Articles

   Chronic Venous Insufficiency (CVI) often presents with the tortuosity and dilation of small veins, posing challenges for naked-eye identification. Complete removal of all affected vessels in a single operation remains difficult, with a high risk of postoperative recurrence. In this paper, we report a case of NIR-II-assisted CVI surgery, which represents the first attempt to visualize CVI vascular lesions. Through the administration of Indocyanine Green (ICG) imaging agent into the dorsal foot veins, precise visualization of vascular crosslinking and trajectorie was achieved, facilitating the guidance of venous laser ablation and foam sclerotherapy procedure.

   We report the case of a 54-year-old male patient with type 2 diabetes on insulin, who presented with a rapidly progressive decrease in visual acuity in his right eye over the past 6 months. Visual acuity was measured as finger counting in the right eye and 3/10 in the left eye. Intraocular pressure was normal. Examination of the anterior segment was unremarkable. Fundus examination of the right eye revealed proliferative diabetic retinopathy with a dense, disorganized, and dehemoglobinized retrohyaloid hemorrhagic clot above the macula (Figure 1).

   A 56-year-old male with past medical history of CLL presented to his primary care physician with complaints of cough, fatigue, low-grade fever, and night sweats for four weeks. Blood work revealed new bicytopenia (anemia and thrombocytopenia) with elevated markers of hemolysis. He was also found to have weakly positive direct Coombs test so the cytopenias were initially presumed to be autoimmune related to CLL. He was started on prednisone but to no effect. This prompted evaluation of Peripheral Blood Smear (PBS) which showed intra-erythrocytic inclusions (Maltese cross) as shown in the figure above (Figure 1).

   The international lockdown as a result from the COVID-19 pandemic elevated the presence of seven explicit factors, which consequently brought negative effects on the female reproductive process of the menstrual cycle. Increased cortisol concentrations, shifted secretion rates of melatonin and resulting changes in circadian rhythm patterns, along with dietary and physical activity rate changes, decreased vitamin D, and the synchronization of cycles, points towards the connection with menstrual irregularities and various symptoms.

   Infective endocarditis by Nocardia is a rare disease carrying very high morbidity and mortality. We report a 50 y/o male patient who was diagnosed with isolated nocardiosis endocarditis. All relevant radiological, microbiological and pathological investigations were done. Aortic valve replacement was performed post CAG and patient was started on TMP SMX and amikacin. This report discusses the challenges faced in the diagnosis of Isolated endocarditis by Nocardia and the treatment regimens, both surgical and medical to improve patient outcome.

   Primary Angiitis of the Central Nervous System (PACNS) is a rare form of vasculitis of unknown cause and is less often in children than adults. The diagnosis of PACNS is often difficult. There are neither specific clinical features nor blood or imaging investigations that can confirm the diagnosis. Pathology reveals inflammation within the wall of Central Nervous System (CNS) blood vessels leading to occlusion and infarction [1]. No standardized treatment protocols exist, and evidence is limited to open-label cohort studies and case reports [2].

   Gallstone ileus is a rare complication of gallstone disease, with stone impaction occurring in the large bowel in up to 4% of cases, making gallstone sigmoid ileus an unusual presentation. This condition predominantly affects older patients with significant comorbidities, contributing to its higher morbidity and mortality rates. Given its rarity, the literature lacks recommendations to guide clinical management. Current evidence favors endoscopic treatment as the initial approach, with surgical intervention reserved for emergency situations and after the failure of conservative management.

   Placental abruption is a medical condition characterized by the premature separation of the placenta from the uterine wall before the baby is delivered. Placental abruption remains a prevalent condition in obstetrics, and it also continues to pose a mystery. Despite the progress made in obstetrics, there are currently no dependable tests or biomarkers available to anticipate and preemptively address the occurrence of placental abruption, which can still be a daunting challenge for the medical team.

