Unusual Condition Research Articles

Therapeutic efficacy of a probiotic preparation on idiopathic halitosis: a retrospective observational study.

Idiopathic halitosis is an unusual condition of unclear causes, which has never been thoroughly investigated. We aimed to explore the role of small intestinal bacterial overgrowth (SIBO) in the pathogenesis of idiopathic halitosis, and to evaluate the therapeutic efficacy of a probiotic preparation on this condition. This retrospective observational study included 162 idiopathic halitosis patients and 198 healthy controls (HCs). Halitosis was diagnosed using the organoleptic test (OLT), and idiopathic halitosis was diagnosed by excluding known causes. SIBO was identified through the hydrogen/methane lactulose breath test (LBT), and accordingly, patients were identified as SIBO-positive or SIBO-negative. Idiopathic halitosis patients were treated with the probiotic preparation Bifidobacterium triple viable capsule for two months, followed by re-evaluation of halitosis and SIBO. This study found that all cases of idiopathic halitosis were extra-oral. The SIBO positivity rate in idiopathic halitosis patients was significantly higher than that in HCs (74.69% [121/162] vs. 3.03% [6/198], P < 0.001), with an odds ratio (OR) of 94.44 (95% CI: 39.99-211.35). After treatment, 80.17% (97/121) of the SIBO-positive patients became SIBO-negative. Moreover, 87.60% (106/121) of the SIBO-positive patients experienced improved halitosis, a rate significantly higher than that observed in SIBO-negative patients (2.75%, 3/41) (P < 0.001). In addition, 98.97% (96/97) of the post-treatment SIBO-negative patients experienced improved halitosis, a rate significantly higher than that of post-treatment sustained SIBO-positive patients (41.67%, 10/24) (P < 0.001). Our findings suggest that idiopathic halitosis is an extra-oral condition which mostly originates from the small intestine. SIBO is one of its underlying causes. The probiotic preparation can effectively improve idiopathic halitosis, probably through its impact on SIBO.

Eosinophilic Meningitis in a Patient With Early HIV Infection, Latent Syphilis and HSV-2 Meningitis

Abstract Eosinophilic meningitis is an unusual condition, particularly in patients with HIV infection or syphilis. The detection of herpes simplex virus (HSV)-2 and HIV-1 in cerebrospinal fluid from a patient with acute eosinophilic meningitis has not been previously reported. Herein, we report a case of a 26-year-old cisgender man newly diagnosed with HIV-1 infection and latent syphilis, presenting with headache and low-grade fever. He was diagnosed with both acute eosinophilic meningitis and HSV-2 meningitis, and his condition improved after treatment with acyclovir and penicillin. The compelling case indicates that HSV-2 meningitis may manifest concurrently with acute eosinophilia meningitis in patients coinfected with HIV and Treponema pallidum. Metagenomics next-generation sequencing plays an important role in identifying and further confirming pathogens responsible for central nervous system infections.

Targeted Genetic Sequencing Analysis of 223 Cases of Pseudomyxoma Peritonei Treated by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Shows Survival Related to GNAS and KRAS Status.

Pseudomyxoma peritonei (PMP) is an unusual condition with unique behaviour caused by a mucinous neoplasm, usually arising from the appendix. The aim of this study was to evaluate the prevalence of genomic alterations in clinical specimens of PMP using a targeted assay and correlate the findings with clinical, pathological and outcome data. Sequencing data from 223 patients were analysed. The median follow-up interval was 48 months. The primary neoplasm was appendiceal in 216 patients, ovarian in 4, urachal in 2 and renal in one. We confirmed common mutations in GNAS and KRAS (42% each) with significant co-occurrence of variants in these genes. TP53 mutations were found in 8%. Other mutations were rare but included novel mutations in BAP1 and ERBB4. Of 17 patients with acellular peritoneal mucin, 6 (35%) were positive for DNA mutations. The non-appendiceal cases generally showed a similar mutational landscape to the appendiceal lesions with GNAS and KRAS commonly mutated, although one urachal lesion showed multi-hit TP53 mutation without variants in either GNAS or KRAS. Survival was significantly associated with the grade of the primary neoplasm, the grade of the peritoneal disease, the completeness of cytoreduction score and with mutation in either GNAS, KRAS or both. The hazard ratio (HR) associated with mutation in GNAS and/or KRAS was 1.87 (p = 0.004). Survival outcome was more closely associated with the grade of the peritoneal disease than with the grade of the primary neoplasm. Our findings support the developing concept that mutational analysis may provide prognostic information in patients with PMP.

