Etiological Origins Research Articles

Unveiling viral pathogens in acute respiratory disease: Insights from viral metagenomics in patients from the State of Alagoas, Brazil.

Respiratory illness affects individuals across all age demographics on a global scale, often precipitated by viral infections. The symptomatic manifestations of these diseases bear clinical resemblance, complicating the accurate determination of their etiological origins. Furthermore, the diagnostic panels for respiratory pathogens used within local medical practices, may not encompass the full spectrum of viral agents responsible for such ailments. Consequently, a significant number of clinically important viral pathogens may remain undetected. In the light of this, we conducted a metagenomic examination of 66 nasopharyngeal swab specimens, obtained from patients presenting with acute respiratory conditions yet tested negative by the standard diagnostic panels available locally. These specimens were obtained from the Public Health Laboratory, Maceio, State of Alagoas. Our findings indicate a predominant diagnostic escape of rhinoviruses and notably enterovirus D68. Moreover, our study identified a substantial quantity of sequence reads attributed to human respirovirus 3 (human parainfluenza 3) along with various herpresviruses including human herpesvirus-1, Epstein-Barr virus (Human herpesvirus-4), Human herpesviruses 6 and 7 and human parvovirus B19 (B19V). Notably, the metagenomic analysis uncovered a widespread presence of the emerging human vientovirus FB in most of sample pools, though its clinical importance remains to be elucidated. The obtained results in this study underscore the invaluable role of viral metagenomics in the identification of underrecognized viruses bearing clinical relevance. Furthermore, it offers insights into the dissemination of these pathogens within the studied area, thereby informing public health strategies aimed at enhancing diagnostic accuracy and improving patient care.

Intrahepatic bilioma as a complication of laparoscopic cholecystectomy: a case report

A biloma is described as an encapsulated collection of intra- or extrahepatic bile related to trauma mechanisms at the level of the biliary tree. Its etiological origin is a traumatic injury following biliary or hepatic surgery, which can cause iatrogenic conditions. In some cases, it can resolve spontaneously, but this is very uncommon. Treatment focuses on performing percutaneous drainage, endoscopy, and should be associated with antibiotics according to the patient's requirements; in some cases, the placement of a stent will be necessary. It is important to note that if the biloma is associated with an infectious condition, it must be drained immediately.

Clinical, Radiological, and Etiological Aspects of Pachymeningitis: A Study of 24 Cases.

Introduction and importance Hypertrophic pachymeningitis (HP) is an uncommon disorder with varied etiological origins and heterogeneous clinical presentation. Establishing the etiological diagnosis poses a challenge, but prompt identification provides a treatment window, potentially leading to a reversal of symptoms.MRI is the reference examination, allowingnot onlythe early diagnosis of pachymeningitisbut alsothe assessment of its extent and importance, detection of possible complications, and suggestion of etiology. Case presentation We conducted a retrospective study involving 24 patients recruited over 5 years for who brain imaginghad revealed the presence ofpachymeningitis.The average age of the patients was 40 years, with a male-to-female ratio of 0.6. Clinical discussion Headache was present in 54.17% of patients. All the patients underwent MRI examinations utilizing different sequences, with subsequent Gadolinium injection showing localized and asymmetrical meningeal thickening in 13cases,and diffuse in the rest. The cerebrospinal fluid study unveiled an inflammatory fluid characterized by a lymphocytic predominance and hyperproteinorrhea, noted in 50% of the patients. The histopathological analysis of a stereotactic biopsyconductedon an individual patient revealed non-diagnostic results. The etiological investigationwas dominatedby tuberculosis, which was detectedin 33.3% of cases.Idiopathic origin was identifiedin 16.7% of patients. Conclusion Meningeal thickening is rare, and the multitude of potential causes makes the etiological investigation challenging unless they fall within the scope of secondary meningeal disorders; otherwise, a dural biopsy becomes necessary, and the prompt initiation of treatment, along with determining the etiology influences the prognosis.

