clinical

Xanthogranulomatosis is an uncommon disease affecting non-Langerhans histiocytes. Laryngeal involvement is very rare.We describe the clinical case of an adult patient with disseminated xanthogranulomas affecting the supraglottic region of the larynx, leading to thickening and immobility of the epiglottis. The patient experienced inspiratory dyspnea on exertion. A transoral supraglottic epiglottectomy was performed, and a tracheostomy was subsequently required.

Primary adrenocortical insufficiency or Addison’s disease (AD) is a rare, life-threatening condition with different aetiologies, but the most common cause is autoimmune destruction of the adrenal cortex. Autoimmune Addison’s disease (AAD) can present as an isolated condition or associated with others, as part of an autoimmune polyglandular syndrome (APS). The aim of this work is to investigate and emphasise the roles of autoantibodies in adrenocortical insufficiency, through the description of three clinical cases.

Purpose: Loop Diuretics (LD) are the first-line pharmacotherapy to address Heart Failure (HF)-associated edema and dyspnea. However, LD causes frequent urinary, resulting in inconvenience and possibly undermining the quality of life. While prescription adjustment is an essential part of Palliative Care Consultation (PCC), it remains unclear how PCC affects the deprescribing of diuretics for adults with HF. Methods: We conducted a pre-post analysis of the percentage of HF patients who were prescribed LD in a national Electronic Health Record (EHR) database 12 months before and after the first PCC. The difference in prescription rates between the periods was determined. Adjusted associations of post-PCC LD prescription with pre-PCC LD prescription and patient’s characteristics, insurance, provider type, and clinical factors were quantified.Results: From 2010 to 2018, 5,969 patients with newly diagnosed HF received at least one PCC, among whom 2,539 (42.5%) were prescribed LD before and 1,552 (26.0%) after their first PCC. Despite a decrease in LD prescription rate encompassing the date of PCC, post-PCC LD prescribing was strongly associated with pre-PCC prescribing (aOR[95%CI] 3.2[2.8,3.7]) and varied by age at first PCC, year of HF diagnosis (aOR[95%CI] 2.1[1.9,2.4]) and months from HF diagnosis to first PCC. While our finding demonstrates reduced polypharmacy associated with PCC, the strong association between pre- and post-PCC indicates reverse therapeutic inertia. Future research should investigate the benefits and costs of polypharmacy among specific patient groups to help develop personalized treatment for HF.

Aim: To compare the demographic and clinical profile of conventional retinopathy of prematurity (ROP) with aggressive posterior retinopathy of prematurity.Material and methods: A prospective, unmasked, and observational study involving 150 ROP patients was conducted over a period of one year. The risk factors including maternal and neonatal risk factors were recorded. The data was entered into the Excel sheet and analyzed to compare the risk factors between the conventional ROP and APROP.Results: A total of 17 (11.3%) babies were found to have AP-ROP and 133 (88.7%) babies were found to have conventional ROP. There was no significant difference in average gestational age between infants diagnosed with AP-ROP (29.6 ± 2.9 weeks) and those with Conventional ROP (30.1 ± 2.2 weeks) (p = 0.428). However, infants with AP-ROP had a significantly lower average birth weight (1022.7 ± 123.5 g) compared to infants with Conventional ROP (1208.2 ± 261.0 g) (p  = 0.004). Multivariate logistic regression analysis revealed that birth weight, surfactant use, number of days of oxygen supplementation, and metabolic acidosis were independently associated with the development of AP-ROP.Conclusion: The development of APROP is multifactorial and complex. Although we have identified factors such as birth weight, surfactant use, number of days of oxygen supplementation, and metabolic acidosis in the causation of APROP, further long-term multicentric studies are required for validation.

