a Vyanjaka Hetu for the disease progression.

Therapeutic interventions and clinical efficacy in Ayurvedic management of Vipadika (Palmoplantar Psoriasis): A Case Report

Vipadika, a skin disorder mentioned in Ayurvedic literature as Kshudra Kustha attributed to Vata and Kapha Dosha imbalance, is analogous to palmoplantar psoriasis in contemporary science. It is a non-infectious chronic inflammatory disease of the skin bound to the palm and sole. It is characterized by pain, itching, and fissures in both soles. Contemporary treatment options often lead to temporary relief with frequent recurrence, leading patients to seek alternative therapies. The present case report aims to assess the therapeutic efficacy of Ayurvedic management in treating Vipadika. A 58-year-old female presented with pruritus, fissures in both sole and severe pain with oozing of bleeding from fissures across both soles; diagnosed as Vipadika. The treatment approach exclusively involved Shamana Chikitsa, including the oral administration of Panchatikta Ghrita, Gandhaka Rasayana, and Avipattikara Churna. Topical care was provided by washing the affected area with Panchavalkala Kwatha mixed with Shuddha Tankana for debridement. After washing, the patient was advised to use a foot scrubber for scrubbing the dead skin around the fissures followed by Jatyadi Malam for topical use. The patient's response was assessed over ten weeks, with follow-up for four weeks to determine using symptom improvement, patient-reported outcomes, and Auspitz sign. This case demonstrates the potential of Ayurvedic therapies for the effective management of Vipadika, suggesting a viable alternative to conventional treatment approaches.

CRISES PSICOGÉNICAS NÃO EPILETIFORMES E PERTURBAÇÃO BORDERLINE DA PERSONALIDADE NUMA JOVEM ADOLESCENTE

Psychogenic Non-epileptic Seizures (PNES) are paroxysmal and involuntary episodes of sudden/temporary behavioral changes, with impairment of motor, autonomic, cognitive and emotional functions. Of the patients diagnosed, some resolve quickly, but in the majority of cases, the symptoms persist for months or years. The persistence of PNES may be associated with another underlying pathology, mainly a Personality Disorder, particularly borderline. The present clinical case report to a 16-year-old female adolescent, referred at the age of 13 to the Child and Adolescent Psychiatry Service (CAPS) after multiple visits to the emergency department due to persistent symptoms of anxiety, sadness, ongoing suicidal ideation, self-injurious behavior and recurrent episodes of falling from her own height. As an intervention, it is worth mentioning follow-up in multiple specialty consultations, without any alterations being detected. The young girl attended CAPS appointments, individual psychotherapy, psychopharmacological and family interventions and multiple hospitalizations in mental health facilities.In carrying out the differential diagnosis, the following diagnostic hypotheses were considered: Functional Neurological Symptom Disorder, Major Depressive Disorder and Borderline Personality Disorder (BPD). As in this case, literature confirms that in many patients with PNES, with severe disability and persistence for months or years, show co-occurrence with BPD. This comorbidity predicts a worse prognosis for PNES. This clinical case illustrates the complexity of the condition, particularly the refractoriness of the functional neurological symptoms and the ineffective response to the multiple interventions. In the future, it would be important to invest in research into other types of therapeutic approaches for these patients.

Villonodular Synovitis of the Index Finger: A Case Report

Villonodular Synovitis (VNS) is a rare condition characterised by abnormal growth of synovial tissue and accumulation of haemosiderin within joints, tendon sheaths and bursae. While the exact aetiology remains unclear, chronic inflammation is a leading theory. Although VNS typically affects large joints, the present case report highlights the possibility of its occurrence in smaller joints like the index finger. Early diagnosis and surgical intervention are crucial for effective management of VNS. The present case report underscores the importance of considering VNS in the differential diagnosis of soft-tissue masses, even in atypical locations. The present case report describes a 24-year-old male presenting with a decade-long history of pain and swelling in his right index finger. Despite initial radiographic findings being normal, Magnetic Resonance Imaging (MRI) revealed a well-defined soft-tissue mass involving the proximal and middle phalanx, flexor tendons and annular pulley. The presence of haemosiderin deposition within the mass was evident on MRI. The patient underwent open synovectomy, during which a brownish nodular synovium was observed, further supporting the diagnosis of VNS. Histopathological Examination (HPE) of the removed synovial tissue confirmed the presence of haemosiderin granules and haemosiderin-laden macrophages, solidifying the diagnosis of VNS. Post-surgery, the patient initiated a regimen of passive flexion and extension exercises for 15 days. At the 12-month follow-up, there were no clinical or radiological signs of recurrence and the patient had regained full range of motion.

ЭЛЕКТРОКАРДИОГРАФИЧЕСКИЕ ПАТТЕРНЫ ВНЕЗАПНОЙ СЕРДЕЧНОЙ СМЕРТИ У ПАЦИЕНТА С ИНФАРКТОМ МИОКАРДА И ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИЕЙ, ВЫЗВАННОЙ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ

Abstract. Introduction. Sudden death remains a major public health problem causing death in 25–50% of patients with a previous myocardial infarction. Studying and searching for new prognostic risk factors for sudden cardiac death are an extremely difficult task. Atrioventricular dissociation may be one of the significant cardiac complications of acute myocardial infarction in a patient diagnosed with a new coronavirus infection. Aim was to present a clinical case of patient G. born in 1936 with sudden cardiac death registered during 24-hour electrocardiography monitoring, which was preceded by arrhythmogenic myocardial activity and atrioventricular dissociation. Materials and Methods. Literature was reviewed, and patient G.’s medical background was studied. Results and Discussion. Changes are shown that took place in the in arrhythmogenic myocardial activity preceding asystole in patient G. born in 1936, who was hospitalized with a diagnosis of coronary heart disease. Repeated myocardial infarction of the inferior wall of the left ventricle dated November 11, 2023. Post-infarction cardiosclerosis (1986). Rhythm and conduction disturbances are a paroxysmal form of atrial fibrillation. First-degree atrioventricular block, complete right bundle branch block. Hypertension stage 3, risk 4. Controlled arterial hypertension. Target blood pressure 120-129/70-79 mm Hg. Hypertrophy of the walls and dilatation of the cavities of the left ventricle and of the left and right atria. Chronic heart failure 2B (Simpson ejection fraction 29%). Functional class III. Bilateral hydrothorax. Community-acquired right-sided pneumonia, severe. Respiratory failure 1-2. Type 2 diabetes mellitus, target glycated hemoglobin level below 8%. Chronic kidney disease C3a (glomerular filtration rate 55 ml/min/1.73 m²). New coronavirus infection (PCR SARS-COV-2 diagnosed on November 21, 2023). Conclusions. In the presented case report, electrophysiological instability of the myocardium preceding asystole in patient G. was recorded on a long-term electrocardiogram recording, the patient having the verified leading risk factors for sudden cardiac death, such as hemodynamically significant ventricular arrhythmias, myocardial infarction, episodes of atrioventricular dissociation, heart failure with the reduced left ventricular ejection fraction, and coronavirus infection.