case report

Excessive ankle stiffness can greatly impact mobility, leading to discomfort, difficulty in walking, and limited Range of Motion (ROM). We aimed to identify and address the symmetry of shank muscle strength, ankle passive stiffness, and plantar pressure distribution, in a patient with unilateral excessive ankle stiffness, utilizing Instrument-Assisted Soft Tissue Mobilization (IASTM) accompanied by Faradic Electrical Stimulation (FES).The patient’s muscle strength and ROM which had diminished due to 3.5 years of ankle immobilization post-rescue from amputation, underwent a 12-week program involving IASTM and FES. The plantar and dorsiflexion muscles’ torque, ROM, and plantar pressure were measured using an isokinetic and plantar distribution system before and after the intervention. Symmetry of muscle torque, ROM, and plantar pressure between two limbs were calculated for pre and post-test.Results indicated improvement in the ratio index of the concentric/eccentric dorsi- and plantar-flexion peak torque and dorsi- and plantar-flexion work, ROM, gait line length, and contact time after a 12-week intervention.The study suggests that IASTM and FES are effective interventions for restoring symmetry in a patient with post-operation complications, highlighting the need for further research on similar cases.

Granulomatous diseases can cause hypercalcemia due to elevated 1,25-dihydroxyvitamin D through the production of 1-α hydroxylase by macrophages in the granulomas. Tophaceous gout is not considered to cause this picture. However, there are a few case reports of this occurrence in tophaceous gout, as well as the description of intense 1-α hydroxylase activity in granulomas of tophi in gout patients. We review this literature, and we report a well-documented case of hypercalcemia with elevated serum 1,25 dihydroxyvitamin D in a patient with extensive tophaceous gout and tophi loaded with granulomas. An extensive work-up ruled out other causes of hypercalcemia and granulomatous diseases. Prednisone corrected the chemical abnormalities. Diffuse tophaceous gout should be considered a rare cause of hypercalcemia due to excessive 1,25 dihydroxy vitamin D.

Ventricular Septal Defect, also known as VSD is a rare and life-threatening complication associated with MI. Therefore, it should be immediately diagnosed and treated. Transcatheter closure of the ventricular septal defect is a new alternative treatment approach compared to surgery. In this case, we presented a patient with post-infarct basal ventricular septal defect whose ventricular septal defect was closed using an atrial septal defect closure device. The ability to successfully close such a large defect via catheter is promising for the treatment of patients with VSD.

Background and importance: Sacral fractures often lead to injuries of the lumbosacral nerve, which will cause tremendous damage to the patient’s motor and sensory functions. At present, the most commonly used surgical method is the posterior median approach, the extent and degree of neurolysis are often insufficient, so the effect of neurolysis is not well, and the functional recovery of patients after operation is often incomplete.Clinical presentation: The patient was a 17-year-old male who accidentally fell from a height and landed on his hip. The main clinical feature of the patient was persistent radiating pain in the right lower extremity with right lower limb sensorimotor disorder. The results of the X-ray examination indicated a sacral fracture and a right pubic fracture. After the injury, the patient underwent pelvic internal fixation surgery within 72 hours. Then 6 months after the surgery, there was no significant improvement in right lower limb function, and the patient came to our hospital seeking treatment. Considering the severe lumbosacral plexus injury and the history of surgery, we performed an “Anterior surgery approach combined with posterior approach for lumbosacral neurolysis” for the patient, postoperative radiation pain disappeared completely, and there were significant improvements in the muscle strength of some muscles and sensory function.Conclusion: The relaxation of the lumbosacral plexus is usually performed through a single surgical approach, which has great limitations in the effect of relaxation. Here, we demonstrate a case in which posterior lumbar incision and anterior laparoscopic lumbosacral plexus neurolysis can benefit the patient, the lumbosacral nerve was released to a great extent. We aim to bring this case to the attention of our worldwide neurosurgical colleagues and share our surgical approach to assist those who may encounter this case in the future.

