Present Case Report Research Articles

Comprehensive Management of Ovarian Tumour-related Torsion: A Case Report

Ovarian tumours are diverse and lead to rare yet critical complications such as torsion. The ovary twists on its own axis and compromises blood flow. Ovarian torsion is uncommon and has considerable risk in women of reproductive age. The present case report elucidates the intricate nature of ovarian tumours, particularly emphasising the rare yet critical complication of torsion, where the ovary twists, compromising blood flow. The presented case involves a 35-year-old multiparous woman with acute abdominal pain, vomiting, and elevated Cancer Antigen 125 (CA-125) levels, leading to the diagnosis of a left ovarian cyst with torsion via Ultrasonography (USG). The subsequent surgical intervention, involving exploratory laparotomy, successfully confirmed and addressed the issue, resulting in detorsion and cystectomy. Histopathological examination further identified a benign serous cystadenoma. The present case underscores the diagnostic challenges associated with ovarian tumour-related torsion, highlighting the importance of symptom analysis and diagnostic imaging for early recognition. It also emphasises the effectiveness of surgical intervention, showcasing varied treatment options, from cystectomy to detorsion, contingent on individual circumstances. The present case report stresses the imperative of a multidisciplinary approach involving gynaecologists, radiologists and surgeons for optimal outcomes in managing this complex condition.

What is the impact of an Abnormal pathogenic variant in COQ8A/CYP17A1 in pediatric patient - A case report

Background: Primary coenzyme Q10 deficiency-4 (CoQ10D4) and isolated 17,20-lyase deficiency (ILD) are both distinct and rare congenital mutations. Mutations in the CoQ8A gene are rare and cause CoQ10D4. Patients with pathogenic mutations in the CoQ8A gene exhibit symptoms such as ataxic gait, dystonia, seizures, exercise intolerance, and cognitive disabilities. Case presentation: The presence of these two mutations in a patient is extremely rare. In this present case report, a 6-year-old identical twin female with CoQ10D4 and ILD began presenting with microcephaly with developmental delay at 4 years of age. She also had regression of milestones (loss of social interaction, grasp, visual interaction, and speech-babbling) without febrile seizures. Conclusion: This case emphasizes the need for further research to elucidate the underlying mechanisms and potential targeted therapies for these rare genetic disorders, emphasizing the importance of a multidisciplinary approach in providing comprehensive care for affected individuals.

Comprehensive Management of Ovarian Tumour-related Torsion: A Case Report

Ovarian tumours are diverse and lead to rare yet critical complications such as torsion. The ovary twists on its own axis and compromises blood flow. Ovarian torsion is uncommon and has considerable risk in women of reproductive age. The present case report elucidates the intricate nature of ovarian tumours, particularly emphasising the rare yet critical complication of torsion, where the ovary twists, compromising blood flow. The presented case involves a 35-year-old multiparous woman with acute abdominal pain, vomiting, and elevated Cancer Antigen 125 (CA-125) levels, leading to the diagnosis of a left ovarian cyst with torsion via Ultrasonography (USG). The subsequent surgical intervention, involving exploratory laparotomy, successfully confirmed and addressed the issue, resulting in detorsion and cystectomy. Histopathological examination further identified a benign serous cystadenoma. The present case underscores the diagnostic challenges associated with ovarian tumour-related torsion, highlighting the importance of symptom analysis and diagnostic imaging for early recognition. It also emphasises the effectiveness of surgical intervention, showcasing varied treatment options, from cystectomy to detorsion, contingent on individual circumstances. The present case report stresses the imperative of a multidisciplinary approach involving gynaecologists, radiologists and surgeons for optimal outcomes in managing this complex condition.