   Diabetes mellitus, additionally notorious as simple diabetes, be a metabolic condition that primarily influences the endocrine gland, where level of blood glucose are elevated for a more period of moment. The indications of this disease are excessive urination, enhanced desire to drink water. This disease influences a lot of 451 million people globally and in addition one of the foremost reasons of demise. In spite of the utilize of highly developed allopathic prescriptions designed for care, the utilize of medication obtained from natural sources is achieving greater significance.

   Usage of traditional herbal treatments is quite popular in Pakistani society. People typically rely on herbal therapies for their diseases because they are more common in villages and the Cholistan desert, where there are less medical facilities. The majorities of herbal medicines are highly efficient and have little adverse effects. According to the existing research, medicinal herbs used to treat skin infections have a fantastic ability to heal eczematous skin and lesions related to atopic dermatitis.

   The patient is a 56-year-old female. She was admitted to hos- pital on September 6, 2018 due to “left retroperitoneal mass found by CT for half a year”; Physical examination showed: T36.7oC, P80 times/min, R20 times/min, BP101/65 mmHg, no eminence in the bilateral renal area, slight percussion pain in the bilateral renal area, no tenderness in the bilateral ureteral travel area, no obvious filling or tenderness in the bladder area. Auxiliary examination: Contrast-enhanced CT scan in the middle and upper abdomen showed two types of circular nodules with near soft tissue density (arrow in Figure 1) in front of the left kidney, about 31.4 x 27.4 mm in size, with smooth contour.

   In the dynamic realm of modern healthcare, research and innovation are imperative for addressing complex chal- lenges [1]. Securing research grants plays a pivotal role in advancing healthcare initiatives [2]. Successful grant pro- posal writing necessitates a profound understanding of the subject matter, adept research methodology, and effective communication of research significance [3].

   Nanoparticles are very ultrafine particles, with potential applications in biomedical sciences. The use of nanopar- ticles in ophthalmology is new approach nowadays. The vital nanoparticles possibilities for the ophthalmology are AuNPs and AgNPs. In this review, issues will be deliberated about the application of nanoparticles which includes laser- heated nanoparticles for ophthalmology, and ophthalmic drug delivery. One approach is using gold nanoparticles, as they have several properties and applications in diagnosis and therapy tools.

   Laryngeal myxedema is a rare complication of severe hy- pothyroidism. It may be responsible for upper airway ob- struction and has to be taken into account as an emergency situation. A 65 years old male presented with difficulty in breathing, hoarseness, facial and cervical edema at a Ter- tiary Center. Clinical suspission led to appropriate blood ex- aminations and the diagnosis of laryngeal myxedema was made. The patient was treated with intravenous levothy- roxine and hydrocortisone. Symptoms were alleviated com- pletely and endotracheal intubation or tracheostomy were not necessary. This case indicates that early suspicion, and diagnosis of laryngeal myxedema, a lethal condition, may be challenging, and with prompt medical treatment, intubation may be prevented.

   Vitamin D, a fat-soluble vitamin, is synthesized in the skin through exposure to ultraviolet B-light radiation [1]. Factors such as limited sun exposure and dietary deficiencies contrib- ute to low vitamin D status among many individuals, across all age groups and geographic locations [2,3], and due to its as- sociation with many diseases, supplementing with vitamin D to restore body reserves is highly important [4]. Yet, concurrently, we are observing an increase in reports of toxicity associated with this vitamin as well [5].

   The cytoskeleton is a complex network of protein fibres found in the cytoplasm of cells, made up of structures such as microtubules, microfilaments (actin) and intermediate fila- ments. The cytoskeleton responds to external and internal stim- uli with rapid orchestrated reorganisation and is involved in pro- cesses such as endocytosis, cell division, intracellular transport, motility and immune function [1]. Patients with actin-related Primary Immunodeficiencies (PIDs) may have defects in hae- matopoiesis and immune cell development, with alterations in recruitment, migration, intercellular and intracellular signalling and the activation of innate and adaptive immune response [2].