Purpose: American expert consensus publications recommend discontinuation of antiplatelet agents 6 to 12 months after Percutaneous Coronary Intervention (PCI) in patients with Atrial Fibrillation (AF) who require chronic anticoagulation, and use of oral anticoagulant monotherapy thereafter. This study aimed to assess real-world long-term antithrombotic therapy management practices and factors associated with the continuation of antiplatelet agents past 12 months post-PCI in patients with AF requiring chronic anticoagulation. Methods: Patients with AF and a history of PCI greater than 12 months before their most recent encounter with physicians at an outpatient electrophysiology clinic were identified by chart review. Patient demographics, clinical characteristics, and current antithrombotic regimen were collected from encounters that occurred between July 2019 and June 2022. The independent predictive factors associated with the continuation of antiplatelet agents were identified using univariate and regression analyses. Results: Out of 66 patients, 67% continued antiplatelet therapy for greater than 12 months post-PCI. Patients on antiplatelets were significantly less likely to have bare metal stents (p = 0.006), be greater than five years post-PCI (p = 0.002), and have a HASBLED score of two or less (p = 0.028) when compared to patients on oral anticoagulant monotherapy. Bare metal stent history (p = 0.045) and HASBLED score of two or less (p = 0.016) were also significant in regression analysis.Conclusion: This study found that most patients with AF and a history of PCI continued antiplatelet therapy longer than 12 months post-PCI, often despite the high bleeding risk.

Objectives: This study aims to introduce and differentiate between traditional craze lines and a newly identified type of line in enamel, termed an “internal craze line.” This novel classification enhances diagnostic precision and carries significant clinical implications for treatment strategies. The goal is to provide a clear description of these two types of lines, discuss their unique clinical implications, and highlight their differing appearances and staining characteristics, contributing to improved understanding and management of enamel anomalies.Method and materials: Four extracted teeth exhibiting visible and internal craze lines were selected and examined using a stereo microscope to observe the structural characteristics of the lines. Cross-sections of the coronal parts of the teeth were prepared to document the differences between traditional craze lines (extending from the dentin-enamel junction [DEJ] to the enamel surface) and internal craze lines (originating at the DEJ but terminating midway through the enamel). Additionally, intraoral observations were conducted under high magnification to identify the visual differences between the two types of lines, noting that traditional craze lines can be stained while internal craze lines cannot.Results: Microscopic examination revealed two distinct types of lines: traditional craze lines extending from the DEJ to the enamel surface and internal craze lines terminating within the enamel. Intraoral observations confirmed that these lines could be distinguished under high magnification. Traditional craze lines appear as continuous lines reaching the enamel surface and can be stained, whereas internal craze lines are shorter, do not extend to the surface, and cannot be stained.Conclusion: The identification of internal craze lines presents significant clinical implications. Differentiating between traditional and internal craze lines can enhance diagnostic accuracy and inform treatment decisions. Recognizing internal craze lines might indicate different etiologies or risk profiles compared to traditional craze lines, influencing preventive and therapeutic strategies in dental practice. Further research is needed to explore the prevalence, causes, and long-term impacts of internal craze lines.