Anaesthesia for Laparoscopic Abdominal Surgery in a Morbidly Obese Female with Hypothyroidism and Hypertension: A Case Report

Obesity is characterised by a body weight that surpasses the expected or ideal weight by over 10%, considering factors such as height, age, body build, and sex. Another way to define obesity is based on body fat content: a male is considered obese if body fat exceeds 25% of his total weight, while a female is considered obese if body fat exceeds 30%. Abdominal obesity, prevalent in 40% of women in India, poses significant challenges in the realm of anaesthesia, particularly during laparoscopic abdominal surgeries. The co-existence of morbid obesity, hypothyroidism, and hypertension present intricate medical conditions that demand precise management. During the surgical procedure, issues related to large intraabdominal tumours and airway maintenance impact respiratory and circulatory dynamics. Notably, intraoperative challenges, including bronchospasm, hypotension, and respiratory acidosis, were addressed to ensure the patient's well-being and a successful surgical outcome. The present case report provides insights into the comprehensive management of high-risk patients undergoing laparoscopic abdominal surgery. It underscores the significance of tailored anaesthesia strategies to mitigate complications and ensure a favourable postoperative recovery. This report presents the case of a 59-year-old female with obesity (BMI: 39.6 kg/m2 ), hypothyroidism, and hypertension who underwent laparoscopic abdominal surgery and discusses managing intraoperative challenges, such as bronchospasm, hypotension, and respiratory acidosis, and the postoperative care for successful patient recovery

Progressive residual lung abnormalities as final outcome in recovered severe COVID-19 pneumonia with lung function abnormalities in spirometry: Pulmonologist and radiologist perspective

ABSTRACT Coronavirus coronavirus-related (severe acute respiratory syndrome-corona virus-2) global pandemic has caused significant mortality and morbidity globally in the last 3 years. Although the pandemic has weaned off since last year, we are not in great peace of relief due to lingering effects of COVID-19 persisted even after 2 years of illness. These long COVID-19 manifestations are documented selected cases of COVID-19 pneumonia in pulmonary and extrapulmonary systems with variable impact on quality of life. In the present case report, a 57-year-old male, presented in the outdoor unit for shortness of breath on exertion, on oxygen supplementation at home during ambulation with a history of severe COVID-19 pneumonia resulted in acute respiratory distress syndrome with hospitalization in the intensive care unit 12 months back and required high flow nasal cannula with noninvasive ventilatory support for 3 weeks. His clinical and radiological severity were very well correlated with highly raised inflammatory markers such as C-reactive protein, interleukin-6, ferritin, lactate dehydrogenase, and D-Dimer. He was offered oxygen supplementation at home with antifibrotics for 3 months and observed significant improvement in clinical and radiological outcomes with persistent requirement of oxygen during ambulation and persistent respiratory symptoms even after 1 year of discharge from hospital. Rheumatological workup documented antinuclear antibody (ANA) and rheumatoid factor positive with inconclusive ANA profile reports. His high-resolution computerized tomography thorax documented at 1 year of discharge from the hospital revealed typical interstitial opacities labeled as progressive residual lung abnormalities (PRLAs) which are predominantly reticular and linear opacities in peripheral parts of lungs with honeycombing within typical pleural-based areas with parenchymal bands and altered lung architecture and decreased lung volume in both lungs. Honeycombing is a typical feature of progressive type of RLAs. We recommend these radiological outcome phenotypes as progressive radiological abnormalities (RLAs) at 1 year should be considered pulmonary fibrosis of unclassified type from a pulmonologist perspective due to pattern and presentation after COVID-19 which is not enrolled into interstitial lung disease classification as of now and progressive pulmonary fibrosis as per radiologists’ perspective due to progressive nature of the disease.

Persistent residual lung abnormalities as final outcome in recovered severe COVID-19 pneumonia with lung function abnormalities in spirometry: Pulmonologist and radiologist perspective

Coronavirus-related (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) global pandemic has caused significant mortality and morbidity globally in the last 3 years. In the present case report, a 51-year-old man presented in the outdoor unit for shortness of breath on exertion with a history of severe coronavirus disease-2019 (COVID-19) pneumonia resulted in acute respiratory distress syndrome with hospitalisation in the intensive care unit 1 year back and required high-flow nasal cannula (HFNC) with noninvasive ventilatory support (NIV) for 2 weeks. He was offered oxygen supplementation at home with antibiotics for 3 months and there was no requirement of oxygen and some respiratory symptoms even after 1 year. His high-resolution computed tomography thorax documented at 1 year of discharge from the hospital revealed typical interstitial opacities labelled as persistent residual lung abnormalities (RLAs) that are predominantly reticular and linear opacities in peripheral parts of lungs without honeycombing within typical pleural-based areas with parenchymal bands and minimally altered lung architecture and preserved lung volume.