Case Report: Delorme Technique for the Treatment of Giant Non-Reducible Rectal Prolapse at the Second Level of Care

Rectal prolapse is an invagination of the rectum that causes it to protrude through the anus. Irreducible rectal prolapse is an unusual condition; in most cases, the prolapse reduces spontaneously. Non-surgical treatment alternatives have been noted, such as the use of sugar, which reduces rectal prolapse. The results have not yet been compared against surgical treatment, so they cannot yet be considered the preferred option. Given the many techniques and procedures, it should be considered that the best procedure must be chosen not only to correct the prolapse but also to restore defecatory function and to improve fecal incontinence throughout the patient's lifetime. The Delorme procedure is a transanal technique that addresses complete rectal prolapse with a low surgical risk and minimal morbidity (less damage to pelvic and hypogastric nerves compared to abdominal procedures). It is associated with a significant improvement in anal continence, low recurrence rates, short hospital stays, and patient comfort.

A Novel Classification Approach for Retinal Disease Using Improved Gannet Optimization‐Based Capsule DenseNet

ABSTRACTAn unusual condition of the eye called diabetic retinopathy affects the human retina and is brought on by the blood's constant rise in insulin levels. Loss of vision is the result. Diabetic retinopathy can be improved by receiving an early diagnosis to prevent further damage. A cost‐effective method of accumulating medical treatments is through appropriate DR screening. In this work, deep learning framework is introduced for the accurate classification of retinal diseases. The proposed method processes retinal fundus images obtained from databases, addressing noise and artifacts through an improved median filter (ImMF). It leverages the UNet++ model for precise segmentation of the disease‐affected regions. UNet++ enhances feature extraction through cross‐stage connections, improving segmentation results. The segmented images are then fed as input to the improved gannet optimization‐based capsule DenseNet (IG‐CDNet) for retinal disease classification. The hybrid capsule DenseNet (CDNet) classifies disease and is optimized using the improved gannet optimization algorithm to boost classification accuracy. Finally, the accuracy and dice score values achieved are 0.9917 and 0.9652 on the APTOS‐2019 dataset.

Congenital Absence of Pericardium: The Swinging Heart.

Congenital absence of the pericardium (CAP) is an unusual condition discovered, in most cases, incidentally but can potentially lead to fatal complications, including severe arrhythmias and sudden death. Recently, the use of modern imaging technologies has increased the diagnosis of CAP, providing important findings for risk stratification. Nevertheless, there is not yet consensus regarding therapeutic decisions, and the management of patients with CAP remains challenging. In this paper, we discuss the pathophysiological implication of CAP, review the current literature and explain the role of multimodality imaging tools for its diagnosis, management and treatment.

Myocardial calcification: case reports and a systematic review.

