Articles

   A common hand motion known as the Hand of Benediction is connected to blessings and spiritual significance. In addi- tion to its symbolic significance, this hand position is regarded by medical professionals as a crucial indicator of median neuropathy. The image in the article explores the relationship between the Hand of Benediction and dysfunction of the median nerve, emphasising its clinical importance and implications for diagnosis.

   The etiopathogenesis of glomerulonephritis is not completely known and several different factors have been suggested as responsible of development of various types of glomerulonephritis (GN). Glomerulonephritis is a renal disease in which immune-mediated glomerular damage is the initiating factor. The hallmark of glomerulonephritis is increased permeability of the glomerular barrier. Proliferative glomerulonephritis is characterized by proliferation of the mesangial cells with influx of inflammatory cells. Membranous glomerulonephritis is characterized by accumulation of matrix and thickening of the glomerular basement membrane (GBM) and capillary wall.

   This report adhered to the ethical principles outlined in the Declaration of Helsinki as amended in 2013. Orbital varices are venous malformations of the orbit caused by vascular dysgenesis. It is a rare condition, accounting for 0-1.3% of all histopathologically proven orbital masses [1]. They are usually diagnosed between the ages of 10-30 years. Most cases occur unilaterally. They most commonly involve the superior ophthalmic vein. Symptoms include intermittent proptosis associated with Valsalva maneuver.

   Takotsubo cardiomyopathy, also commonly known as stressinduced cardiomyopathy or 'broken heart syndrome,' was first described by Japanese physicians in the 1990s and has since garnered global recognition [1]. It is characterized by transient regional systolic dysfunction, typically affecting the apex of the left ventricle, and often mimics the clinical presentation of acute coronary syndrome. However, a key distinguishing fea ture of this condition is the absence of obstructive coronary artery disease on angiography [2].

    Takotsubo cardiomyopathy (TCM), also known as acute stressinduced cardiomyopathy or broken heart syndrome, is a temporary heart condition characterized by transient dysfunction and ballooning of the left ventricle (LV) of the heart. The condition is often attributed to events that cause major physical or emotional stress. Surgery may also impose substantial physiological and psychological stress on patients [1]. Diagnosis of TCM is typically based on the Mayo Clinic criteria and the criteria established by Kawai et al [2].

   Pericardial cysts are the most common primary benign masses found in the mediastinum and are typically discovered incidentally during chest imaging [1]. The estimated incidence of pericardial cysts in the population is approximately 0.001%, accounting for 33% of all mediastinal cysts. Interestingly, 75% of patients with pericardial cysts do not experience any symptoms [2]. However, in the remaining cases, symptoms primarily arise due to the mass effect exerted by the cyst.

    The anaplastic large cell lymphoma (ALCL) is a set of malignancies inside of the non-Hodgkin lymphomas, mostly with histopathologic and immunohistochemical features like cells of T origin. One of their first descriptions was made in 1985 by Stein et al, who presented a series of cases consisting of lymphomas composed of large and pleomorphic cells capable to express Ki-1 (CD30), considering it an entity derived from activated lymphocytes, probably cytotoxic T cells [1].

   Intramedullary nailing has become the gold standard for stabilizing fractures in the lower extremity, promoting early mobilization and faster healing. However, a small subset of patients may experience complications, such as a bent intramedullary nail [1]. The removal of a bent intramedullary nail (IMN) is a rare but challenging issue in orthopedics. While various re- moval techniques have been described in the current literature, there is a lack of comprehensive reviews or established algorithms to guide surgeons in managing such cases effectively [2].

   Femoral neck fractures (FNF) or true cervical fractures are defined by their intracapsular location and their anatomical limits, namely the cervico-trochanteric crest and the cervicocephalic chondro -osseous junction. They most often occur during low-energy domestic trauma in elderly women with osteoporosis [1, 2]. In young adults, true cervical fractures occur after high-energy trauma and often in the context of polytrauma and multiple fractures [3]. The treatment of choice for most femoral neck fractures is operational to allow early mobilization of the patient, reduce the risk of complications and improve functional results [4].

   The larva in the third stage of development is inoculated into a vertebrate organism during the insect’s feeding through a sting, after which it crosses the dermis and enters to the lymphatic vessels. In humans the life cycle of the parasite lasts between five to 12 months and in the vector between 10 and 12 days. Over a period of 9 month the larva transform into an adult worm with dimensions between 20 and 100 milimeters. In general the parasite can survive for about 5 years [1].