Introduction: In many developing countries, particularly in Africa, the use of renal biopsy (RB) in clinical nephrology is severely lacking. The objectives were to describe the anatomoclinical and etiological profile of these biopsied nephropathies, as well as the factors associated with the etiology of the nephropathies.Patients and method: This was a retrospective descriptive and analytical study from 1 April 2020 to 30 October 2022. The patients were selected from the renal biopsy register of the nephrology department of the Thiès Regional Hospital. Sociodemographic, clinical, biological, and histological parameters were studied.Results: 75 renal biopsies were included. The mean age was 33.3 ± 14.8 years, with a male predominance (65.3%). The main indications were nephrotic syndrome in 50.67% of cases. RB was adequate in 82.7%, inadequate in 13.3%, and borderline in 4%. Glomerular nephropathies predominated, with focal segmental glomerulosclerosis (FSGS) in 34.7%, membranous nephropathy (MN) in 17.3%, minimal change disease (MCD) in 10.67%, extracapillary glomerulonephritis (ECGN) in 5.3% and lupus nephritis (LN) in 3.9%. Thrombotic microangiopathy (TMA) was found in 9.3%. Chronic tubulointerstitial nephropathy (CTIN) accounted for 5.3% of all RB and acute tubular necrosis (ATN) for 4%. The etiologies were primary in 48%, secondary in 28%, and undetermined in 24%. In the bivariate analysis, the etiology was correlated with the mean SBP (p = 0.023), the mean level of hemoglobin (p = 0.028), the levels of GFR (p = 0.017), and the type of kidney disease (p = 0.000).Conclusion: Glomerular nephropathy was more frequent and FSGS was the most common histological lesion found. Primary causes predominated. Associated factors were identified to improve patient management.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive disease characterized not only by pathological changes in the lungs but also by significant extrapulmonary manifestations and serious concomitant diseases. The current problem for the study is the features of the relationship between COPD and adipose tissue since there are contradictory data in the literature. This review presents studies that claim that obesity aggravates the course of COPD, as well as the results of studies that describe the “obesity paradox” in patients with COPD. Due to the lack of unambiguous data, it is necessary to continue studying this problem to optimize the tactics of managing this group of patients and draw up clear recommendations for patients with COPD.

The ciliated hepatic cyst of the anterior intestine is a less frequent benign entity that arises from the alteration in the migration of embryological remains. Most of them are found in the left lobe of the liver, especially in segment IV. Its wall is covered by a pseudostratified ciliated columnar epithelium, a layer of connective tissue, smooth muscle, and a surrounding fibrous outer layer. We present the case of a 61-year-old man who, in the context of a scheduled admission for drainage of an intraabdominal abscess, was incidentally discovered to have a hepatic lesion of cystic aspect. The anatomopathological diagnosis was that of a ciliated hepatic cyst. Due to its low frequency in clinical practice (in part due to its incidental character), a review of the case and a review in the literature of the peculiarities of said entity are proposed.

Background: Clinical research is a vital component of medical advancements, contributing to the discovery of new treatments, procedures, and health interventions. This paper discusses the importance of clinical trials, the structure and phases of trials, ethical considerations in research, and the role of modern technologies in reshaping clinical trials.Objective: This article aims to provide a comprehensive overview of the clinical trial process, ethical compliance, and the integration of technological advancements, with real-world examples and recent studies to support the discussion.Methods: The article provides a descriptive analysis of the different types of clinical research, the various phases of clinical trials, and ethical considerations based on established guidelines such as the Declaration of Helsinki and the Belmont Report. It also examines how recent technological innovations, including AI, wearable devices, and Electronic Health Records (EHRs), have revolutionized the field.Results: The integration of technology into clinical research has resulted in more efficient, data-driven, and patient-centric trials. Ethical compliance, guided by international regulations, remains a critical factor in ensuring patient safety and maintaining public trust in clinical research.Conclusion: The future of clinical research relies heavily on technological innovation and strict adherence to ethical guidelines. As new treatments and therapies emerge, the structure of trials and the responsible use of technology will play an essential role in shaping the future of healthcare.

Chronic obstructive pulmonary disease (COPD) is associated with numerous comorbidities, including muscle involvement which consists of changes in the structure and function of peripheral and respiratory muscles. Ultrasound can provide a non-invasive assessment of muscle damage. Ultrasound assessment of the quadriceps contractility index (Qci) is feasible, rapid, simple, and reliable. Numerous studies have demonstrated that Qci is linked to the severity of COPD, clinical symptoms, and respiratory muscle activity. Furthermore, ultrasound makes it possible to observe the dynamics of the diaphragm by measuring its amplitude, its contraction speed, and the duration of each contraction phase. Ultrasound examination of muscle damage in COPD could constitute a promising new tool to assess the severity of the disease.