Myocardial calcification is an unusual condition in which excess calcium is deposited in the myocardium. Herein, we report two cases of myocardial calcification from our clinical experience. Furthermore, we conduct a systematic review to examine the clinical course and associated pathologies of myocardial calcification. This systematic review was registered in PROSPERO (CRD42023463285). PubMed and Scopus were searched according to the following inclusion criteria: (i) case reports or case series describing patients with myocardial calcification; (ii) diagnosis of myocardial calcification by computed tomography (CT); (iii) adequate description of patients, including their chief complaint, medical history, evaluations, and treatments; and (iv) publication in English. Among the 75 patients, 24 had sepsis, 14 had myocarditis, and 37 had other pathologies. The mortality rate was 33% for patients with sepsis, 14% for patients with myocarditis, and 11% for patients with other pathologies. Follow-up CT findings beyond 2 years were reported in six patients, showing that the CT findings of myocardial calcification persisted but subsided over time. Autopsy was performed in seven patients, and extensive interstitial fibrosis and collection of inflammatory cells were observed in patients with myocarditis, sepsis, and ischaemic heart disease. While various medical conditions can cause myocardial calcification, accompanying conditions commonly reported with myocardial calcification were sepsis and myocarditis. The CT findings of myocardial calcification tend to regress over time if the underlying disease can be treated.

Knowledge and conduct of dental students about mouthwash prior to dental procedures amid the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) generated an unusual condition around the world, affecting the essentials of clinical practice in dentistry. Aim: The purpose of this survey was to determine dental students’ conduct and knowledge regarding using pre-procedural mouthwashes. Methods: A cross-sectional study was undertaken for 148 undergraduate dental students at the Dental College/University of Mosul using an online questionnaire. participated in this survey, where 36.5% were female and 63.5% were male, and The survey format had 12 questions delivered to participants, and the replies were statistically analyzed. The data were imported and analyzed using SPSS software (version 22). Results: The current study found that 59.5% of participants thought pre-procedural mouthwash was helpful in preventing COVID-19 infections in dental settings, while 40.5% of participants believed that it is not, and for the most effective mouthrinse against COVID-19, 48.6% of participants said chlorhexidine for 30 seconds, while 51.4% said chlorhexidine for 60 seconds. Conclusions: Dental students are conscious of the value of pre-procedural mouthwash but need more clarity on the correct concentration, amount, and duration.

Isolated infarct of the corpus callosum: About a case

We report here the case of an isolated corpus callosum (CC) infarct in a 48-year-old woman. Characteristics of this unusual condition are illustrated by magnetic resonance imaging (MRI). We discuss the clinical signs of this rare entity and the more important differential diagnoses.

3D impression to facilitate in situ surgical renal segmental artery aneurysm repair: A novel open approach option for an unusual vascular condition.

Renal Artery Aneurysms (RAA) affect approximately 0.01%-0.97% of the population. Early diagnosis, thorough 3D-preoperative planning, and timely surgical treatment may offer effective and safe management. We report the open reparation of a segmental renal artery saccular aneurysm close to the bifurcation with detailed preoperative planning based on 3D printing, and with successful postoperative results. We report the case of a 36-year-old man with a 3.5 × 5cm segmental renal artery saccular aneurysm close to the bifurcation, for which endovascular management was ruled out and open management was chosen with detailed preoperative planning based on 3D printing and with successful postoperative results. When an open approach is chosen in the RAA treatment, a detailed study of the anatomical configuration of the RAAs is mandatory, and life-size 3D printing is a valuable tool that could contribute to the operative technique, reduce surgical times associated with renal ischemia and provide minute details that would make a clear anatomical difference during in situ repair.