Effect of pre-eclampsia on lactogenesis: Breastfeeding and the effect of breastfeeding on women's postpartum blood pressure

Preeclampsia is a serious complication of pregnancy, affecting 3 to 8% of all pregnancies and endangering both the pregnant woman and the fetus. The predominant etiological origin of preeclampsia has been shown to result from abnormal placentation, leading to abnormal remodeling of the spiral arteries and placental ischemia. The placenta plays an important role in pregnancy as it produces a multitude of hormones which are necessary for the maintenance of women's physiology, the development of embryos and also for the promotion of the developed mammary epithelium, so that breastfeeding becomes possible postnatally. Human breast milk is the most valuable nutritional source for infants. Women with preeclampsia more often have problems with lactogenesis II and breastfeeding than women without. It appears that the effect of preeclampsia on breastfeeding is multifactorial in nature and that a strong predictor of breastfeeding outcome is women's intention to breastfeed. Women with hypertensive disorders breastfeed for a shorter period of time and use the formula more easily. Breastfeeding appears to be protectively associated with blood pressure in later life in women, and the shortest duration of breastfeeding associated with benefit is one month. Further investigations are needed to elucidate the mechanism of delayed galactogenesis II in the presence of preeclampsia. Education about the benefits of breastfeeding to prevent hypertension in women is a low-risk intervention and may have a positive impact on cardiovascular outcomes in mothers over time.

I smell something weird - Ictal olfactory hallucinations in patients with primary brain tumors

IntroductionIctal olfactory hallucinations (the experience of a smell due to a focal seizure in the absence of an environmental stimulus for the sensation) are rare. They often appear in a context of a brain tumor located in the orbitofrontal or mesotemporal region. However, their accurate prevalence, etiology and anatomical origin remains unclear, as few studies focused on this type of seizures specifically.ObjectivesTo evaluate the clinical, neurophysiological and imaging characteristics of patients with brain tumors and olfactory seizures.MethodsWe present a 3-year retrospective patient record study carried out at the Portuguese Institute of Oncology in Lisbon. Clinical records of 572 patients admitted due to a primary Central Nervous System (CNS) tumor, for their first neuro-oncology appointment, between July 2020 and July 2023, were reviewed.Results8 patients with olfactory seizures were identified. Five were men. The mean age was 57.75 (ages between 15 and 70 years old). In seven patients, olfactory seizures constituted the initial clinical presentation of the tumor. In two patients, focal olfactory seizures had progression to bilateral tonic clonic. Most seizures were perceived as unpleasant (smells of metal, ammonia, “hot blood”, “dead bodies” were described). Tumors involved the temporal lobe in all patients, the insula in two of them and, for the majority, the lesion was right-sided. Six patients were diagnosed with Glioblastoma IDH wildtype (Grade 4, WHO), one patient with Oligodendroglioma, IDH-mutated and 1p/19q-codeleted (Grade 2, WHO) and the pediatric patient with a diffuse pediatric type high-grade glioma, H3 and IDH wildtype. The average follow-up time was 6.8 months, two patients died.ConclusionsThis is the first retrospective study carried out in Portugal that documents the prevalence of olfactory seizures in patients with primary CNS tumors. Given the scarce literary evidence, we consider that olfactory seizures may be more frequent than documented, particularly in the presentation of brain tumors. As so, active semiological investigation may contribute to an earlier diagnosis.Disclosure of InterestNone Declared

Child effects on positive parenting vary with neighborhood opportunity.

Prior theoretical and empirical research has highlighted links between positive parenting and the socioeconomic characteristics of the family's neighborhood, but has yet to illuminate the etiologic origins of this association. One possibility is that the various predictors of parenting outlined by Belsky (1984; e.g., characteristics of the child, characteristics of the parent, and contextual influences) may matter more in some neighborhood contexts than in others. To examine this possibility, we conducted etiologic moderation analyses in a sample of 1,030 families of twins (average age 8 years; 51% male, 49% female; racial composition: 82% White, 10% Black, 1% Asian, 1% Indigenous, and 6% multiracial) from the Twin Study of Behavioral and Emotional Development in Children in the Michigan State University Twin Registry. Neighborhood and parenting were assessed using multiple informants and assessment strategies (neighborhood and family informants, administrative data, and videotaped parent-child interactions). Results pointed to strong evidence of etiologic moderation, such that child effects on positive mothering were prominent in neighborhoods with little opportunity and near zero in neighborhoods with ample opportunity. Such findings not only reframe the magnitude of child effects on the parenting they receive as context-dependent, but also indicate that mothers in impoverished neighborhoods may be more responsive to their children's characteristics than mothers in neighborhoods with ample opportunity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