   Ocular trauma is a frequent reason for consultation. A distinction is made between perforating and contusive trauma. They constitute an ophthalmological emergency requiring rapid management to preserve the visual prognosis. We report the case of a patient who had some sequelae of ocular trauma.

   Cold Agglutinin Disease (CAD) represents a rare hemolytic disorder, constituting 15-30% of cases within the spectrum of Autoimmune Hemolytic Anemias (AIHAs) [1,2]. The pathogen- esis of CAD revolves around autoantibodies known as Cold Ag- glutinins (CAs), named for their capacity to induce erythrocyte agglutination at temperatures below 37°C. Those autoantibod- ies typically consist of monoclonal Immunoglobulin (Ig) M type, less commonly IgA or IgG, and they target the carbohydrate antigens on the erythrocyte surface, predominantly antigen I [3-5].

   Recurrent Spontaneous Abortion (RSA) is a serious reproduc- tive disorder of pregnancy that presents an unresolved issue in the fields of gynecology and obstetrics. RSA is usually defined as a woman suffering from ≥3 spontaneous abortions with the same sexual partner. The incidence rate of RSA ranges from 1 to 5% in women of childbearing age [1]. Recent research has determined that the etiology of RSA is extremely varied, chiefly advanced high maternal age, inheritable genetic abnormali- ties, anatomical factors, infections, and endocrine dysfunctions. However, in most patients, the cause is unclear.

   Thyroid nodules are a common clinical challenge, with approximately 5-7% of the adult population exhibiting palpable nodules. While the majority of these nodules are be- nign, a subset presents as indeterminate on Fine-Needle Aspiration Cytology (FNAC), posing a diagnostic dilemma. Molecular diagnostic tests have emerged as promising tools to aid in the management of patients with indeterminate thyroid nodules. This article provides a comprehensive overview of the advancements in molecular diagnostic tests for indeterminate thyroid nodule cytologies, focusing on their mechanisms, performance, clinical implications, and challenges.

   We would like to present this case to inform practicing clinician the importance of laboratory results in helping us to differentiate between infection and flare up in SLE pa- tients. The initial presentation of fever might be difficult to clearly distinguish between these two but with the help of laboratory results clinician can confidently make a diagno- sis. CRP and ESR are two common tests done for patients presenting with febrile illness. Generally, CRP is elevated in infection while ESR is elevated in inflammatory reactions like SLE flare up.

   Hydatid cyst is a parasitic infection most commonly local- ized in the liver. They may not be diagnosed early because they remain asymptomatic at small sizes and may reach large sizes at the time of diagnosis. In this situation, compression symptoms may occur and they may present with serious complications such as rupture and anaphylactic shock, which are rare. Treatment methods are determined by classification according to the imaging techniques used in the diagnosis.

   Preventing Colorectal Cancer (CRC) is of great importance, as it is the third most common malignant tumor globally, accounting for approximately 10% of all new cancer cases annually [1,2]. The progression pattern from adenoma to carcinoma is widely accepted to play a crucial role in the development of colorectal cancer [3]. Removal of colonic tumors is effective in reducing the incidence and overall burden of CRC [4,5]. While colonoscopic tumor resection is a safe and effective procedure [6,7], it can still lead to serious complications, including bleeding, perforation, and electrocoagulation syndrome.

   The “collodion baby” phenotype is a rare clinical entity in a heterogeneous group of cornification skin disorders, first described by Hallopeau and Watelet in 1844, with an estimated incidence of 1 in 50,000 to 100,000 live births. The collodion phenotype is common to several different forms of autosomal recessive congenital ichthyosis, characterised by xerosis of the skin, either in isolation or in association with other extra-cutaneous signs, particularly ophthalmological, which may affect the functional prognosis as a result of blinding corneal sequelae.