Clinicopathological Features of a Lower Lip Verruciform Xanthoma: A Rare Case Report

Verruciform Xanthoma (VX) is an uncommon, benign, asymptomatic lesion of the oral cavity. The incidence rate of VX is 0.025%, with the most common location reported to be the gingival margin, followed by the tongue, hard palate, buccal and labial mucosa. It may also present on the skin and genitals. VX can manifest as a solitary or multiple lesion with well-defined margins. It appears as a papule or plaque with verrucous or papillary growth, exhibiting variable colours ranging from reddish-pink and yellow to grey. While the lesion typically appears verruciform, it may also have a polypoid, papillomatous, or sessile nature. In the present case report, the authors present a 45-year-old male patient with a history of tobacco use, who exhibited a reddish-pink papillomatous growth on his labial mucosa for a duration of three months. The growth was surgically excised, and histopathological evaluation confirmed the characteristic features of VX. The lesion healed without complications, and no recurrence was observed. Clinically, VX may be mistaken for various malignant or premalignant lesions such as papilloma, verrucous carcinoma, or proliferative verrucous leukoplakia. Therefore, it is crucial to differentiate VX from these conditions to avoid inappropriate intervention. Histopathological evaluation is necessary for the definitive diagnosis of the lesion, which reveals the pathognomonic presence of foamy histiocytes within the elongated dermal papillae. The present case report highlighted the diverse clinical features of VX and discusses its histological findings along with the differential diagnosis.

A Case of Adenomatoid Odontogenic Tumour in a 14-year-old Female

Adenomatoid Odontogenic Tumour (AOT) is a rare odontogenic neoplasm that primarily affects adolescents and young adults. The present case report discusses the presentation, diagnosis, and successful surgical management of AOT in a 14-year-old patient with a six-month history of upper left jaw swelling. Radiological investigations confirmed the lesion’s characteristics, leading to a provisional diagnosis of AOT. Subsequently, surgical enucleation and histopathological examination {Haematoxylin and Eosin (H&E)} confirmed the diagnosis. The patient showed no recurrence during follow-up at three weeks and six months postsurgery, with excellent functional and aesthetic outcomes. Postoperative follow-up is essential for optimal patient care and long-term outcomes. The present case report contributes to the existing literature on AOT, providing real-world clinical insights and data, which aids in a better understanding and management of this rare condition.

Case Report on Mucocele of Appendix with Tubo-ovarian Complex and Review of Literature

Mucocele of the appendix is a rare condition caused by mucus accumulation due to a blocked appendix resulting from inflammation, infection, or faecal matter blockage. It presents as lower abdominal pain, vomiting, nausea, abdominal mass, and distension. It is more common in individuals over 50 years old and is more prevalent in the elderly. Mucocele can be differentiated into mucinous cystadenocarcinoma, mucosal hyperplasia, and mucinous cystadenoma. It is often diagnosed incidentally during radiological, laparoscopic, or surgical interventions. Ultrasound and computed tomography imaging techniques are useful in screening and diagnosing appendiceal mucocele, as they can detect a cystic mass or soft tissue mass and differentiate between a mucocele and other neoplasms. Most cases are reported in older individuals, with few in young adults. In the present case report, the authors present a case of a 34-year-old female with a history of occasional abdominal pain. On investigation, it was found to be an inflamed appendix with a mass in the right iliac fossa for which the patient underwent appendectomy. Due to the involvement of the right adnexa with tubo-ovarian complex and omentum, the present case presents a unique manifestation of an appendix mucocele.

Ingestion of Unknown Snake Venom: A Case Report

Venom from a snake is extremely uncommonly consumed by humans. It can be administered in a variety of ways, including a direct bite on the tongue or other parts of the body, or it can be taken as a venom pill at rave parties. The belief is that upon consumption, it provides virility, a sense of elation, and excitement, among other effects. However, it is more often dangerous to the human body and can even be fatal. Only a very small number of cases have been described in publications. In the present case report, a 36-year-old male patient who was an alcoholic and had a history of psychiatric disease initially arrived with anxiety as a result of having consumed snake venom the day before. As for the patient’s vital signs, they were acceptable. For observation, the patient was admitted to the intensive care unit reserved for medicine. However, antisnake venom was not administered. After 24 hours, he was released from the hospital. This is an unusual case where the patient was relatively unharmed after the consumption and didn’t show any obvious lasting effects on the neurological or haematological systems. If the venom is not effectively broken down in the intestines and is absorbed as such, drinking snake venom can have deadly repercussions. The treatment is determined by the features that the patient presents. In the present case, antivenom was not administered, as the need was not justified. However, there may arise situations in other cases where it should be administered sparingly.