MICROBIOTA ANALYSIS OF PAROTID GLAND SECRETIONS IN CHILDREN WITH EXACERBATION OF CHRONIC PARANCHYMAL MUMPS

In the structure of chronic nosological forms of sialoadenitis, chronic parenchymal mumps accounts for 80%, and is characterized by a recurrent course. To date, the issue of its etiologic origin remains controversial, and data on the pathogenetic influence of external and internal factors on the occurrence of another exacerbation are constantly being supplemented. In particular, the role of the duktogenic pathway of microbial penetration into the glandular duct system is often discussed. Objective: to study the microbiota of parotid secretion in children with exacerbation of chronic parenchymal mumps.
 Materials and methods. To investigate the qualitative characteristics and quantitative parameters of microbial flora in the secretion of the parotid salivary glands during disease exacerbation, we enrolled 41 children aged 3 to 15 years, with 18 cases classified as having an active course and 23 as inactive. The study was conducted following the guidelines outlined by CLSI, EUCAST, and relevant State Regulatory Orders and Supplements.
 Results. It was found that at the time of the exacerbation in the active course, plasma-coagulating staphylococci and hemolytic streptococci strains in the amount of 106-107 CFU/ml prevailed in the glandular secretion, which were mainly sensitive to beta-lactam antibiotics of all generations, macroliths, natural and semi-synthetic aminoglycosides. An association of microorganisms was isolated from the secretion of 4 glands (11.1%), consisting of coccal cultures, gram-negative bacilli, and yeast cells. In the inactive course, Staphylococcus aureus and hemolytic streptococci slightly prevailed in the glandular secretion, but the proportion of non-pathogenic coccal microorganisms increased, and their number was 105-106 CFU/ml. Their antibiotic patterns did not differ significantly from those in the active course. The isolation of microbial associations concerned 8 glands, which amounted to 17.5%.
 Conclusion. Taking into account the presence of microorganisms in the secretion from the parotid glands in the acute exacerbation of chronic parenchymal mumps with pathogenicity factors and an increase in their number depending on the activity of the disease, it is necessary to take a differentiated approach to rational antibiotic therapy by instillation of antimicrobial drugs into the ductal system.

Inhibition of lysyl oxidase by pharmacological intervention and genetic manipulation alleviates epilepsy-associated cognitive disorder

Epilepsy-associated cognitive disorder (ECD), a prevalent comorbidity in epilepsy patients, has so far uncharacterized etiological origins. Our prior work revealed that lysyl oxidase (Lox) acted as a novel contributor of ferroptosis, a recently discovered cell death mode in the regulation of brain function. However, the role of Lox-mediated ferroptosis in ECD remains unknown. ECD mouse model was established 2 months later following a single injection of kainic acid (KA) for. After chronic treatment with KA, mice were treated with different doses (30 mg/kg, 100 mg/kg and 300 mg/kg) of Lox inhibitor BAPN. Additionally, hippocampal-specific Lox knockout mice was also constructed and employed to validate the role of Lox in ECD. Cognitive functions were assessed using novel object recognition test (NOR) and Morris water maze test (MWM). Protein expression of phosphorylated cAMP-response element binding (CREB), a well-known molecular marker for evaluation of cognitive performance, was also detected by Western blot. The protein distribution of Lox was analyzed by immunofluorescence. In KA-induced ECD mouse model, ferroptosis process was activated according to upregulation of 4-HNE protein and a previously discovered ferroptosis in our group, namely, Lox was remarkably increased. Pharmacological inhibition of Lox by BAPN at the dose of 100 mg/kg significantly increased the discrimination index following NOR test and decreased escape latency as well as augmented passing times within 60 s following MWM test in ECD mouse model. Additionally, deficiency of Lox in hippocampus also led to pronounced improvement of deficits in ECD model. These findings indicate that the ferroptosis regulatory factor, Lox, is activated in ECD. Ablation of Lox by either pharmacological intervention or genetic manipulation ameliorates the impairment in ECD mouse model, which suggest that Lox serves as a promising therapeutic target for treating ECD in clinic.