ВИВЧЕННЯ ЛОГІКИ ЯК УМОВА РОЗВИТКУ КРИТИЧНОГО МИСЛЕННЯ У ЗДОБУВАЧІВ ВИЩОЇ ОСВІТИ

The purpose of the study is the process of critical thinking development based on the study of educational material on logic by students of higher education. The research methodology is based on modern educational and scientific approaches to the development of thinking, the development of critical thinking, active cognition and assessment of the environment, the ability to analyze business situations and problems, the development of professional skills for making current and strategic management decisions, etc. Scientific novelty: it has been proven that the condition for the development of critical thinking of students of higher education is the study of logic, solving problematic tasks. Conclusions. Classes in logic provide a wide range of necessary problem tasks for the development of critical thinking of students of higher education. Tasks in logic can involve both elementary calculations and tasks with complex calculations, both illustrative examples and sophisticated abstractions, long searches from the “general” and instant concentration of a large amount of information in the thesis, generally accepted stereotypes and the search for a solution to problem situations. The main condition for the development of critical thinking in logic classes should be the solving of a task constructed in a certain way by students. A logic task can be standard or non-standard, mathematical or not so much. The main thing is that a non-standard logical task should have some kind of surprise in it, should have an original character – whether it is an unusual condition of the task, an original idea, an unexpected solution. The ability to see the depth of the task, to distinguish the main from general details is important for solving this type of tasks. Logic contributes to sharpening the skills of rational analysis, critical evaluation of the information flow. Logic is a necessary tool for the development of a person’s critical thinking. Key words: critical thinking, logic, student of higher education, professional education, information.

Impacted maxillary permanent first molar

Abstract Tooth impaction is an abnormality that occurs when a tooth does not emerge into its place in the dental arch. Impacted permanent molar is an unusual condition that is usually detected during a routine examination. This impaction type is mostly problematic and can cause serious issues, especially when early detection and appropriate treatment are not achieved. This article highlights a case with a complaint of an ill-fitting denture, accompanied by an impacted molar that was identified during routine radiographic examination. The available treatment options include periodic follow-up, surgical exposure and orthodontic repositioning, and more invasively, surgical extraction and prosthetic replacement. The case was treated by a nonsurgical prosthodontics approach, in addition to regular follow-up, avoiding surgical interventions. This approach successfully restored both the patient’s function and esthetics. The case demonstrated the potential of prosthodontics therapy for managing impacted teeth and offering a minimally invasive and short treatment alternative to surgical and orthodontic interventions.

E027 A rare cause of shoulder pain: calcific tendonitis at the pectoralis major humeral insertion

Abstract Background/Aims Shoulder pain in the elderly is very common and often caused by calcific tendonitis of the rotator cuff muscles. We report the case of a lady presenting with unilateral shoulder pain who had an X-Ray which showed calcification over the proximal humerus. This calcification turned out to be due to calcific tendonitis of the humeral insertion of the pectoralis major, which is very rare. Unfamiliarity with this unusual condition could lead to inappropriate investigation, such as invasive biopsy, and possible mismanagement. Methods A 61-year-old lady of Pakistani origin with dual antibody positive rheumatoid arthritis, well controlled on methotrexate, reported new and severe right shoulder pain during her outpatient appointment. Her past history included coeliac disease, osteoarthritis, hypertension, iron and vitamin D deficiency, and she was not currently taking any calcium supplements. The pain had rapidly progressed over weeks to months without any trauma history and was significantly limiting all shoulder movements, particularly shoulder abduction and rotation. Her rheumatoid arthritis was in remission. Concerningly, she reported nocturnal pain, which alongside the rapidly progressive nature of the pain raises suspicions of a more sinister cause like malignancy. Results Blood tests showed a normal CRP, calcium profile and ALP. An X-Ray of the right shoulder showed no calcification or osteoarthritis affecting the glenohumeral joint, but demonstrated the unusual finding of a prominent focus of calcification close to the lateral aspect of the proximal humerus. An MSK radiologist advised further imaging to confirm nature of lesion. Subsequent USS confirms a focus of calcification (14mm x 18mm) in the pectoralis major humeral insertion, adjacent to the long head of the biceps tendon. Features that are suggestive of benign calcification rather than neoplasm include the characteristic location of the calcification and absence of an overlying soft tissue mass. The patient was reassured regarding the benign nature of the calcification and was managed conservatively with simple analgesia and physiotherapy. Conclusion Calcific tendinopathy is a common disease, but calcification of the pectoralis major at its humeral insertion point is very rare. This case highlights the importance of familiarity with this condition to enable the clinician to make an accurate diagnosis, and reduce the likelihood of unnecessary investigations and stress for the patient. Conservative management, such as simple analgesia and physiotherapy, is very effective for the majority of patients and should be used as first-line treatment. Steroid injection can be considered with orthopaedic intervention advised for those who have not responded to conservative management. Disclosure E.M. Quinlan: None. M. Kazmi: None.

