Clinical Case Report Research Articles

Knee valgus deformity: indications and outcomes for a high tibial medial closing-wedge osteotomy

IntroductionTraditionally, knee valgus deformities have been corrected through distal femur osteotomies. The advances in preoperative planning allow surgeons to understand the leading site of deformity better and, therefore, propose corrections at the appropriate anatomical location. ObjectivesThe purpose of this evaluation is to present a case of a knee valgus deformity where most of the deformity resulted from the joint and the proximal tibia. A medial closing wedge tibial osteotomy corrected the proximal tibia deformity, while a fresh osteochondral allograft aimed to improve the surface of the lateral compartment of the knee, optimizing the joint lateral convergence angle. In addition, indications, outcomes and a scoping review of the literature for closing wedge high tibial osteotomy for knee valgus deformity is reviewed. MethodsA clinical case report example of a patient with knee valgus deformity requiring closing wedge high tibial osteotomy is presented. Detailed discussion of preoperative templating, planning and surgical completion is reviewed. A systematic review of previous studies and outcomes after closing wedge high tibial osteotomy was undertaken and summarized. ResultsThe case presented demonstrates an example of a valgus knee deformity with alignment correction vis a proximal tibial ostetomy. A review of and summary of previous case reports and outcomes studies for similar pathology demonstrates a high degree of success for this surgical approach. ConclusionsClosing wedge high tibial osteotomy is a viable treatment option for knee valgus deformity with an abnormal mechanical medial proximal tibial angle (mMPTA). A thorough evaluation of joint orientation angles is necessary to appropriately address limb deformity at the specific locations(s) of significant anatomic abnormality.

Pancreatitis Associated With Teduglutide: A Disproportionality Analysis via the Food and Drug Administration Adverse Event Reporting System (FAERS) Database.

Introduction Teduglutide is a glucagon-like peptide-2 analog that is indicated for the treatment of short bowel syndrome (SBS) by reducing patient dependence on parenteral support. Due to the rarity of SBS as well as the recent timeline of the adoption of teduglutide, the safety of teduglutide is relatively poorly understood. Several recent clinical case reports have highlighted elevated pancreatic enzymes and pancreatitis as a concerning complication of teduglutide. This prompts a systematic study of the association between pancreatitis and teduglutide. Methods This study conducts a case-control design disproportionality analysis by using data from the US Food and Drug Administration Adverse Event Reporting System (FAERS). Reports from the first quarter of 2020 through the first quarter of 2024 were retrieved from this database, and a disproportionality analysis was conducted. The analysis consisted of traditional methods of analyzing adverse drug events such as the reporting odds ratio (ROR) and proportional reporting ratio (PRR), as well as Bayesian methods such as the empirical Bayes geometric mean (EBGM) and information component (IC). A confidence interval for ROR and PRR that excludes a ratio of 1 or a confidence interval for IC that excludes a score of 0 was used as the criterion for a statistically significant association between pancreatitis risk and teduglutide use. Results Out of 11,696 reports of teduglutide adverse effects in over four years of adverse effects data drawn from the FAERS database, 79 cases of pancreatitis were identified. The disproportionality analysis revealed an ROR of 3.73 (95% CI (2.99, 4.66)), a PRR of 3.71 (95% CI (2.97, 4.63)), an EBGM of 3.70, and an IC of 1.84 (95% CI (1.51, 2.16)). All of these statistics indicate a statistically significant association between pancreatitis risk and teduglutide use. Conclusion The results reveal a statistically significant association between pancreatitis risk and teduglutide use. Our findings highlight the necessity for the careful monitoring of pancreatitis in patients undergoing teduglutide therapy going forward.

Management of Multiple Infantile Hemangiomas in a Preterm Infant: A Clinical Case Report

Management of Multiple Infantile Hemangiomas in a Preterm Infant: A Clinical Case Report

Uncommon Millettia pachycarpa Benth poisoning: A case report.