From synaptic dysfunction to atypical emotional processing in autism.

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition mainly characterized by social impairments and repetitive behaviors. Among these core symptoms, a notable aspect of ASD is the presence of emotional complexities, including high rates of anxiety disorders. The inherent heterogeneity of ASD poses a unique challenge in understanding its etiological origins, yet the utilization of diverse animal models replicating ASD traits has enabled researchers to dissect the intricate relationship between autism and atypical emotional processing. In this review, we delve into the general findings about the neural circuits underpinning one of the most extensively researched and evolutionarily conserved emotional states: fear and anxiety. Additionally, we explore how distinct ASD animal models exhibit various anxiety phenotypes, making them a crucial tool for dissecting ASD's multifaceted nature. Overall, to a proper display of fear response, it is crucial to properly process and integrate sensorial and visceral cues to the fear-induced stimuli. ASD individuals exhibit altered sensory processing, possibly contributing to the emergence of atypical phobias, a prevailing anxiety disorder manifested in this population. Moreover, these individuals display distinctive alterations in a pivotal fear and anxiety processing hub, the amygdala. By examining the neurobiological mechanisms underlying fear and anxiety regulation, we can gain insights into the factors contributing to the distinctive emotional profile observed in individuals with ASD. Such insights hold the potential to pave the way for more targeted interventions and therapies that address the emotional challenges faced by individuals within the autism spectrum.

Пермь – земля задняя

The study serves as a follow-up to the article that provided a historiographical review of the debate surrounding the etymology of the toponym Perm. About 40 geographical objects with Permian names found on the territory of Finland and 13 regions of the Russian Federation were involved in the historical-geographical research. Various kinds of “back lands” (Perm) are evenly distributed throughout the studied territory, and parallel searches for “front lands” did not yield results, which forces us to question the version of a drifting toponym. At the same time, an abundance of Permian hydronyms is recorded, although this should seem paradoxical, because Perm is the “back land”. The use of historical-geographical methods made it possible to clarify the etiology (origin) of the names of the Permian series, which should be understood not just as the back ground, but the land on the river bottoms, in the upper reaches of rivers, in areas of concentration of overland sections of waterways. Portages of varying intensity of use are recorded in the vicinity of 30 “perm”, in 19 cases it was not possible to detect portages. Exceptions to the rule are fixed in the southeastern periphery of the studied area, in villages and villages named Permyaki and Perminov, which are nominated by origin or by the surname of the first settlers. In ancient times, the most important transit and transport interchanges were carefully fixed on the ground by Perm toponyms and hydronyms, which is why the areas of concentration of the most important transport routes (Perm and Permtsa) attracted special attention of the Novgorod and later Moscow authorities as nodes of strength in the colonized territory.

Global research in schizophrenia and serotonin: a bibliometric analysis.

Schizophrenia is a chronic mental illness that affects millions of individuals worldwide. The etiological origin of schizophrenia is heterogeneous, but it has been shown to be associated with dysfunction in serotonin activity, serotonin receptors, and serotonin metabolism in the brain. Bibliometric analysis is a tool used to scrutinise and analyse research activities and evidence in a specific research area. No existing bibliometric analyses have considered both serotonin and schizophrenia. We conducted a bibliometric analysis including 12,027 studies related to the schizophrenia-serotonin link published from the inception of the study to 2023 and available in the Scopus database. We used VOSviewer software to identify global trends, analyse the author and editors keywords, the most cited articles and author, as well as the most productive institutes and journals publishing research on schizophrenia-serotonin link. Most publications related to the link between schizophrenia and serotonin are focused on adult humans and examine topics such as antipsychotic agents, depression, and serotonin uptake inhibitors. The Journal of Clinical Psychiatry has published the most papers on the schizophrenia-serotonin relationship. Among nations, the United States is the leader in publications. King's College London is the institution with the highest number of publications, and H. Y. Meltzer is the most influential author. Growing trends in schizophrenia-serotonin research are personalised medicine, alternative medicine, transcranial magnetic stimulation, artificial intelligence, nervous system inflammation, brain-gut axis, and the gut microbiome. Since 1950, there have been several fluctuations in the number of published studies related to schizophrenia and serotonin. We believe that the development of novel medications and treatments for schizophrenia will be increased in the future, as well as research into genetic risks, psychological factors, and cranial neuroimaging components. Future schizophrenia and serotonin research is likely to focus on personalised medicine, alternative therapies, novel pathogenesis of schizophrenia, and the use of emerging technologies such as artificial intelligence.