Congenital fibrinogen qualitative disorders, including dysfibrinogenemia and hypo-dysfibrinogenaemia, are highly heterogeneous, both in clinical manifestation and for the mutational molecular spectrum driving these disorders. Correlations between phenotype and genotype remain poorly defined. Considerable work lies ahead in order to achieve diagnostic and prognostic precision and subsequently provide targeted management for this rare disease. Here we report the laboratory test, the clinical and molecular characterisation of a family with dysfibrinogenemia.

There is increasing evidence of the difficulty in understanding the “biological functioning” of some complex microbial communities. Complex microbial communities exist everywhere in nature, and the interactions among their constituent microorganisms are a crucial aspect that influences their development. The ability of microorganisms to colonize an environment includes their ability to interact with other species in the same ecosystem, as well as their ability to adapt and integrate into the evolving community. The interactions among microorganisms and not just their numbers, or the presence of different species, biotypes, and variants, in many cases, seems to become a decisive factor in understanding and analyzing the development of microbial ecosystems and the biological function of the individual microbial entities that are part of them.After working to isolate individual microbial cells and study the mechanisms of their functioning and development, it is time to embark on a backward journey “from the small to the complex” for a better understanding of complex microbial ecosystems and their application potential. The purpose of this brief contribution is to further the development of the understanding of the role of microbial communities in nature and the mode of their development and evolution.

Sleep disorders represent a significant public health concern due to their widespread prevalence, impact on overall health, and the economic burden they impose. These disorders encompass a broad spectrum of conditions, ranging from insomnia and obstructive sleep apnea (OSA) to narcolepsy, restless legs syndrome (RLS), and parasomnias. They are often associated with comorbidities such as cardiovascular diseases, metabolic dysfunctions, and mental health disorders, making their identification and management critical.The publication of this work is of high interest as it contributes to the expanding body of literature focused on understanding the complex interplay between sleep disorders and health outcomes. By presenting detailed case reports, this study provides valuable insights into the diagnostic challenges, treatment modalities, and potential avenues for personalized interventions in sleep medicine. Case reports are particularly important in this field as they shed light on unique presentations and rare conditions that might otherwise go unnoticed in large-scale epidemiological studies. From an epidemiological perspective, sleep disorders are highly prevalent globally. According to the World Health Organization (WHO), approximately 30% - 45% of the global population experiences sleep disturbances. Obstructive sleep apnea, for instance, affects nearly 1 billion individuals worldwide, with varying prevalence across age, gender, and geographic regions. Insomnia affects roughly 10% - 30% of adults, with rates as high as 50% - 60% in older populations.Meanwhile, narcolepsy, though rare, is estimated to affect 1 in 2,000 people in the general population. These statistics underscore the pressing need for enhanced diagnostic methods, improved treatment strategies, and comprehensive patient management. By detailing real-world cases, this publication aims to bridge the gap between clinical observations and broader scientific understanding. The insights gained from these case studies have the potential to inform future research directions, improve clinical practices, and ultimately enhance patient outcomes in sleep medicine.Sleep disorders affect millions of individuals globally, disrupting physical, mental, and emotional well-being. Conditions such as insomnia, obstructive sleep apnea (OSA), narcolepsy, and restless legs syndrome (RLS) are among the most studied. This paper examines the etiology, diagnosis, and management of sleep disorders, presenting detailed case reports and integrating relevant sleep study findings. Figures such as polysomnography (PSG) outputs and statistical trends provide visual insights into diagnostic and therapeutic interventions. Sleep disorders encompass a wide range of conditions that significantly disrupt sleep quality and overall well-being. Common disorders such as insomnia, obstructive sleep apnea (OSA), narcolepsy, and restless legs syndrome (RLS) affect millions globally, posing risks to physical health, mental stability, and cognitive performance. This study explores the clinical presentation, diagnostic approaches, and management of sleep disorders through the lens of detailed case reports and sleep study data.Polysomnography (PSG), the gold standard for sleep disorder diagnosis, plays a pivotal role in identifying abnormal sleep patterns, respiratory irregularities, and neural disruptions. Multiple sleep latency tests (MSLT) and actigraphy complement PSG, offering insights into disorders like narcolepsy and circadian rhythm abnormalities. This paper presents three representative case reports: chronic insomnia, severe OSA, and narcolepsy with cataplexy. Each case is analyzed in-depth, highlighting patient history, PSG findings, treatment interventions, and outcomes. For chronic insomnia, cognitive-behavioral therapy for insomnia (CBT-I) and pharmacological intervention resulted in marked improvements in sleep latency and efficiency. In the OSA case, continuous positive airway pressure (CPAP) therapy significantly reduced the apnea-hypopnea index (AHI) and alleviated daytime symptoms. The narcolepsy case demonstrates the efficacy of modafinil and sodium oxybate in managing excessive daytime sleepiness and cataplexy.Despite advancements, challenges persist in the field, including patient adherence to therapy, accessibility to specialized sleep studies, and the ethical implications of AI-driven diagnostic tools. Future research should focus on scalable, patient-centric approaches and the role of emerging technologies in enhancing diagnostic accuracy and treatment efficacy. This paper aims to contribute to the evolving understanding of sleep disorders, bridging clinical case insights with the broader implications for sleep health and research.