   Zoological gardens play a vital role in the conservation of endangered species and provide an opportunity for the public to connect with wildlife (Fukano et al., 2020; Spooner et al., 2023). The well-being of animals in these settings is paramount, and veterinary care is central to achieving conservation goals (Tallo-Parra et al., 2023). The concept of zoos has always been a subject of controversy, with various concerns raised by researchers (Maynard, 2018). Some argue that animals can seem to be controlled and confined for human benefit, rather than their own welfare (Normando et al., 2018).

   Carotid body tumors, arising from the neural crest-derived paraganglia located at the carotid bifurcation, they’re rare representing less than 0,7% of head and neck neoplasms. Radiological techniques play a pivotal role in enhancing our understanding of the anatomical relationship between these tumors and adjacent structures, guiding treatment decisions, and improving patient outcomes. We present the case of a 60-year-old in whom CBT was diagnosed following hospitalization for a progressive cervical mass.

   Apple peel atresia is the rare form of atresia with an incidence of 0.7-0.8% in 10,000 live births accounting to 5-10 % of all intestinal atresias [1]. Premature newborns have a higher risk of developing atresia. It is formed up of a distal small bowel that spirals around its vascular supply strongly resembling an apple peel and a proximal jejunum that ends in a blind pouch. They hypothesized that jejunal and ileal atresia occur due to an intrauterine vascular assault due to placental vascular anomalies [1, 2]. We present a report of fetal MRI findings in JIA with corroborative postnatal radiologic and surgical examination.

   Due to their distinctive structures and excellent properties, metal complexes have been widely used in catalysis [1], biosensing [2], gas storage [3] and capture [4] and molecular recognition and separation [5], and they exhibit antifungal [6], antituberculous [7], analgesic [8] and anticancer [9] activities. Organic carboxylic acids are widely used as ligands in the design of metal-organic complexes because they can bridge multiple metal ions using various coordination modes, such as monodentate coordination and bidentate chelation [10].

   The root of the term euthanasia is Greek. It is derivative of two words “eu” and “thanatos” meaning “good death” or “easy death”. Another term used for this phenomenon is mercy killing. In other words to cause pain free death for a person who is otherwise suffering from a hopelessly incurable and agonizing disease is called euthanasia [1]. There are different sets of rights and wrongs associated with different forms of euthanasia.

   Any organ or system in the body might become affected by tuberculosis. Patients with disseminated TB may experience extrapulmonary involvement alone or in conjunction with a pulmonary focus [1]. One of the most severe forms of extrapulmonary tuberculosis is tuberculous meningitis (TBM), which accounts for 70-80% of instances of neuro tuberculosis. TBM is caused by Mycobacterium tuberculosis [2].

   Brucellosis, also known as “Mediterranean undulant fever”, remains the most common zonoosis worldwide [1]. It is caused by Gram-negative coccobacillus bacteria belonging to the genus Brucella which include 12 species [2]. Its myriad presentation and various symptoms explain the diagnostic delay and the evolution of the disease to the sub-acute cases of brucellosis with the occurrence of osteoarticular, cardiovascular and neurological complications [3].

   Classic lipomas are among the most prevalent soft tissue tumors and histologically resemble white fat. The back, specifically the inter-scapular region, is the location of hibernoma that is most frequently observed. The neck, axillae, thigh, and intra-thoracic region are other frequent locations. Hibernoma is a lesion that shouldn't be excluded from the differential diagnosis because it can't be distinguished from malignant tumors clinically or radiographically.

   Syphilis is a chronic infectious disease caused by Treponema pallidum (TP). It is mainly transmitted through sexual intercourse. Syphilis can also infect fetuses through mother-tofetus transmission. Syphilis can invade the genitals and skin in the early stage. It often invades the central nervous system or cardiovascular system in the late stage but rarely affects the lungs [1, 2]. The prevalence of the disease has increased all over the world in recent years [3]. In addition, HIV infection usually results in secondary syphilis due to immune deficiency, and clinical manifestations are usually nonspecific, which poses a challenge for clinical diagnosis [4]. Here, we report a case of pulmonary nodules in an HIV-positive patient diagnosed with secondary syphilis.

   Sino nasal polyposis (SNP) is a chronic rhinosinusitis with bilateral and multifocal polyps in the nasosinusal cavities especially in the ethmoid [1]. It represents a prevalence estimated to be around 4% in general population. However, its pathophysiology remains poorly elucidated. Indeed, the hypertrophic transformation of the nasosinusal mucosa leads to nasal obstruction, anosmia and sometimes rhinorrhea. In fact, nasal obstruction is one of the main diagnostic criteria for chronic rhinosinusitis according to the definition of EPOS (European Position Paper on Rhinosinusitis and Nasal Polyps) in 2012 [2]; though it has a significant physical and psychosocial impact on quality of life.