A report of a giant parathyroid adenoma

Giant parathyroid adenoma is a rare condition characterized by the presence of an abnormally large tumor in the parathyroid gland. A 62-year-old patient diagnosed with primary hyperparathyroidism and severe nephrolithiasis leading to nephrectomy. During workup for etiologic origin of hyperparathyroidism she was found to have a giant parathyroid adenoma with 7,8x3,6x4,3 cm estimated dimensions, located posteriorly to the trachea and extending to the thoracic inlet. She was then submitted to a Kocher cervicotomy and a partial superior sternotomy. The diagnosis is initially made throw laboratorial tests that reveal the elevated calcium and PTH levels. After diagnosis, imaging studies are essential to locate the gland in order to safely remove the entire associated adenoma. Management of giant adenoma is surgical with most patients achieving cure after the gland excision.

Diagnosis of Autism Spectrum Disorder (ASD) Using Recursive Feature Elimination-Graph Neural Network (RFE-GNN) and Phenotypic Feature Extractor (PFE).

Autism spectrum disorder (ASD) poses as a multifaceted neurodevelopmental condition, significantly impacting children's social, behavioral, and communicative capacities. Despite extensive research, the precise etiological origins of ASD remain elusive, with observable connections to brain activity. In this study, we propose a novel framework for ASD detection, extracting the characteristics of functional magnetic resonance imaging (fMRI) data and phenotypic data, respectively. Specifically, we employ recursive feature elimination (RFE) for feature selection of fMRI data and subsequently apply graph neural networks (GNN) to extract informative features from the chosen data. Moreover, we devise a phenotypic feature extractor (PFE) to extract phenotypic features effectively. We then, synergistically fuse the features and validate them on the ABIDE dataset, achieving 78.7% and 80.6% accuracy, respectively, thereby showcasing competitive performance compared to state-of-the-art methods. The proposed framework provides a promising direction for the development of effective diagnostic tools for ASD.

Acanthocheilonema Reconditum (Spirurida: Onchocercidae) in the Oral Cavity of a Dog in Northeastern Brazil: Case Report

Abstract An 11-year-old male dog presenting exophthalmia and perforation of the cornea of the left eye was seen at the veterinary hospital of the State University of Maranhão. Upon physical examination, irregularly shaped granulomas of crumbly appearance were observed on the dog’s tongue. The dog was sent for ocular enucleation surgery. The following tests were requested: complete blood count, serum biochemistry, hemoparasite investigation, chest X-Ray, echocardiogram, electrocardiogram, cytology and nodule histopathology. The blood count revealed neutrophilia, signs of anemia, increased total plasma protein and thrombocytopenia. Serum biochemistry and the imaging examinations showed normal results. The cytological examination on the tongue nodules showed microfilariae and the histopathological examination showed chronic glossitis. Polymerase chain reaction (PCR) and genetic sequencing were performed on a blood sample, which made it possible to identify the species Acanthocheilonema reconditum. This is the first record worldwide of the occurrence of microfilariae of A. reconditum on tongue nodules. This finding serves to alert dermatologists and dentists regarding the need for a differential diagnosis for types of oral cavity lesions of unknown etiological origin.

Phenotypically Discordant Anomalies in Conjoined Twins: Quirks of Nature Governed by Molecular Pathways?