Millettia pachycarpa Benth, rich in rotenone, can disrupt the mitochondrial electron transport chain. Ingestion may cause respiratory and central nervous system depression, and in severe cases, lead to death. This is the first detailed clinical case report of M. pachycarpa Benth poisoning, aiming to help systematization of diagnosis and treatment. An elderly male who lost consciousness for 3 hours after consuming the fruit of M. pachycarpa Benth. Arterial blood gas analysis indicated a significant decrease in pH, a sharp increase in lactate levels, and elevated CO2 partial pressure with normal O2 partial pressure. The patient was diagnosed with food intoxication by M. pachycarpa Benth, concomitant with aspiration pneumonia and distributive shock. The patient was given continuous renal replacement therapy (CRRT) and invasive mechanical ventilation. The patient was successfully discharged after 5 days of hospitalization. Follow-up after 2 weeks showed no significant discomfort. Isolated CO2 retention without hypoxemia, significantly reduced pH, and markedly elevated lactate levels strongly suggest poisoning by M. pachycarpa Benth. CRRT and invasive mechanical ventilation are beneficial for patients. Early implementation of CRRT to remove toxins and early initiation of assisted ventilation to improve respiratory failure are recommended upon suspicion of the disease.

Emerging Role of Biologic Drugs Targeting IL-17 and IL-23: Pityriasis Rubra Pilaris.

Pityriasis rubra pilaris (PRP) is a rare, papulosquamous, inflammatory skin disease. PRP represents a therapeutic challenge. The rarity of this disease and its possible spontaneous remission makes the conduction and interpretation of therapeutic studies particularly difficult. Moreover, PRP not infrequently proves resistant to common topical and conventional systemic therapies. In this context, numerous biologic agents have been reported in PRP treatment. The aim of our manuscript was to review the current literature to evaluate the possible role of biologics targeting the IL17/23 axis in PRP management. Recent cases in the literature have highlighted the use of several promising drugs: IL-17 inhibitors, IL-23 inhibitors, and the IL-12/23p40 inhibitor ustekinumab. However, it should be noted that all these drugs are approved for moderate-to-severe plaque psoriasis and their use in PRP is off label. The treatment of PRP is based on clinical experience, case reports or case series reported in the literature, as randomized controlled trials are difficult to conduct due to the rarity of the condition. Despite data on the efficacy of drugs targeting IL-17 and IL-23 being promising, they are still limited. Certainly, further studies are desirable to better characterize PRP and establish shared guidelines.

Onset of Rheumatoid Arthritis with eye manifestations (clinical case report)

Objective. Rheumatoid Arthritis may onset with ocular manifestations. The purpose of our work was presentation of clinical case of the onset of rheumatoid arthritis with an eye lesion.Materials and methods. A clinical case of rheumatoid arthritis with an atypical onset was analyzed. As well, a search and review of relevant literature was performed.Results. Patient with rheumatoid arthritis got bilateral ulcerous keratitis, refractory to conventional treatment and complicated by bilateral corneal perforation with iris prolapse. Due to the atypical clinical course of ophthalmic lesions being insusceptible of medical treatment, the patient was examined further. Laboratory immunological workup revealed positive rheumatoid factor, anti-CCP and anti-MCV antibodies. The typical symmetric presentation of arthritis developed 8 months after the onset of ophthalmic disorders. Baseline therapy of rheumatoid arthritis has demonstrated efficacy both in controlling the joint manifestations and preventing relapse of keratitis.Conclusion. The development of eye syndrome may precede articular manifestation of rheumatoid arthritis. While managing patients with recurrent bilateral keratitis, rheumatologic pathology should be suspected.

A systematic review of cell therapy modalities and outcomes in cerebral palsy.

Cerebral palsy is widely recognized as a condition that results in significant physical and cognitive disabilities. Interventions aim to improve the quality of life and reduce disability. Despite numerous treatments and significant advancements, cerebral palsy remains incurable due to its diverse origins. This review evaluated clinical trials, studies, and case reports on various cell therapy approaches for cerebral palsy. It assessed the clinical outcomes of applying different cell types, including mesenchymal stem cells, olfactory ensheathing cells, neural stem/progenitor cells, macrophages, and mononuclear cells derived from peripheral blood, cord blood, and bone marrow. In 60 studies involving 1474CP patients, six major adverse events (0.41%) and 485 mild adverse events (32.9%) were reported. Favorable therapeutic effects were observed in 54 out of 60 cell therapy trials, indicating a promising potential for cell treatments in cerebral palsy. Intrathecal MSC and BM-MNC applications revealed therapeutic benefits, with MSC studies being generally safer than other cell therapies. However, MSC and BM-MNC trials have shown inconsistent results, with some demonstrating superior efficacy for certain outcomes. Cell dosage, transplantation route, and frequency of administration can affect the efficacy of these therapies. Our findings highlight the promise of cell therapies for improving cerebral palsy treatment and stress the need for ongoing research to refine treatment protocols and enhance safety. To establish conclusive evidence on the comparative effectiveness of various cell types in treating cerebral palsy, randomized, double-blind clinical trials are essential.