Middle Phalangectomy for the Correction of Macrodactyly of the 2nd Digit in an Adult Patient: A Case Report

Macrodactyly, a rare congenital anomaly characterised by localised gigantism of one or more digits, presents significant challenges in therapeutic management due to the absence of established guidelines. The present case report explored the surgical management of an 18-year-old female patient with macrodactyly of the second digit, addressing discomfort, footwear issues and psychological distress. The study adapts techniques from prior paediatric cases to suit adult care needs, particularly focusing on middle phalangectomy as a feasible treatment option for isolated macrodactyly. Clinical examination and radiographic assessments confirmed primary macrodactyly affecting the patient’s left second toe. The surgical intervention involved middle phalangectomy, debulking of fibrofatty tissue, joint capsule and tendon repair, along with a Winograd wedge resection procedure. Postoperative care included pain management and wound dressing. Despite encountering delayed wound healing and mild necrotic changes, the patient reported manageable pain levels and expressed satisfaction with the cosmetic outcome and improved footwear options at the six-month follow-up. The present case report contributes valuable insights into the management of macrodactyly, highlighting the efficacy of middle phalangectomy in adult patients. Preoperative assessment for peripheral arterial disease is emphasised to mitigate neurovascular complications. Proactive patient counseling regarding potential postoperative complications is crucial for informed decision-making. Overall, the findings underscore the importance of tailored surgical approaches in addressing macrodactyly and improving patients’ quality of life.

Complete Lung Atelectasis Following Caesarean Section in a Case of Imminent Eclampsia- A Case Report

In the early postpartum period, acute life-threatening problems can occur and cause maternal morbidity and mortality. In the present case report, a 19-year-old primipara had undergone caesarean delivery following which she developed breathlessness, tachycardia and fall in oxygen saturation after 14 hours of surgery. Her Chest X-Ray (CXR) report confirmed a complete collapse of the left lung. Contrast-enhanced Computed Tomography (CECT) of the thorax showed a complete collapse of the left lung due to obstruction at the level of the proximal main stem bronchus. Medical management with mucolytics was administered. The patient showed improvement clinically and a repeat CXR after 24 hours showed normal lung findings with complete resolution of collapse and medical management was continued. The patient recovered progressively and follow-up of the patient was uneventful. This is a rare case of development of respiratory distress and atelectasis, hence proper diagnosis is essential.

Considerations for Optimal Dental Management in a 10-year-old Child with Congenital Heart Disease and Dextrocardia: A Case Report

Congenital Heart Disease (CHD) is one of the most common developmental anomalies seen in children and there is an increased risk of developing oral disease and its systemic effects in children with CHD. The present case report highlights the dental management of a 10-year-old boy with CHD and dextrocardia. The diagnosis for the patient included dextrocardia (where the position of the heart is developmentally changed from the left to the right-side), complete atrioventricular septal defect and double outlet right ventricle with pulmonary stenosis. After consultation, diagnosis and treatment planning and upon obtaining consent from the parents and modifying the child’s behaviour, the dental needs of the child were addressed on a visit-by-visit basis. A quadrant approach was adopted to complete the extractions of all retained carious primary teeth, followed by restorative treatment. Oral prophylaxis was performed, followed by topical fluoride application and the patient was then referred to the Department of Orthodontics for treatment of malalignment. This case report focuses on the guidelines followed for antibiotic prophylaxis against Infective Endocarditis (IE) and highlights the importance of maintaining good oral health for this group of patients. The dental management of children with CHD can be complex, as oral health is often neglected by both parents and patients. Cardiovascular problems can significantly impact both the child and the parent, affecting management and financial implications. The dental considerations require early diagnosis of dental problems and prompt treatment to prevent complications and difficulties in implementing treatment due to systemic repercussions. The present case report aimed to improve dental care for children with severe systemic alterations, as there is a lack of scientific literature regarding the dental management of paediatric patients with CHD.