A multitude of additional anomalies can be observed in virtually all types of symmetrical conjoined twins. These concomitant defects can be divided into different dysmorphological patterns. Some of these patterns reveal their etiological origin through their topographical location. The so-called shared anomalies are traceable to embryological adjustments and directly linked to the conjoined-twinning mechanism itself, inherently located within the boundaries of the coalescence area. In contrast, discordant patterns are anomalies present in only one of the twin members, intrinsically distant from the area of union. These dysmorphological entities are much more difficult to place in a developmental perspective, as it is presumed that conjoined twins share identical intra-uterine environments and intra-embryonic molecular and genetic footprints. However, their existence testifies that certain developmental fields and their respective developmental pathways take different routes in members of conjoined twins. This observation remains a poorly understood phenomenon. This article describes 69 cases of external discordant patterns within different types of otherwise symmetrical mono-umbilical conjoined twins and places them in a developmental perspective and a molecular framework. Gaining insights into the phenotypes and underlying (biochemical) mechanisms could potentially pave the way and generate novel etiological visions in the formation of conjoined twins itself.

A new epileptic seizure prediction model based on maximal overlap discrete wavelet packet transform, homogeneity index, and machine learning using ECG signals

Epilepsy, a complex pathology with various etiological origins, is characterized by producing hyperexcitability in the brain, which can have multiple disruptive symptoms. It impacts about 40 million people worldwide, of which 20 to 30% have chronic and intractable seizures. Each seizure can create hazardous situations for patients resulting from fractures, burns, submersion accidents, and soft-tissue injuries. Therefore, a method capable of predicting a seizure with sufficient window time before its onset is highly desirable because it will allow the patient to locate a safe place or take appropriate precautionary actions. In this article, a novel method is presented through adroit integration of maximal overlap wavelet packet transform, homogeneity index, and a K-Nearest Neighbors classifier to predict an epileptic event twenty minutes before its onset using electrocardiogram (ECG) signals. The method's effectiveness for predicting an epileptic seizure is verified by employing a database provided by the Massachusetts Institute of Technology-Beth Israel Hospital (MIT-BIH), which includes seven patients with ten epileptic seizures. The results show that the proposed method effectively predicts an epileptic seizure 20 min prior to its onset with an accuracy of 93.25%.

The Collaborative Study on the Genetics of Alcoholism: Overview.

Alcohol use disorders (AUD) are commonly occurring, heritable and polygenic disorders with etiological origins in the brain and the environment. To outline the causes and consequences of alcohol-related milestones, including AUD, and their related psychiatric comorbidities, the Collaborative Study on the Genetics of Alcoholism (COGA) was launched in 1989 with a gene-brain-behavior framework. COGA is a family based, diverse (~25% self-identified African American, ~52% female) sample, including data on 17,878 individuals, ages 7-97 years, in 2246 families of which a proportion are densely affected for AUD. All participants responded to questionnaires (e.g., personality) and the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) which gathers information on psychiatric diagnoses, conditions and related behaviors (e.g., parental monitoring). In addition, 9871 individuals have brain function data from electroencephalogram (EEG) recordings while 12,009 individuals have been genotyped on genome-wide association study (GWAS) arrays. A series of functional genomics studies examine the specific cellular and molecular mechanisms underlying AUD. This overview provides the framework for the development of COGA as a scientific resource in the past three decades, with individual reviews providing in-depth descriptions of data on and discoveries from behavioral and clinical, brain function, genetic and functional genomics data. The value of COGA also resides in its data sharing policies, its efforts to communicate scientific findings to the broader community via a project website and its potential to nurture early career investigators and to generate independent research that has broadened the impact of gene-brain-behavior research into AUD.