Background: SARS-CoV-2 is increasingly recognized for its cardiovascular complications. To address the knowledge gap in our region, this study investigated the relationship between electrocardiographic (ECG) features and in-hospital mortality among COVID-19 patients.Methods: A prospective cohort study was conducted involving 140 RT-PCR-confirmed COVID-19 patients at Dhaka Medical College Hospital from August 2021 to July 2022. Patients were divided into two groups based on ECG findings: normal (Group A) and abnormal (Group B). Clinical data and ECG parameters were analyzed using SPSS 24.0.Results: Patients with abnormal ECGs were older, more likely male, and presented with higher rates of dyspnea and palpitations. They were also at increased risk of severe COVID-19 and had longer hospital stays. In-hospital mortality was significantly higher in Group B (21.4% vs.4.3%). ST-T changes and atrial fibrillation were associated with increased mortality. Independent predictors of in-hospital mortality included ECG abnormalities and admission SpO₂ < 90%.Conclusion: ECG abnormalities are significantly associated with adverse outcomes in COVID-19 patients. Further large-scale studies are warranted to strengthen these findings.

Insulin resistance, often referred to as impaired insulin sensitivity. This clinical case focusses on a woman with insulin resistance and a long-standing and recurring history of obesity to demonstrate how diet therapy can be applied in addition to standard medication therapy.

Long COVID can be defined as a set of symptoms appearing more than 28 days after a documented acute COVID-19. Among them, extreme fatigue and troubles of moods are the most common. To verify that acupuncture can efficiently alleviate long COVID, a chronic disease partly escaping to other treatments, especially fatigue and troubles of mood. To collect data pertaining to the patients included in the study as described in the STROBE guideline. To diagnose the clinical conditions of the patients using the Nan jing in order to choose the meridian and the points to be toned or dispersed depending on the observation of tongue and pulse. Acupuncture can greatly improve the troubles of patients suffering from long COVID after a reduced number of sessions (1 to 4).

Pneumomediastinum (mediastinal emphysema) is an uncommon condition characterized by the accumulation of air or gas in the mediastinum. Here is a case of a 16-year-old female known to have depression who presented to the emergency department with complaints of shortness of breath, restlessness, chest discomfort, and hoarseness of voice for 2 days. She was initially diagnosed with panic attack, and later on clinical examination, surgical emphysema over the right supraclavicular area was noticed. Chest X-ray was found to be normal, and further imaging with high-resolution computed tomography (HRCT) of the thorax showed pneumomediastinum. In this report, the clinical presentations, radiological features, and management of pneumomediastinum will be discussed.

Background: One of the problems in vitro fertilization (IVF) treatment for infertility is the high frequency of embryo developmental arrest in the preimplantation stages. Arrested embryos were not selected for transfer and were usually discarded. Case report: We present a case of clinical pregnancy and live birth following IVF treatment and transfer of one arrested embryo. A 31-year-old woman with unexplained infertility underwent IVF treatment. Using the IVF procedure, 7 embryos were produced which were frozen on day 3. In order to embryo transfer in the blastocyst stage, two embryos were thawed and cultured for 2 days. After thawing, one of them was not suitable for transfer and another embryo was arrested at the 10-12 cell stage. Discussion: The Clinical pregnancy and live birth happened after the transfer of an arrested embryo on day 5.Conclusion: This case showed that arrested embryos may resume growth after the transfer to the uterus and result in a successful pregnancy and live birth.