   In the last few decades, computed tomography (CT) scans have revolutionized the imaging and diagnosis of calvarium. Calvarial thickness in humans can be measured with a computerized tomography scan (CT scan). This could aid in determining racial and gender differences in calvarial thickness in a population. The information collected from the calvarial thickness study in the human population may be beneficial to researchers, anatomists, anthropologists, surgeons, and surgical screw manufacturers. Measurement of calvarial thickness is also important in various disease conditions including hemolytic anemia like thalassemia where there is expansion of diploic space and increased calvarial thickness.

   A 39-year-old woman with no notable pathological history presented to our department with a genital formation that had been progressively evolving for 1 year and becoming uncomfortable. The clinical examination found a painless nodule of cystic consistency measuring approximately 2 cm, covered with normal skin located in the labia minora (Figure 1). We performed an excisional biopsy under local anesthesia, revealing cystic formation with a regular, simplified cubo-cylindrical epithelium, resting on a fibrous layer. The lumen contained a polymorphous inflammatory infiltrate with cellular debris. The diagnosis of Bartholin’s cyst was made.

   The incidence of systemic air embolism (SAE) during percutaneous lung puncture is between 0.02% and 0.21%, and the occurrence is rare but potentially fatal [1-3]. During percutaneous lung puncture with positive pressure ventilation, air passes into the pulmonary vein if alveolar or bronchial pressure is higher than venous pressure, thus forming SAE. Coronary and cerebral embolism lead to cardiac and neurologic ischemia [3, 4]. Several diagnostic tools can detect intracardiac and cerebral embolism, such as TEE, Doppler and CT [5, 6].

   Nocardia spp. is clinically important bacterial pathogens that cause suppurative infections ranging from localized lung or cutaneous involvement to disseminated disease. The number of sdhpmacases of pulmonary nocardiosis reported in the literature is increasing, and in some cases, a diagnosis is reached even postmortem [1,2]. The majority of the human Nocardia infections has been attributed to Nocardia asteroids and Nocardia brasiliensis, with Nocardia otitidiscavarium, Nocardia nova, Nocardia farcinica and Nocardia elegans known as uncommon pathogens [3,4,5].

   As follows from the content of the State Health Development Program of the Republic of Kazakhstan "Densaulyk" for 2020- 2025, approved by Decree of the President of the Republic of Kazakhstan dated October 12, 2021 No. transfer of modern medical technologies [1]. During the period of implementation of the State Health Development Program of the Republic of Kazakhstan "Salamatty Kazakhstan" for 2011-2015, the following was noted: an increase in the population in the republic to 17,417.7 thousand people (as of 01.01.2015) with an annual population growth rate of 1, 4%; increase in life expectancy to 71.62 years.

   A 26-year-old patient, presented with a bilateral corneal clouding that had been slowly progressive over the last 2 years. He was a sports trainer having consumed protein for bodybuilding. Visual acuity was 6/10 in the Right Eye (RE) and 1/20 in the Left Eye (LE). Slit lamp examination showed deep yellow corneal deposits with stromal neovascularization (Figure 1). No other ocular abnormalities were found. The anterior segment optical coherence tomography revealed a hyper-reflective area in the deep stroma.

   Squamous cell carcinoma is the most common epithelial malignancy of the conjunctiva [1]. The tumor primarily affects middle-aged to elderly male patients [1]. Sun injury, viral infections, and immunocompromised states are known etiological factors. The limbal epithelial cells appear to be the progenitors of this disease [2]. It is generally a low-grade tumor. Invasive squamous cell carcinoma, however, is uncommon, and intraocular extension has rarely been reported [3].

   A 22-year-old female patient sought emergency medical services because she was complaining of asthenia, cough and haemoptysis for one month. She had a past medical history of a pulmonary tuberculosis four years ago while she was living abroad. The treatment was administered only for three months but isolates, antibiotic sensitivity and exact therapeutic regimen were not known. Upon clinical examination, patient exhibited sings of respiratory distress, lung sounds were abolished in the right hemithorax and diminished in the left hemithorax. Recurrent episodes of hemoptysis were evident. The chest-x-ray upon admission revealed a complete absence of lung parenchyma in the right hemithorax and in the upper half of the left hemithorax.