Beta thalassemia major is a genetic disorder requiring recurrent blood transfusion leading to iron overload in endocrine glands and major organs like the heart. Iron overload in the heart may lead to many conduction abnormalities. This is a case report of a 20-year-old female who was on recurrent blood transfusion. She was on chelation therapy for iron overload. She developed Right Ventricular Outflow Tract Tachycardia (RVOT) which could not be managed with chemical or electrical cardioversion. Her condition was successfully managed with an Automatic Implantable Cardioverter Defibrillator (AICD) implantation and no ventricular tachycardia was observed even after four years of follow-up.

Visualizing a nodule in the liver parenchyma of a patient with chronic liver disease raises the suspicion of hepatic malignancy. We report here the case of a 63-year-old female with primary biliary cholangitis (PBC) in whom a hepatic pseudolymphoma (HPL) was incidentally detected. This fairly rare lesion mimics primary liver cancer, has no specific radiological features, and requires histology for a definite diagnosis. This tumor-like lymphoid liver proliferation has been reported in clinical situations with immune-mediated inflammation including PBC. It can be observed in many organs but very rarely in the liver. The diagnosis of HPL should be considered when detecting a liver nodule in a patient with this particular chronic cholestatic liver disease.

Shoulder dystocia is a rare but severe complication of vaginal delivery with possibly serious consequences. Certain risk factors are associated with shoulder dystocia, but a general forecasting model is lacking. We present a Case report using a newly modified Posterior Axilla Maneuver technique that saved a 5.140 g (11 lbs. 5 oz.) newborn from shoulder dystocia. The child was born with Apgar 7/9, pH 7.17. Currently, there are no signs of any long-term sequelae.Our procedure comprised the following steps: 1. First, we pulled the posterior shoulder downwards - in the direction and to the outer surface of the perineum. 2. Then we pulled the posterior shoulder backward - toward the maternal spine - when it was already outside the perineum and finished extracting the posterior shoulder. 3. By completing the first two steps, a Tilt of the shoulder girdle was reached in the midsagittal plane, resulting in a backward slope for the shoulder girdle so that the anterior shoulder touched the symphysis slightly from the back in a skewed manner, freeing it from the initial impacted position. 4. We applied the Kristeller procedure only after dislodging the anterior shoulder from its initial impacted position. 5. We also applied the McRoberts Maneuver at the end of the process to increase the diameter of the birth canal.