   A 55-year-old woman with hereditary spastic paraparesis and a neurogenic bladder managed with an indwelling urethral catheter developed two large bladder stones (3 cm and 4 cm stones), a vesicovaginal fistula, and history of kidney stones requiring percutaneous nephrolithotomy. As definitive therapy for her neurogenic bladder, a supravesical urinary diversion with ureteroileal urinary conduit diversion and open cystolithotomy was planned. The vesicovaginal fistula was to be unrepaired and the defunctionalized bladder would be left in situ without performing a cystectomy.

   We report the case of a 58-year-old patient with no particular pathological history who presented with a unilateral, peripheral, hollowing and circumferential corneal ulcer without healthy cornea interval with intense conjunctival hyperemia. The ulcer was treated with antibiotics and healed but without improvement. An etiological assessment did not reveal any other etiology. The introduction of topical corticosteroid therapy brought improvement but with an increase in symptoms when treatment was stopped.

   This is a 6-year-old child who consulted in the ophthalmological emergency room 2 days after his accidental trauma at the end of the woods. Initial clinical examination of the left eye revealed visual acuity at NO light perception, eyelid edema with blood clot. The rest of the exam was difficult to assess due to the pain. The child was taken to the emergency operating room for exploration and treatment after having carried out a CT scan which revealed an intraocular foreign body measuring 8 x 6 mm. Intraocular wooden foreign body visible at the edges of the wound.

   Eosinophilic Gastroenteritis (EGE) is a rare inflammatory dis- ease that leads to stomach and/or small intestine eosinophil infiltration and inflammatory symptoms [1]. While the cause remains unknown, many factors can trigger EGE. Klein classifi- cation divides EGE into three subtypes: mucosal, muscular and serosal and the symptoms depend on the inflamed part of the gastrointestinal tract wall [2,3]. Typical symptoms include ab- dominal pain, diarrhea, vomiting, nausea, intestinal obstruction and ascites. Exclusion of other causes of tissue eosinophilia and endoscopy with the biopsy is required to confirm the diagnosis.

   ST-Segment Elevation Myocardial Infarction (STEMI) is an Acute Coronary Syndrome (ACS) that warrants immediate at- tention either by medical or surgical/interventional therapy. The clinical presentation can be elemental to diagnosing a STE- MI however, the revelation on an EKG can prove ischemia caus- ing tissue necrosis and/or myocardial injury. This may very well lead to an eventful cardiac dysfunction then consequentially proceed to arrhythmia and death. Hence, when a high index of suspicion of ACS is on a clinical presentation, it is classified as a medical emergency till proven otherwise.

   In daily practice, pathologists frequently encounter slides that have been inadequately fixed or mishandled during the tis- sue processing stage, resulting in significant alterations in tis- sue details. The processing of specimens for histopathological examination is prone to both material and human errors, which can give rise to artifacts. These artifacts can cause distortions in normal morphologic and cytologic features, and in severe cases, render the tissue completely unusable [1,2].

   The liver is the largest exocrine gland and fulfils vari- ous vital functions. Xenobiotic metabolism (including various drugs and pharmacological substances) and detoxica- tion are among the most prominent. During this process, the liver can be damaged. This phenomenon is known as Drug-Induced Liver Injury (DILI) or Herbal-Induced Liver In- jury (HILI). If a herbal product is the cause. Our case report summarizs a 62-year-old patient suffering from HILI after kratom ingestion.

   Medical treatment requires that the patient be present be- fore the physician in order for the physician to examine the current state of the patient, including the physical and mental con- ditions of the patient. The physician will conduct an anamnesis on the patient to obtain any information and find out about the diseases suffered by the patient. By doing so the physician can examine and diagnose the patient diseases and further provide the patient with the right medication or treatment. That correct information can only be done when the patient meets face-to- face with the physician.

   We present here the case of a 34-year-old woman, recently diagnosed with infiltrating ductal breast carcinoma, who presented to our department for management. A thoracic-abdom- inal-pelvic CT scan performed as part of the extension work-up revealed incidentally an enlargement of the left lobe of the liver surrounding the spleen (Figure 1), giving the appearance of a beavertail liver.