Development and Optimization of Oligonucleotide Ligation Assay (OLA) Probes for Detection of HIV-1 Resistance to Dolutegravir.

The WHO currently recommends dolutegravir (DTG)-based ART for persons living with HIV infection in resource-limited-settings (RLS). To expand access to testing for HIV drug resistance (DR) to DTG in RLS, we developed probes for use in the oligonucleotide ligation assay (OLA)-Simple, a near-point of care HIV DR kit. Genotypic data from clinical trials and case reports were used to determine the mutations in HIV-1 integrase critical to identifying individuals with DTG-resistance at virologic failure of DTG-based ART. Probes to detect G118R, Q148H/K/R, N155H and R263K in HIV-1 subtypes A, B, C, D and CRF01_AE were designed using sequence alignments from the Los Alamos database and validated using 61 clinical samples of HIV-1 subtypes A, B, C, D, CRF01_AE genotyped by PacBio (n = 15) or Sanger (n = 46). Initial OLA probes failed to ligate for 16/244 (6.5%) codons (9 at G118R and 7 at Q148H/K/R). Probes revised to accommodate polymorphisms interfering with ligation at codons G118R and Q148R reduced indeterminates to 3.7% (5 at G118R and 4 at Q148H/K/R) and detected DTG-mutations with a sensitivity of 96.5% and 100% specificity. These OLA DTG resistance probes appear highly sensitive and specific across HIV-1 subtypes common in RLS with high burden of HIV infection.

Evaluation of the appropriateness of nursing case studies using the CARE checklist

Case report is a narrative description of the problem of one or several patients. The CARE checklist (CAse REport) is the consensus document for reporting clinical case reports and through adaptations to the different CARE disciplines is used to define standards for authors in scientific journals; however, the specificity of the nursing process makes it difficult to adjust nursing case reports to CARE. The aim was to analyze the publications of clinical cases with a nursing perspective in scientific journals, as well as the quality standards and evaluation systems used. Few journals reviewed agreed to publish nursing case reports or stated standards for authors to adjust to CARE. Preliminary results indicated average or poor adherence to CARE, with the most reported elements being: Keywords, patient information and introduction. Adherence was lower for the elements: Timeline, therapeutic intervention, follow-up and outcomes, and patient perspective. The characteristics of the nursing process implies a low adherence to CARE, so it is necessary to unify criteria to guide researchers, authors, reviewers and editors of scientific journals, as well as to improve the rigor and quality of the reports. Currently, there are no specific guidelines for reporting clinical case reports with a nursing perspective available. These normative gaps could be solved by developing a CARE extension adapted to the methodological characteristics of the nursing process.

Enzyme replacement therapy for hypophosphatasia-The current paradigm.

Hypophosphatasia (HPP) is a rare, inherited, and systemic disorder characterized by impaired skeletal mineralization and low tissue nonspecific serum alkaline phosphatase (TNSALP) activity. It is caused by either autosomal recessive or dominant-negative mutations in the gene that encodes TNSALP. The phenotype of HPP is very broad including abnormal bone mineralization, disturbances of calcium and phosphate metabolism, pain, recurrent fracture, short stature, respiratory impairment, developmental delay, tooth loss, seizures, and premature death. Other than supportive care, there has been no disease-specific treatment available for those with HPP. Asfotase alfa is a fully humanized, recombinant enzyme replacement therapy for the management of HPP. It is available in several countries for the treatment of the more severe forms of HPP, namely perinatal and infantile HPP. This review will summarize the preclinical data on asfotase alfa and highlight the data from clinical trials and case reports. These data show the transformative nature of asfotase alfa when administered as part of an interdisciplinary treatment model.