Protonthérapie haute énergie des tumeurs extra-oculaires, kératite neurotrophique et conséquence fonctionnelle : une série de 3 cas

High energy proton therapy (HEP) is a form of radiation therapy using protons for extraocular tumors. Its ballistic properties are theoretically advantageous, but the real impact on the surrounding ocular tissues during cerebral and ENT irradiation is poorly documented. We describe three consecutive patients with corneal damage following such irradiation. Post-proton therapy neurotrophic keratitis (NK) is defined as corneal hypo/anesthesia responsible for an alteration of corneal trophicity and graded according to the Mackie classification, in terms of a prospective ophthalmological follow-up protocol for all patients with extraocular tumors treated with HEP. Among 193 patients treated with HEP between 2018 and 2021 for extraocular tumors, three patients developed severe neurotrophic keratitis, i.e. 1.6% of treated patients. According to the Mackie classification, the three patients showed grade 3 NK less than one year after the conclusion of their HEP. These three patients underwent amniotic membrane grafting. They were placed on autologous serum eye drops. Two of the three patients had to be eviscerated. The dose to the cornea was greater than 50 Gray (Gy)_Relative biological effectiveness (RBE) in the three cases. The diagnosis and etiological origin of neurotrophic keratitis are often difficult to establish. In these cases, the imputability of radiation therapy, proton therapy in our cases, in the development of neurotrophic keratitis was plausible based on the dosimetry of the patients, all of whom had anterior tumors with a poor prognosis requiring high tumoricidal doses. Further studies to establish the impact of proton therapy on corneal sensitivity are necessary. However, this feedback and the multidisciplinary management of tumors can help to limit the risk of some complications of radiation therapy. Early diagnosis allows for appropriate management and could possibly minimize the anatomical and functional ocular complications of neurotrophic keratitis.

Gallstone Ileus in the Absence of Gallbladder, Rare Etiology of Bowel Obstruction: A Case Report and Literature Review

Background: Gallstone ileus post-cholecystectomy is extremely rare surgical emergency causing mechanical bowel obstruction. This condition is usually misdiagnosed due to its non-specific clinical features. Radiological investigations are essential to evaluate and diagnose gallstone ileus cases. Case Presentation: A 92-year-old female patient, cholecystomized, presented to our hospital with a one-week history of an acute confusional state, generalized abdominal pain, and vomiting. The physical examination showed a disoriented patient with a distended abdomen and generalized tenderness, especially in the epigastric area. Hyperactive bowel sounds were audible. Laboratory investigations were non-specific. A plain abdominal X-ray was insignificant. The abdominal ultrasound showed marked abdominal gaseous distention. Then, an abdominal CT scan was performed, revealing an impression of gallstone ileus causing small bowel obstruction with no evidence of fistula formation. So, surgical intervention was decided, and an 8-gram gallstone was exteriorized through an enterolithotomy. The postoperative period was uneventful. Discussion: Gallstone ileus is an unusual entity that often affects elderly females. The clinical features of gallstone ileus include abdominal pain, abdominal distension, nausea, and vomiting. Diagnosis of gallstone ileus relies on imaging and physical examination. Abdominal CT with contrast provides a definitive diagnostic tool. The surgical options to manage the gallstone ileus can be either one or two-staged enterolithotomy. Conclusion: Due to the rare etiologic origin of the gallstone ileus in post-cholecystectomy cases, we report the case of a 92-year-old female with an acute confusional state and generalized abdominal pain, found to be caused by detected gallstone ileus, lacking evidence of fistula formation.

A rare occurrence of an incidental primary intra-abdominal Cystic Lymphangioma in a Middle Eastern adult female: A case report.

The authors hereby demonstrate the case of a 46-year-old lady who presented to the outpatient general surgery clinic at our university hospital complaining of chronic right hypochondriac abdominal pain. Investigative radiological imaging marked a cystic formation with well-defined borders and homogenous content extending from the lower pole of the right kidney to the lower hepatic border. Surgical intervention was performed by completely resecting the lesion in question. Directly afterward, histopathological analysis was achieved and established the diagnosis of a CL.Conclusion:CL is a rare neoplasm with ill-defined symptoms and ambiguous clinical presentations. They remain poorly studied due to their rarity and lack of sufficient data in the published literature. This magnifies the importance of clinical awareness and time-efficient surgical intervention. Documenting these cases aids in identifying their subsequent etiological origins, disease-specific risk factors, clinical course, and yields proposals of novel therapeutic approaches.