   Peritonitis with Non-Typhoid Salmonella (NTS in end- stage kidney disease patients treated with Peritoneal Di- alysis (PD) is extremely rare and has been associated with poor outcomes including death and refractory, recurrent or relapsing infection typically necessitating removal of the peritoneal dialysis catheter. We report the twelfth case of NTS-associated PD peritonitis in a 61-year-old male that was successfully managed by combining the use of Tissue Plas- minogen Activator (TPA) to disrupt the catheter biofilm and a prolonged course of intraperitoneal antibiotics.

   Clomiphene citrate is a selective estrogen receptor modu- lator that is widely used in the treatment of infertility in both male and female populations [1]. While its use in the female population has been widely studied and is used in the manage- ment of a wide array of medical conditions, especially those as- sociated with ovulation, its use in the male population remains controversial. It has been used as an off-label medication in the management of male infertility and hypogonadism since the 1970s but its efficacy has not been well established [2].

   Although oral steroid therapy is commonly used to treat pemphigoid, complications associated with steroids often cause several problems in patient with advanced cancer. Al- though the effectiveness of tetracycline antibiotics against pemphigoid has been recently demonstrated, there is still room for debate. We encountered a case in which minocy- cline was effective for bullous pemphigoid in a patient with advanced lung cancer who had developed oral candidiasis during steroid treatment and was unable to continue ste- roid therapy.

   Dementia are a class of disease based on several etio- logical factors, clinical pattern, the most common is the Al- zheimer’s disease, followes by the vascular form or mixed (vascular-degenerative), by dementia at Lewy body and by frontotemporal dementia. In Italy the number of people with dementia extimated is about one million of which about the 60%-70% is affected by Alzheimer’s desease.

   This clinical case presents a 60-year-old woman with stage IIIA invasive ductal breast carcinoma with hormone receptors and Her2 positive. We initiated neoadjuvant therapy with per- tuzumab, trastuzumab and docetaxel. After two cycles of che- motherapy, the patient suddenly developed fever, dry cough, and dyspnea on minor exertion. The patient required non-in- vasive oxygen. The chest scan revealed bilateral opacities with patchy ground-glass areas (Figures 1 & 2). We started empiric broad-spectrum antibiotics to cover the probable infectious etiology and prednisone 1 mg/kg/day orally because we sus- pected acute pneumonitis caused by docetaxel.

   A 61 years old male patient with reactive amyloidosis was admitted for worsening renal function, signs and symptoms of heart failure and diuresis contraction. Compared to year ago, echocardiogram showed worsening valvular pathology: aortic and mitral insufficiency become severe while aortic and mitral stenosis moderate. There was also a restrictive diastolic pattern with elevated filling pressure but medial mitral annulus tissue-Doppler demonstrated elevated early diastolic velocities (e’). Severe pulmonary hypertension and right ventricular dysfunction were also present.

   Arachnoiditis ossificans is a rare medical condition that in- volves inflammation of the leptomeninges, a thin membrane that covers the brain and spinal cord. This inflammation leads to the formation of calcifications in the dural sac, which is the protective covering that surrounds the spinal cord. The calci- fications can cause compression of the spinal cord and nerve roots, leading to a range of symptoms including chronic pain, numbness, weakness, and bowel and bladder dysfunction. The condition can be difficult to diagnose and treat, and may re- quire a combination of medical and surgical interventions to manage symptoms and improve quality of life.

   Ameloblastoma is a neoplastic process of the jaw that originates from the odontogenic epithelium. Its early diagno- sis is of particular interest because of the need for resection with a wide margin of safety, which reduces the likelihood of local recurrence. The neoplasia is difficult to differentiate from other common lesions in pediatric patients, such as osteomyelitis, dental cysts, and fibrous lesions. We report a 14-year-old female patient of Asian descent presented with a palpable painful mass in the left jaw region.