INCLUSION CYST IN A BABY'S ORAL CAVITY: Clinical case report with a four-month-old patient in the city of Mato Verde - MG

Oral inclusion cysts are benign abnormalities and present spontaneous remission. The lesions have similar clinical characteristics, but have different locations and origins. Therefore, inclusion cysts are classified according to their location as: Epstein's Pearls, Bohn's Nodules and Dental Lamina Cyst. The objective of this study was to report a clinical case of inclusion cysts in the oral cavity of a four-month-old baby. This is a descriptive study, carried out in the municipality of Mato Verde-MG at Faculdade Verde Norte - FAVENORTE. Female patient, Caucasian, four months old, attended the FAVENORTE dental clinic taken by the person in charge, with the following main complaint "My daughter is teething". During intra-oral clinical examination, bilateral changes were observed in the region of primary molars located at the alveolar ridge line, measuring approximately 3 mm in diameter and whitish in color and asymptomatic. The changes are characteristic of Dental Lamina Cysts, the person responsible was reassured after diagnosis and the proposed treatment was quarterly clinical monitoring and guidance with gentle digital massage daily regarding the changes. It is of fundamental importance that professionals know the normal characteristics of the baby's oral cavity, only then will it be possible to reach accurate diagnoses related to changes in the baby's oral cavity, avoiding unnecessary therapeutic procedures.

Prevalence and Species Distribution of Neonatal Candidiasis: A Systematic Review and Meta-Analysis.

Candida infection is a significant cause of morbidity and mortality in neonatal intensive care units (NICU) globally. We aimed to conduct a systematic review to investigate the prevalence of candida among causative organisms of neonatal sepsis and identify the distribution of candida species infecting Saudi neonates. We comprehensively searched Web of Science, Scopus, PubMed, and Cochrane Library from their inception till November 2023. After screening titles, abstracts, and full texts, we ultimately included 21 eligible studies. The designs of the included studies were randomized clinical trials, cohorts, case-control, and case reports; the methodological quality was appraised using the Cochrane risk of bias assessment tool, NIH tool for observational studies, and Murad tool for assessing case reports. Our systematic review and meta-analysis pooled data reported in 21 studies in the Saudi populations, which provided data on different types of candidal infections in 2346 neonates. The pooled data of ten retrospective studies enrolling 1823 neonates revealed that candida species resembled 4.2% of the causative organisms of neonatal sepsis among Saudi neonates (95%CI [2.5%; 5.9%], p = 0.000). Additionally, out of a total of 402 candida species that were identified among the included studies, C. albicans prevailed mostly among Saudi neonates, followed by C. parapsilosis, NS candida, and C. tropicalis (50.25%, 21.40%, 12.44%, and 9.45%, respectively). We found that candida species prevailed in 4.2% of 1823 cases of neonatal sepsis; the most common candida species was C. albicans. We could not pool data regarding risk factors or susceptibility of candida species to different treatment modalities due to insufficient data, requiring future large-scale, high-quality studies to be conducted.

Treatment of Class II Malocclusion in a pediatric patient using Bionator – Clinical Case Report

Treatment of Class II Malocclusion in a pediatric patient using Bionator – Clinical Case Report

Long-term Sequelae: Sheehan’s Syndrome Unveiled 12 Years Postpartum Haemorrhage Complicated by Pulmonary Tuberculosis – A Clinical Case Report

Sheehan’s syndrome, a rare but significant endocrinopathy, often emerges in the backdrop of severe postpartum haemorrhage and can remain undiagnosed for years. Primary care physicians play a crucial role in suspecting and diagnosing this condition, especially in women presenting with a history of puerperal haemorrhage, lactation failure and amenorrhea. The syndrome’s potential to cause life-threatening adrenal crises during episodes of acute illness, such as infections or pulmonary tuberculosis, underscores the need for vigilance and prompt intervention in affected individuals. This report highlights the case of a 35-year-old female who was diagnosed with Sheehan’s syndrome a notable 12 years after experiencing a severe postpartum haemorrhage. Her condition was eventually unmasked following her affliction with pulmonary tuberculosis, emphasising the complexity and delayed presentation of this syndrome. This case underscores the critical need for heightened awareness among healthcare professionals for early identification and management of Sheehan’s syndrome to prevent serious complications.

