Archives of Clinical and Medical Case Reports
Archives of Clinical and Medical Case Reports is an open access, peer reviewed Journal with rapid publication process. The aim of the journal is to provide an excellent platform for scientists and medical specialties to update a database of new case reports in the field of Clinical and Medical to provide best practice.
Editorial for the Proceedings of the 5th Pediatric Andrology Meeting on Cryptorchidism.
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Copyright (c) 2026 Archives of Clinical and Medical Case Reports
Combined Intravenous Selenium, Zinc, and Magnesium Therapy for Refractory Chemotherapy- Induced Peripheral Neuropathy: A Case Report
Chemotherapy-induced peripheral neuropathy (CIPN) is a doselimiting toxicity with limited treatment options. We report a 68-year-old female with Anaplastic Lymphoma Kinase (ALK)-mutant non-small cell lung cancer who developed severe, refractory CIPN (numeric rating scale [NRS] 9/10) and sensory ataxia following paclitaxel and carboplatin therapy. Conventional medications, including duloxetine, were ineffective and poorly tolerated. Nutrient analysis revealed low-normal selenium and magnesium alongside zinc deficiency. An intravenous nutrient cocktail of sodium selenite, zinc sulfate, and magnesium sulfate was initiated. Over five months, the patient achieved complete pain relief (NRS 0/10) and nearcomplete restoration of hand function and proprioception. Mechanistically, selenium stabilizes mitochondria and reduces oxidative stress; zinc inhibits transient receptor potential vanilloid 1 (TRPV1)-mediated nociception; and magnesium acts as an N-methyl-D-aspartate (NMDA) receptor antagonist. This case suggests that intravenous nutrient cocktail therapy is a safe and effective adjunct for managing severe, refractory CIPN, warranting further clinical validation.
Extensive and Potential Life-Threatening Bilateral Neck Swelling Post-Tonsillectomy: A Case Report
Objective: This paper reports an unusual case of post-tonsillectomy emphysema and pneumomediastinum. Methods: This is a clinical case report with a review of literature. Results: Tonsillectomy is one of the most common otolaryngological procedures. It is a safe procedure, however, there are some complications typically associated with tonsillectomy. A 28-year-old female presented with a less than one-day history of extensive right-sided tender neck swelling. The patient underwent bilateral tonsillectomy, which was uneventful, but subsequently developed a sudden onset of right-sided neck swelling on the zero-post-operative day. Extensive crepitus was felt on palpation. Examination findings were confirmed by imaging. The patient was conservatively managed and subsequently discharged home. Conclusion: Post-tonsillectomy surgical emphysema and pneumomedia stinum are rare complications. Pneumomediastinum and bilateral neck involvement made our case rather unique. Surgical technique plays an important role, especially in the adhesions of tissues. Patients should be managed conservatively under close observation. Avoidance of coughing and straining will help to prevent the worsening.
Erratum: A Comprehensive Analysis of Dermatological Manifestations in Lower Limb Para-Athletes
Evidence- Based Interventions for Functional Restoration and Pain Management following Traumatic Brain Injury
Traumatic brain injury is a major cause of death and long-term disability worldwide and can lead to persistent functional impairment and chronic pain that significantly impact quality of life. Patients with traumatic brain injury commonly experience motor deficits, impaired balance and coordination, cognitive dysfunction, and behavioral changes. Chronic pain, particularly post-traumatic headaches and musculoskeletal pain, is also frequently reported and can limit participation in rehabilitation and daily activities. This narrative literature review summarizes current evidence on the epidemiology, pathophysiology, and clinical course of traumatic brain injury, with a focus on functional restoration and pain management. Existing research supports the use of multidisciplinary rehabilitation approaches that incorporate physical therapy, occupational therapy, cognitive rehabilitation, and structured exercise to improve recovery and independence. In addition, both pharmacologic and non-pharmacologic pain management strategies play an important role in addressing chronic symptoms and supporting rehabilitation efforts. Overall, early recognition of functional deficits and integrated rehabilitation strategies are essential for improving long-term outcomes and quality of life in patients with traumatic brain injury.