Secondary organizing pneumonia associated with protracted COVID: A case series

ObjectivesImmunocompromised B-cell-depleted patients are at risk of developing protracted COVID-19, a clinical syndrome characterized by prolonged viral shedding and respiratory symptoms that can lead to hypoxemic pneumonia. Our aim is to describe this unusual condition and its treatment. Patients and methodsThis monocentric retrospective study reports six cases of severe organizing pneumonia that developed during the clinical course of protracted COVID-19. ResultsAll patients developed organizing pneumonia (OP) in the setting of protracted COVID. Clinical improvement was obtained after several treatment lines including specific antiviral agents and occurred simultaneously with control of the viral load. ConclusionAs it was the most frequent presentation of protracted COVID-19 in our survey, we believe that this specific form of organizing pneumonia warrants increased awareness. Furthermore, specific antiviral therapy seems to control this condition.

A novel RLBP1 gene mutation associated to a flecked retina syndrome.

To present an unusual fleck retina condition associated to a novel RLBP1 gene mutation.Methods/Results: A 25-year old male presented flecks on fundoscopic examination. Clinical presentation, multimodal imaging and ERG were compatible with the diagnosis of benign familial fleck retina. Genetic analysis detected an RLBP1 gene, a gene commonly associated with more severe retinal disease. Flecked retina syndromes and other genetic retinal diseases have a complex genotype-phenotype relation and need further research for their pathophysiology to be fully understood.

Unconventional features in the transcription and processing of spliceosomal small nuclear RNAs in the protozoan parasite Trichomonas vaginalis

Trichomonas vaginalis is a medically important protozoan parasite, and a deep-branching, evolutionarily divergent unicellular eukaryote that has conserved several key features of eukaryotic gene expression. Trichomonas vaginalis possesses a metazoan/plant-like capping apparatus, mRNAs with a cap 1 structure and spliceosomes containing the five small nuclear RNAs (snRNAs). However, in contrast to metazoan and plant snRNAs, the structurally conserved T. vaginalis snRNAs were initially identified as lacking the canonical guanosine cap nucleotide. To explain this unusual condition, we sought to investigate transcriptional and processing features of the spliceosomal snRNAs in this protist. Here, we show that T. vaginalis spliceosomal snRNA genes mostly lack typical eukaryotic promoters. In contrast to other eukaryotes, the putative TATA box in the T. vaginalis U6 snRNA gene was found to be dispensable for transcription or RNA polymerase selectivity. Moreover, U6 transcription in T. vaginalis was virtually insensitive to tagetitoxin compared with other cellular transcripts produced by the same RNA polymerase III. Most important and unexpected, snRNA transcription in T. vaginalis appears to bypass capping as we show that these transcripts retain their original 5′-triphosphate groups. In conclusion, transcription and processing of spliceosomal snRNAs in T. vaginalis deviate considerably from the conventional rules of other eukaryotes.

Atypical perforated appendicitis secondary to schistosomiasis: a rare case report

Introduction: Schistosomiasis is the second most common parasite disease after malaria and a rare cause of appendicitis. It has been well-documented in the literature that schistosomiasis infection can have several multisystem effects. The unusual condition known as schistosomal appendicitis was initially described by Turner. Case presentation: We present a 48-year-old man with perforated appendicitis and schistosomiasis-like radiological findings. An appendectomy was performed, and schistosomiasis was confirmed by a histological study of the excised appendix. Praziquantel was administered in a single dosage. Conclusion: Although schistosomiasis is a rare cause of appendicitis and is very prevalent in developing nations, it should be considered when managing the condition. Anti-shistosoma drugs, which are not frequently used in post-appendectomy cases, should also be considered in the management.