Schwannoma (Neurilemmoma). Ectopic Position in Maxillary Sinus

A Schwannoma (Neurilemmoma) is a benign nerve tumor arising from a myelinated nerve fibers sheath, that can appear in any part of the body. Forty-five percent of the cases occur in the head and neck region. Intraoral Schwannomas are rather uncommon, intranasal and intrasinus Schwannomas are even rarer (less than 1%). The clinical case reports a young, man 14-years-old male with a Neurilemmoma the left maxillary sinus, involving the left third molar. The reports include case information, radiological findings, the surgery treatment, the histological characteristics of this particular tumor, a differential diagnosis, the post-operation process, and a review of the available literature.

Postoperative hemorrhages in vestibular schwannoma surgery pontine hemorrhage. Clinical case report

Vestibular schwannoma (acoustic neuroma) is a benign tumor that develops from Schwann cells and can be life-threatening. Nowadays, surgical treatment is the method of choice in the management of patients with this type of tumor. We present a clinical case report of 71 y.o. patient with vestibular schwannoma (Koos grade IV, Samii grade 4B) with severe compression of the pons and the left cerebellar hemisphere. Microsurgical removal of the tumor was performed via the retrosigmoid approach. Starting from postoperative day 1, signs of respiratory distress developed. Control multislice spiral computed tomography (MSCT) of the brain revealed the area of hemorrhage in the left regions of the pons. On postoperative day 24 the patient's condition rapidly worsened progressing to coma with pronounced arterial hypotonia and cardiac arrest. Hemorrhage in the brain stem structures is a rare and life-threatening postoperative complication in vestibular schwannoma surgery. The incidence of postoperative hemorrhage is 2–11% of cases. Vascular complications are the leading cause of mortality. The key predisposing factors are older age, large and giant size of the tumor, tumor invasion into the pia mater of the brainstem, and vascularization of the tumor stroma. Comprehensive assessment of the tumor blood supply status, the state of the brainstem, intra- and postoperative clinical and neurophysiological monitoring, careful and thorough dissection of the tumor capsule and strict control of blood pressure in the postoperative period are the basis for the prevention of these complications.

Bilateral Germectomy in Pediatric Patient: Clinical Case Report

Germectomy is a surgical treatment that consists of the extraction of the tooth germ; indicated when there are morphostructural alterations, ectopic impactions or eruption not permitted due to dysplastic alterations of the tooth germ. It is a surgical procedure of choice that involves the extraction of a dental organ with all its embryonic attachments when it is in the early stages, the prevalence of impactions and pathologies of the mandibular third molar can be avoided with this surgical treatment. Objective: To perform a careful cost-benefit evaluation to evaluate the indications of early third molar extraction. Methods: An observational and descriptive study was carried out in the operating room of the dental clinics of the American University from September 2023 to November 2023. An 12-year-old patient was evaluated, surgically intervening on two tooth germs of mandibular third molars. Evaluating the position, location, and morphostructural change of the third molar germ; as well as trans and postoperative complications and the evolution.

Perioperative Naltrexone Management: A Scoping Review by the Perioperative Pain and Addiction Interdisciplinary Network.

Substance use disorders, including alcohol use disorder, are a public health concern that affect more than 150 million people globally. The opioid antagonist naltrexone is being increasingly prescribed to treat opioid use disorder, alcohol use disorder, and chronic pain. Perioperative management of patients on naltrexone is inconsistent and remains a controversial topic, with mismanagement posing a significant risk to the long-term health of these patients. This scoping review was conducted to identify human studies in which the perioperative management of naltrexone was described. This review includes a systematic literature search involving Medline, Medline In-Process, Embase, PsycINFO, and Web of Science. Seventeen articles that describe perioperative naltrexone management strategies were included, including thirteen guidelines, one case report, and three randomized trials. Despite its use in patients with alcohol use disorder and chronic pain, no clinical studies, case reports, or guidelines addressed naltrexone use in these clinical populations. All of the guideline documents recommended the preoperative cessation of naltrexone, irrespective of dose, indication, or route of administration. None of these guideline documents were designed on the basis of a systematic literature search or a Delphi protocol. As described by the primary studies, perioperative pain relief varied depending on naltrexone dose and route of administration, time since last naltrexone administration, and underlying substance use disorder. None of the studies commented on the maintenance of recovery for the patient's substance use disorder in the context of perioperative naltrexone management. The current understanding of the risks and benefits of continuing or stopping naltrexone perioperatively is limited by a lack of high-quality evidence. In patients with risk factors for return to use of opioids or alcohol, the discontinuation of naltrexone should have a strong rationale. Future studies and guidelines should seek to address both acute pain management and maintaining recovery when discussing perioperative naltrexone management strategies.