Ayurvedic Management of Pakshmashata (Madarosis): A Case Report

Madarosis is characterised by either complete or partial loss of eyebrow or eyelash hair. Hair loss occurs due to interrupted blood supply to that region. In contemporary medicine, the management of madarosis includes hair transplant surgery or the use of steroids. There is no direct correlation to madarosis in Ayurveda; however, concepts like “Pakshmashata” described by Acharya Vagbhata exhibit symptoms that closely resemble this condition. In the present case report, a 30-year-old female patient presented to the Outpatient Department (OPD) of Kayachikitsa, complaining of sudden hair loss over the past month, accompanied by itching and a burning sensation in the affected area. A physical examination was conducted, and the patient was diagnosed with Pakshmashata. The treatment included Asthi Majja Pachak Kwath (a decoction for bone and bone marrow tissues), along with Manjistha (Rubia cordifolia) and Haridra (Curcuma longa), as well as a local paste (lepa). Jaloka Avcharan (leech therapy) was administered to the patient twice a month. For local application, Snehana (oil massage) with Eranda (Ricinus communis), taila was used three times a day. Significant improvement in hair growth in the affected area was observed during follow-ups on the 45th and 60th days.

Pseudoaneurysm of the Petrous Section Internal Carotid: A Co-incidence or a Complication of Chronic Otitis Media: A Case Report

Although rare, a Petrous Internal Carotid Artery (ICA) pseudoaneurysm is a possible complication following chronic otitis media. A 57-year-old woman was brought to the Emergency Department with multiple painless episodes of right ear bleeding and epistaxis over the last two months. Upon evaluation, bony dehiscence was observed over the petrous carotid’s first (proximal) genu, along with a pseudoaneurysm detected in the Magnetic Resonance Angiography (MR angiogram). The Balloon Occlusion Test (BTO) showed no cross-flow from the opposite side. Consequently, the patient was considered for high-flow bypass surgery between the external carotid artery and the M2 segment of the Middle Cerebral Artery (MCA), utilising a radial artery graft in the neurosurgery specialty. The present rare case report emphasises the significance of maintaining a high index of suspicion and implementing prompt intervention through a multidisciplinary approach. It also raises an open-ended question about whether the petrous carotid pseudoaneurysm is a complication of chronic otitis media or merely a co-incidence.

Digital planning of the anterior sector for changing defective resin veneers to lithium disilicate. Case report

The esthetic problem of defective resin restorations in the anterior sector leads to psychological, esthetic, functional and periodontal soft tissue problems. Smile design is a current issue in restorative dentistry, the search for beauty is what motivates us to obtain an esthetically pleasing smile. The present clinical case reports a 34-year-old female patient, with no medical history, where defective resin veneers were observed in the anterosuperior sector, where lithium disilicate veneers were planned. The objective of this clinical case study was to determine the esthetic results with digital planning in the anterior area with lithium disilicate veneers. This research reveals that lithium disilicate veneers offer remarkable esthetic results, improving dental appearance in a versatile and long-lasting manner, which positively impacts patients' self-image and confidence. Digital anterior planning for changes from defective resin veneers to lithium disilicate is a highly promising strategy in esthetic dentistry. The combination of digital technology and the use of lithium disilicate offers outstanding esthetic and functional results, with greater preservation of tooth tissue and increased patient satisfaction

A Case of Celiac Disease with Pericardial Effusion

Celiac disease is a unique enteropathic immune disorder and is now considered a distinct disease entity with protein manifestation and worldwide distribution. The deposition of immune complexes in the small intestine could be a possible reason for the extraintestinal autoimmune manifestations of Celiac disease. Pericardial effusion, though rare in adults, is likely a result of these autoimmune disorders related to Celiac disease. In present study case report, the authors present the case of a 67-year-old female patient with generalised oedema, anasarca, and pitting oedema in the lower extremities. Due to multiple episodes of vomiting, upper gastrointestinal endoscopy was performed, which revealed atrophic duodenal mucosa, and duodenal biopsies were taken from the second part of the duodenum (D2 biopsies). The possibility of Celiac disease was considered, and anti-deamidated gliadin peptide, Immunoglobulin A (IgA), and Immunoglobulin G (IgG) antibodies were sent. Celiac disease was diagnosed based on elevated serum levels of anti-deamidated gliadin peptide, IgA, and IgG antibodies, as well as histologic findings in the small bowel (duodenal biopsies D2). During the thorough evaluation, pericardial effusion was incidentally detected. Celiac disease is an autoimmune disorder in which exposure to gluten triggers inflammation in genetically predisposed individuals. The illness is estimated to have a prevalence of 2%, and most affected people remain undiagnosed. Pericardial effusion is a possible manifestation of Celiac disease, but there is currently no evidence that the disease directly causes the effusion.