Africa is one of the continent’s most vulnerable to the effects of climate change despite contributing the least to global greenhouse gas emissions. The continent has faced many environmental challenges recently, including rising temperatures, altered precipitation patterns, frequent droughts, and extreme weather events. These changes exacerbate existing vulnerabilities in agriculture, water resources, human health, and infrastructure, which are vital for the livelihoods of millions of people. Africa’s population is 60% occupied by agriculture and is threatened by shifting rainfall patterns and extended droughts. Crop yields are increasingly variable, leading to food insecurity and exacerbating poverty. Water scarcity is another pressing concern, as reduced rainfall and more frequent droughts strain already limited water resources, affecting agriculture and access to clean drinking water. Coastal regions are also at risk, with rising sea levels threatening millions living in low-lying areas. In effect, the impacts of climate change extremely affect Africa’s low-level income populations, deepening social and economic inequalities. Africa’s limited financial resources and infrastructure hinder its ability to adapt to these challenges. Nonetheless, Africa also has the potential for resilience through nature-based solutions, renewable energy investments, and regional cooperation. Efforts to enhance climate adaptation, such as sustainable farming practices, improved water management, and climate-smart policies, are critical in building the resilience of communities in combating climate change.

The postpartum period is a phase during which various endocrine disorders may arise due to changes in the immune system. Postpartum thyroiditis and postpartum hypophysitis (lymphocytic hypophysitis) are two autoimmune diseases that typically occur independently but are rarely found together in the same patient.Postpartum thyroiditis usually starts with thyrotoxicosis and progresses to hypothyroidism, while postpartum hypophysitis can lead to adrenal insufficiency and dysfunction of other pituitary hormones.This case report discusses a female patient who presented with severe headaches, fatigue, and hypotension five months after childbirth. The patient was diagnosed with both postpartum thyroiditis and postpartum hypophysitis simultaneously, and dysfunction of both the thyroid and pituitary was detected. Hormone replacement therapies were administered, and the patient’s symptoms were brought under control.This case emphasizes the importance of carefully evaluating both thyroid and pituitary function during the postpartum period. Early diagnosis and appropriate treatment are crucial for preventing potential complications and improving long-term health outcomes.

Cardiac arrhythmias are frequent complications of the consumption of toxic substances, including cannabis, which can be fatal.We report in this case a patient who developed a cardiac arrhythmia-type focal atrial tachycardia a few moments after the consumption of an important dose of cannabis but which reduced spontaneously and without having administered any medication or an external electric shock.All the rest of the etiological assessment of this arrhythmia was negative and the arrhythmia was linked to the consumption of cannabis which is known to cause these complications.

This work aims to report a case where a minimum incision and with vascular control endoscopically assisted transvesical prostatectomy was carried out to control hemostasis after prostate digital enucleation.

Extrahepatic biliary neuroendocrine tumors (EBNETs) are a rare group of neoplasms with varying characteristics, with 223 cases documented since their discovery. In this case report, an EBNET is described as a result of vague abdominal pain and significantly elevated liver function tests in a 41-year-old woman who presented with vague abdominal pain and elevated liver function tests. Despite the challenges faced in preoperative diagnosis, including the need to differentiate from cholangiocarcinoma, surgical intervention was successful. Due to the tumor’s complex nature, meticulous dissection and reconstruction were required, leading to crucial insights into surgical management. In addition to highlighting the rarity of EBNETs, this case emphasizes the importance of early detection and customized surgical approaches.

This case report discusses a 74-year-old male patient diagnosed with recurrent pancreatitis associated with a CFTR heterozygous mutation. The patient presented with complaints of epigastric pain, and laboratory findings revealed elevated amylase and lipase levelsGenetic testing revealed a p.Phe1052Val (c.3154T>G) heterozygous mutation in the CFTR gene, which has been associated with recurrent pancreatitis through autosomal dominant inheritance. A cystic lesion detected in the pancreas (suggestive of IPMN or serous cystic neoplasm) was evaluated for malignancy and deemed low-risk based on PET-CT findings and a negative CA 19-9 level. This case is presented to emphasize that CFTR mutations should be considered in the differential diagnosis of patients with recurrent pancreatitis, that symptoms may present in adulthood, and that the diagnosis can be easily established through genetic testing.