P-382 Clinical case studies of women achieving successful pregnancy outcomes in natural cycle endometrial preparation while continuing breastfeeding: a gap in the existing literature

Abstract Study question Existing research in assisted reproductive technology excludes women who are breastfeeding.The influence of lactation on embryo transfer outcomes remains underexplored. Summary answer This collection of clinical cases underscores the viability of natural cycle endometrial preparation for women who wish to continue breastfeeding while pursuing fertility treatments. What is known already Endometrial preparation for embryo transfer often involves hormonal regimens and synchronization with the menstrual cycle. However, little attention has been given to women who choose to continue breastfeeding while pursuing fertility treatments. This study presents clinical case reports of women who successfully achieved ongoing pregnancies by utilizing natural cycle endometrial preparation during continued lactation, shedding light on a crucial gap in the current literature regarding embryo transfers in lactating women. Study design, size, duration A series of clinical case reports were analyzed, focusing on women who maintained breastfeeding while undergoing natural cycle endometrial preparation for embryo transfer. The cases encompass various age groups and underlying fertility issues. Data collected includes menstrual regularity, hormonal profile, and outcomes of embryo transfers. Participants/materials, setting, methods Retrospective review of a group of women of varying ages and fertility backgrounds who opted to continue breastfeeding while pursuing embryotransfer. We performed frozen embryo transferchoosing natural cycle endometrial preparation. Clinical data were collected from the participants, including menstrual regularity, hormonal assesment, and outcomes of embryo transfers. Patients were monitored to determine the timing of natural ovulation. The women continued breastfeeding throughout their cycle, and embryo transfers were performed according to standard protocols. Main results and the role of chance Our preliminary findings indicate that women who continued breastfeeding during natural cycle endometrial preparation achieved successful pregnancies with evolving embryos. These case reports highlight the potential feasibility of this approach in fertility treatments, despite the limited scientific literature examining the impact of breastfeeding on embryo transfer outcomes. Limitations, reasons for caution Limited number of clinical cases, which may not fully represent the diversity of patient experiences. Additionally, the absence of a control group makes it challenging to draw definitive conclusions about the sole influence of breastfeeding on the outcomes. Future investigations should involve larger cohorts and controlled studies to provide evidence. Wider implications of the findings This collection of clinical cases underscores the viability of natural cycle endometrial preparation for women who wish to continue breastfeeding while pursuing fertility treatments.. These cases advocate for a broader understanding of reproductive options and potential adaptations to existing protocols for lactating women in the field of assisted reproductive technology. Trial registration number not aplicable

The rehabilitation of a combined mid-facial defect using a magnetretained intra- and extra-oral prosthesis: a case report

There are several treatment options available to restore function and appearance in patients with combined mid-facial defects. Owing to the size of the defect and the associated size and weight of the prostheses, adequate retention can be challenging to achieve. Retention of a facial prosthesis can be improved using several techniques, such as medical grade adhesives, attachments, or osseo-integrated implants. For patients with a history of radiotherapy, surgical rehabilitation may be less favourable than non-surgical approaches owing to the risk of osteoradionecrosis and a reduced blood supply in the surgical fields. This clinical case report highlights the conservative rehabilitation of a combined mid-facial defect using a magnet-retained intra-oral and extra-oral prosthesis. CPD/Clinical Relevance: A thorough medical and clinical assessment will highlight factors that will influence the treatment planning process when managing a combined mid-facial defect.