A Case of Celiac Disease with Pericardial Effusion

Celiac disease is a unique enteropathic immune disorder and is now considered a distinct disease entity with protein manifestation and worldwide distribution. The deposition of immune complexes in the small intestine could be a possible reason for the extraintestinal autoimmune manifestations of Celiac disease. Pericardial effusion, though rare in adults, is likely a result of these autoimmune disorders related to Celiac disease. In present study case report, the authors present the case of a 67-year-old female patient with generalised oedema, anasarca, and pitting oedema in the lower extremities. Due to multiple episodes of vomiting, upper gastrointestinal endoscopy was performed, which revealed atrophic duodenal mucosa, and duodenal biopsies were taken from the second part of the duodenum (D2 biopsies). The possibility of Celiac disease was considered, and anti-deamidated gliadin peptide, Immunoglobulin A (IgA), and Immunoglobulin G (IgG) antibodies were sent. Celiac disease was diagnosed based on elevated serum levels of anti-deamidated gliadin peptide, IgA, and IgG antibodies, as well as histologic findings in the small bowel (duodenal biopsies D2). During the thorough evaluation, pericardial effusion was incidentally detected. Celiac disease is an autoimmune disorder in which exposure to gluten triggers inflammation in genetically predisposed individuals. The illness is estimated to have a prevalence of 2%, and most affected people remain undiagnosed. Pericardial effusion is a possible manifestation of Celiac disease, but there is currently no evidence that the disease directly causes the effusion.

Role of yoga and Ayurveda in the management of functional dyspepsia

ABSTRACT Functional dyspepsia (FD) is commonly known as chronic indigestion and manifests as a group of upper gastrointestinal symptoms such as epigastric pain or burning, postprandial fullness, bloating, belching, nausea, vomiting, and early satiety without any organic or structural cause. In Ayurveda, these symptoms can be considered Ajīrṇa. A 25-year-old male patient with FD, taking on and off conventional treatment for the past few months without much relief, presented to the outpatient department. As the pathophysiology of FD is complex and multifactorial, it is difficult to manage it only with oral medication. Pawanamuktāsana-II and Vajrāsana were advised, along with Hingwāṣṭaka Cūrṇa, to manage the related symptoms. After 4 months of treatment, the signs and symptoms of the disease significantly decreased. The present case report elucidates the role of Yoga as an adjuvant therapy in the Āyurvedic management of FD.

Incidental Primary Cystic Duct Lymph Node Tuberculosis in a 28-year-old Female: A Rare Case Report

Tuberculosis (TB) is an infectious disease caused by acid-fast bacilli Mycobacterium tuberculosis (MTB). The lung remains the most common site involved by it. Extrapulmonary sites of TB are lymph nodes, pleura, bone, joints, urogenital tract, and meninges. Isolated Cystic Duct Tubercular Lymphadenitis (CDL TB) without involving the gallbladder is an uncommon manifestation of TB that primarily affects the lymph nodes around the cystic duct. A multidisciplinary approach is essential for accurate diagnosis and successful management of such cases. The authors hereby present a case of a 28-year-old female, without any evidence of TB elsewhere and an incidental finding of CDL TB. “The patient was sent with a clinical diagnosis of Chronic Calculus Cholecystitis (CCC)”. This highlights the need for comprehensive clinical evaluation and diagnostic investigations to avoid misdiagnosis or delayed management. This underscores the significance of maintaining a high index of suspicion for extrapulmonary TB, particularly in regions where the disease remains endemic. Healthcare practitioners should be vigilant when encountering unusual clinical presentations or when dealing with atypical combinations of gallbladder pathologies, as illustrated by the concurrent occurrence of CDL TB with CC with evidence of Pyloric Metaplasia (PM) and cholesterolosis without cholelithiasis, as in the patient of the present case report.