Limy bile syndrome or milk of calcium bile: An unexpected encounter

IntroductionLimy bile or milk of calcium bile caused due to precipitation of calcium salts in bile is an extremely rare condition of gall bladder, wherein the lumen of gall bladder is filled with chalky white paste like material. Not many cases have been reported till date.AimIn this exceptional case, we tried to correlate the radiological and surgical findings with the histopathology.Case studyWe hereby present an interesting case of a 59-year-old male who presented with dyspepsia and painful abdomen and was finally diagnosed with limy bile syndrome.Results and discussionThe etiology of this rare entity is not fully understood, but it certainly has strong association with impacted stone at the neck of gall bladder and hyperparathyroidism. Females are more commonly affected than males. Patients usually present with complaints of painful abdomen and are commonly diagnosed radiologically, as a radiopacity in gall bladder. Cholecystectomy is the preferred method of treatment for this unusual condition and histopathologically chronic cholecystitis is seen along with presence of slender needle shaped crystals of calcium salts.ConclusionsA thorough evaluation of the clinicoradiological and histopathological findings can sometimes bring to light many uncommon variants of common looking pathologies.

Origin and survival outcomes of Pseudomyxoma peritonei-A retrospective study.

Pseudomyxoma peritonei (PMP) is an unusual clinical condition typically presenting with widespread mucinous neoplastic lesions within the peritoneum resulting in gelatin material-rich ascites. It was first described by Werth in 1884. Ever since, its clinical presentation, definition, site of origin, and prognosis have been a subject of debate. However, many histopathologic, immunohistochemical, and genetic studies have attempted to locate the primary lesion in the appendix in both genders. To analyze the histological origin and survival outcomes of pseudomyxoma peritonei in patients treated at a regional cancer center. Fifteen cases of PMP were diagnosed during the five-year study period. The demographic and clinicopathological details were retrieved; the slides were reviewed and histological parameters reassessed. Descriptive statistics were used to express proportions. Continuous variables were recorded as mean (SD) or median (IQR). Kaplan-Meier (KM) curve was used to estimate overall survival. Mean age for PMP was found to be 47.5 years for low grade Mucinous Carcinoma Peritonei (MCP), 54.2 years for high grade MCP, and 58 years for high grade MCP with signet ring cells. Most common overall presentation was abdominal distension in 53.3% (8/15) of cases, followed by acute appendicitis in 20% (3/15) cases. PMP was detected synchronous with the primary tumor in 9/15 cases (60%). Primary lesion in the appendix was grossly identified in 7/15 cases, while it was not explored in the remaining eight cases. Yet, by combined clinical, radiological, histopathological, and immunohistochemical analysis, we identified that most of the cases (14/15) had an appendiceal origin (93.3%). The overall survival for 12 months was 50% and for 18 months was 37%. The surgeon and radiologist may well bear in mind the most common possibility of an appendiceal origin for PMP and resect the appendix, irrespective of the presence of a grossly or radiologically detectable lesions. We emphasize that immunohistochemistry helped to detect the site of origin even when the primary was occult.

FAMILIAL FOURTH MOLARS IN NON-SYNDROMIC PATIENTS: CASE REPORT OF AN UNUSUAL ENTITY

Objectives: This work aims to report an unusual case of fourth molars in three patients from the same family. Case Report: The patient underwent third and fourth molars removal with little morbidity. Some important aspects were discussed, in particular the use of piezosurgery. Important features of the classification and epidemiology of distomolars and paramolars were discussed. The authors believe this to be the first report of familial fourth molars. Conclusions: Although considered a rare condition, fourth molars can be treated as an unusual or uncommon condition. The term rare is not appropriate to this situation and the authors debate it. Piezosurgery is very harmful in extensive osteotomies to remove third and/or fourth molars.