   A 82-year-old woman, never smoker, retired farmer with known medical history of hypertension, heart failure, chronic kidney disease, hyperuricemia, and dyslipidaemia was referred to a pulmonology consultation due to the identification of a nodule on a chest-x-ray and one-year history of fatigue. A chest CT scan confirmed a well-defined nodular lesion (22x20mm) in the external segmental of the middle lobe. A PET-CT scan showed increased metabolic activity (SUVMax of 3.5).

   Subdural hematomas are mostly located on the frontal, temporal and parietal surfaces over convexity [1]. However, there are also subdural hematoma types, which are called by various names according to the location like peritentorial, and pure tentorial vs vs [2,3]. However, the main classification of subdural hematomas is based on the bleeding time as acute, subacute and chronic [4,5-9]. Acute tentorial subdural hematomas are rare among these types. Although it generally has a benign course, sometimes it may be complicated [6,7].

   Inherited Retinal Dystrophy (IRD) is a diverse range of diseases characterized by the degeneration of retinal cells due to genetic factors. Among these, Retinitis Pigmentosa (RP) is the most prevalent and is a leading cause of visual impairment in most countries [1]. RP is a clinically and genetically heterogeneous group of retinal degenerations primarily affecting the peripheral photoreceptors. The estimated prevalence is approximately 1 in 3000 individuals [2]. It is characterized by a progressive loss of vision, initially presenting as night blindness, followed by the gradual decline of peripheral visual fields. It is often accompanied by central vision deterioration [3].

   An unrestrained growth of cells in the lungs characterizes lung cancer, a harmful tumor. Without proper treatment, this cancerous growth has the potential to progressively spread into nearby tissues or even affect other parts of the body [1]. Primary lung cancer can be categorized into two main types [2]: Non-Small Cell Lung Cancer (NSCLC), which accounts for approximately 85 percent of all diagnosed cases, and Small Cell Lung Cancer (SCLC) are the two main types of lung cancer. Among NSCLC subtypes, adenocarcinomas are the most commonly observed.

   Physical examination: afebrile, conscious and oriented. Left otoscopy: minimal whitish-yellowish discharge, crust with tympanic retraction is observed. Right otoscopy without alterations. The rest of the physical examination was unremarkable. Given the clinical findings and the patient's comorbidities, we started antibiotic treatment with amoxicillin-clavulanic acid and she was called to assess again in 48 hours, after which she presented with feverish spikes of up to 40ºC and abundant otorrhea. To conscious exploration, disoriented in time and space. Otoscopy disabled by pain.

   Streptococcus pyogenes is a rare pathogen of meningitis. However invasive infections as bacteraemia, pneumonia, skin and soft tissue, and toxic shock due to S pyogenes are common. Very few cases of Sinus vein thrombosis as a complication of S pyogenes have been reported [1]. Children suffer from associated complications much more than adults. This case report point out an uncommon presentation of meningitis due to S pyogenes [2].

   Biologic therapy has evolved in recent years as the mainstay of treatment in Inflammatory Bowel Disease (IBD). Despite the cause of this condition being yet unknown, it is considered a result of an inappropriate inflammatory response, in which Tissue Necrosis Factor (TNF) is a central mediator. Thus, antiTNF drugs like Infliximab (IFX) improved moderate-to-severe IBD [1]. Despite this success, they have limitations, including a high rate of primary and secondary failure. Approximately 30% of patients do not respond. There are several explanations for this loss of response; however, Anti-Drug Antibody (ADA) development is the most common cause of this loss [2].

   A 45- year- old male from an urban community, laborer, heavy alcohol consumer, exclusively on rice diet presented to outpatient department in primary health care centre with chronic diarrhea for three months. He was treated multiple times with antibiotics with no improvement. There was no family history of similar illness. He had normal vital signs and mental state. On general examination, he had typical sharply marginated symmetrical scaly hyperpigmented plaques in sun exposed areas of his forearms and hands and necklace pattern of erythematous scaly plaque around the neck popularly known as Casal’s necklace as described in figure 1.

   Insufficient stability and retention are the main complaints of the conventional complete dentures users. This prosthetic rehabilitation is associated with several problems, such as lack of stability, support and retention. However, when mandibular complete denture is supported by implants an improvement could be seen in the patients' psychological and social well-being. This treatment also requires different types of attachment systems that connect the complete denture to the implant [1].

   Patellofemoral pain syndrome (PFPS) is one of the most prevalent causes of anterior knee pain encountered by physicians. Its etiology remains without a clear consensus; however, it is probably multifactorial. One of the main factors seems to be muscular imbalance. Isokinetic assessment is regularly used in this regard to accurately measure muscle function at different modes and speeds and is therefore the investigation of choice in mechanical knee disorders such as PFPS.