Coronary Artery Disease (CAD) is a leading cause of mortality worldwide, with coronary angioplasty being a crucial intervention for patients with significant disease. This study aimed to identify and analyze the causes of coronary angioplasty denial in patients with significant coronary artery disease in Afghanistan, focusing on demographic, socioeconomic, and clinical factors.A case-control study was conducted with a sample size of 213 patients diagnosed with significant CAD at tertiary care center in Afghanistan. The case group consisted of 106 patients who were denied angioplasty, and the control group included 107 patients who underwent the procedure. Data were collected on demographic characteristics, comorbidities, education, residence, functional status, income, and the reasons for angioplasty denial. Descriptive statistics and comparative analyses were performed to assess the factors associated with denial.The primary reasons for angioplasty denial were financial constraints (45.3%, p < 0.001), limited hospital facilities (15.1%, p = 0.045), patient refusal (23.6%, p < 0.001), and physician preference for conservative management (12.3%, p = 0.091). Denial rates were higher among patients who were older, had multiple comorbidities, were from rural areas, and had lower education and income levels. Illiteracy and cultural beliefs contributed significantly to patient refusal, while inadequate healthcare infrastructure disproportionately affected rural populations.Financial and infrastructural barriers are the leading causes of coronary angioplasty denial in Afghanistan, exacerbating disparities in healthcare access, particularly among low-income and rural patients. Addressing these issues through policy reforms, improved healthcare infrastructure, and targeted public health education is essential to reducing CAD-related morbidity and mortality in the country.

Fibrothecal tumors of the ovary are rare neoplasms, comprising less than 4% of all ovarian tumors and primarily affecting post-menopausal women. These benign tumors arise from the stromal tissue of the ovary and may produce hormones, particularly estrogen. Their diagnosis presents considerable challenges, frequently leading to misclassification as malignant ovarian tumors or uterine myomas. This report describes the case of a 59-year-old woman who presented with abdominal distension and pelvic pain. Clinical examination revealed a large, lobulated mass and imaging studies classified the right ovarian mass as ORADS 4. An exploratory laparotomy confirmed the absence of metastasis, resulting in total hysterectomy, bilateral adnexectomy, and omentectomy. The anatomopathological analysis identified the latero-ovarian mass as a fibrothecoma. Generally, fibrothecal tumors are benign with a favorable prognosis following surgical intervention. Common symptoms include pelvic pain and abdominal distension, and diagnosis typically relies on imaging techniques such as ultrasound and CT, with definitive confirmation achieved through histopathological examination. Given their potential to mimic malignant ovarian cancer, accurate diagnosis is critical and necessitates a multidisciplinary approach.

The SARS-CoV-2 pandemic, which began in late 2019, initially manifested with acute respiratory symptoms, including bilateral pneumonia, and later emerged as a systemic disease. This brief report assesses changes in the clinical profiles of psychiatric outpatients before, during, and after the pandemic’s most severe periods, focusing on mood, anxiety, and cognitive symptoms. Data from a private psychiatric facility in Rome reveal that both pandemic-related stressors and SARS-CoV-2 infection itself may contribute to enduring affective and cognitive symptoms in both older and younger adult subgroups. Notably, during the pandemic, older patients showed elevated psychopathology scores (BPRS-24) compared to younger individuals. In the post-pandemic period, younger adults exhibited increased positive symptoms on the PANSS Positive subscale, suggesting a gradual worsening in symptoms post-pandemic ( = 0.47). Cognitive assessments (MMSE and PM38) further highlighted fluctuating performance over time, with older adults showing two distinct declines during the pandemic and in 2024. This work underscores the importance of sustained mental health interventions to address the pandemic’s psychosocial and neuroinflammatory legacy. This perspective also considers new data on the CNS effects of “toxin-like peptides” synthesized by microbiome bacteria.

Congenital Dyserythropoietic Anaemia (CDA) is a rare genetic disorder that affects the maturation of red blood cells. The disorder is classified into different types, with a prevalence ranging from 1 in 100,000 to 1 in 1,000,000 individuals. Treatment strategies are designed with the primary focus on symptom management, the prevention and treatment of complications, and the underlying disease pathophysiology. The advent of bone marrow transplantation, gene therapy, and targeted therapies has considerably expanded the scope for therapeutic intervention in CDAs. Supportive care, including blood transfusions and iron chelation therapy, has demonstrated efficacy in managing iron overload and improving overall survival rates. The potential of gene therapy, targeted therapies, and hematopoietic growth factors in the treatment of CDA is currently being investigated. Further research and clinical trials are required to develop more effective and personalized therapeutic interventions.