Intussusception is a leading cause of intestinal obstruction in young children, typically presenting with colicky abdominal pain and altered stool characteristics, before progressing to abdominal distension and bilious vomiting. This case report describes an 8-month-old male who presented with gastrointestinal symptoms, respiratory distress, and signs of intestinal obstruction. The patient was diagnosed with intussusception and found to be positive for Respiratory Syncytial Virus (RSV). After an attempted ultrasound-guided hydrostatic fluid enema, he underwent laparotomy to resolve the intussusception but developed post-operative complications, including delayed wound healing and wound dehiscence. The interplay of viral infections like RSV, and treatments such as steroids in pediatric surgical cases warrants further attention, especially concerning postoperative outcomes.

Bilateral trigeminal neuralgia refractory to medical therapy is a rare occurrence and it is mandatory to choose therapeutic procedures minimizing possible bilateral sensitive deficit due to the employment of bilateral mininvasive ablative techniques.  A patient affected by bilateral trigeminal neuralgia refractory to medical therapy secondary to multiple sclerosis is presented. Multiple therapeutic tools were employed in this challenging pathology. The second and third left trigeminal divisions were involved by the neuralgia, while the third division was involved in the right facial side. Controlled radiofrequency thermocoagulation was employed for the isolated right third division, then radiosurgery was conducted for the left hemifacial side.  After one month, because of the persistence of pain attacks of the left second trigeminal division, peripheral authorizations were performed. Control of pain, with the withdrawal of medical therapy (BNI scale class I), was achieved in this patient with a multi-therapeutic approach. Radiofrequency thermorizotomy was performed for the right third division because neuralgia was very acute, and immediate pain relief was achieved. Pain in the left third trigeminal division regressed after radiosurgery, while pain in the left second division continued after radiosurgery, then peripheral alcoholization was performed with pain control.Bilateral trigeminal neuralgia refractory to medical therapy should be treated by the dedicated neurosurgeon, avoiding bilateral ablative techniques for the same division and using neurosurgical techniques according to the trigeminal division interested by the neuralgia and according to the intensity of pain.

Double-Positive Patients (DPPs), characterized by the simultaneous presence of Anti-Neutrophil Cytoplasmic Antibody (ANCA) and anti-Glomerular Basement Membrane (anti-GBM) antibodies, represent a rare subset in systemic vasculitis. We present two cases of DPPs with renal involvement and review the existing literature to elucidate the clinical characteristics, histopathological findings, management strategies, and prognostic outcomes associated with this condition. Both cases exhibited renal involvement with rapidly progressive glomerulonephritis, requiring renal replacement therapy. Renal biopsies confirmed crescentic glomerulonephritis with features of both anti-GBM disease and ANCA-associated vasculitis. Management included high-dose glucocorticoids, cyclophosphamide, and consideration of plasma exchanges. Double-positive ANCA and anti-GBM vasculitis pose challenges in management and prognosis. Further research is essential to improve therapeutic strategies for this rare and heterogeneous condition.

Anaplastic Pleomorphic Xanthoastrocytoma is a very rare tumor of the Central Nervous System (CNS). BRAFV600E mutation is a common mutation in pleomorphic xanthoastrocytoma. We present a 52-year-old male patient who underwent total resection due to a temporal lobe mass. The primary tumor in the temporal lobe was given postoperative radiotherapy. During follow-up, genetically and histologically proven metastasis was detected in the paraspinal region. The adjuvant RT was given to metastasis after surgery. The patient, who used the combination of dabrafenib and trametinib after recurrence, is being monitored in remission.