Autologous Platelet-Rich Plasma Concentrate as an Adjunct to Autologous Retinal Transplant for Large Post-Traumatic Macular Holes Results in Favorable Anatomical and Visual Outcomes: A Case Report
Purpose: Report spontaneous closure of residual eccentric defect following autologous retinal transplant (ART) and adjunct autologous platelet-rich plasma concentrate (PRPC) for a large post-traumatic macular hole (MH), with an unusual improvement in vision after silicone oil removal (SOR). Case description: A 14-year-old male of African descent suffered OD blunt trauma from a projectile, resulting in a large (1200 microns) fullthickness MH. He underwent vitrectomy and ART. At the end of surgery, after fluid-air exchange, three drops of PRPC were added to the ART before silicone oil injection. He had silicone oil removed four weeks postoperation with an air-filled vitreous cavity. Outcome: A notable host–donor eccentric edge defect was observed on OCT day one after ART surgery. The defect was expected to widen with postoperative graft retraction. However, the defect closed spontaneously, seen on OCT one week after surgery. Additionally, two months after SOR, vision improved significantly from 6/36 (20/120) to 6/12 (20/40), N10 unaided. He remains phakic, and no side effects from PRPC were observed. OCT Angiography showed vascularization of the donor graft. Conclusion: This report on ART with adjunctive PRPC shows a positive outcome. We believe PRPC significantly contributed to the uncommon closure of the eccentric defect and the good visual results. Further research on PRPC is needed to explore its potential cellular rejuvenation and fibrin effects in ART, which might result in it becoming standard practice. Larger prospective studies that combine ART and PRPC could provide stronger evidence to validate this method.
Stellate Ganglion Block in Anxiety Disorder with Coexistent Resistant Hypertension: A Report
Autonomic nervous system dysfunction is reported in the neurobiology of both anxiety disorder and resistant hypertension. Stellate ganglion block can dampen sympathetic activity and has been effective in the management of treatment-resistant anxiety disorder. Patients with anxiety disorder and coexistent resistant hypertension were reviewed by an interdisciplinary team comprising clinical psychologists, general medicine physicians, and pain medicine and palliative care physicians. Patients were offered stellate ganglion blocks in the management of treatmentresistant anxiety disorder. A validated outcome measure was completed at baseline and post-intervention. Eight patients with anxiety disorder with coexistent resistant hypertension, who underwent stellate ganglion blocks are presented. The intervention resulted in an improvement in anxiety symptoms with enhanced blood pressure control at the 24-week review in seven patients (7/8, 88%). There was a mean reduction of 21 mm Hg in systolic blood pressure and 11 mm Hg in diastolic blood pressure at the 24-week review. All patients were able to reduce antihypertensive medications. Stellate ganglion block could have a role in the management of resistant hypertension with comorbid anxiety.
Post-Pandemic Evaluation of Emergency Medicine Workforce Stability
Physician workforce projections in emergency medicine were developed in the year 2020 based on the assumptions and baseline data during the unprecedented disruption in healthcare delivery due to COVID-19 pandemic. However, the fundamental assumptions in this project might not be realistic in the post COVID-19 era. In this article, the accuracy of 2020 emergency medicine workforce oversupply projection was critically evaluated and comprehensively reassessed considering post COVID-19 data. The findings support the underestimation of the demand and exaggeration of projected physician surplus. The post-pandemic trends suggest a more fragile emergency medicine workforce marked by sustained attrition and vulnerability to stressors. A stable or modest increase in the demand for emergency physicians between the years 2030 and 2040 is projected. The findings suggest that clinical workload per physician is likely to increase due to the emergency care of aging population, delayed presentations of acute and chronic diseases, and increased boarding and throughput challenges. Accordingly future workforce projections must incorporate updated attrition estimates and account for structural shifts in emergency care delivery. This would require maintaining or expanding demand for emergency physicians in next decade and beyond.
Shifting Career Landscapes: Analyzing the Fall in Physician-Owned Practices
Over the past several decades, the structure of physician employment in the United States has shifted markedly, with a growing proportion of physicians choosing employed positions over private practice. This transition reflects broader economic, regulatory, and organizational changes within the healthcare system. This literature review examines the decline in physicians entering private practice and analyzes the economic, administrative, professional, and market-driven factors contributing to this trend, as well as its implications for physician autonomy, patient care, and healthcare costs. A comprehensive review of national workforce data, longitudinal studies, and peer-reviewed literature published between 1983 and 2024 was conducted. Trends in physician employment were evaluated across specialties, geographic regions, and demographic groups, with particular attention to policy changes, healthcare consolidation, and evolving practice models. The proportion of self-employed physicians declined from 35.2% in the early 2000s to under 25% by the mid-2010s, with continued declines in subsequent years. Contributing factors include rising overhead costs, declining reimbursement, increasing regulatory and administrative burdens, and narrowing income differentials between employed and self-employed physicians. Younger physicians and women demonstrate a stronger preference for employment, often citing worklife balance, financial stability, and organizational support. Healthcare consolidation, hospital employment, and private equity acquisition further limit opportunities for independent practice. The ongoing decline of private practice has significant implications for physician autonomy, continuity of care, healthcare spending, and patient-physician relationships. While employed models offer stability and infrastructure, they may compromise professional independence and increase system-level costs without improving care quality. Alternative models such as direct primary care and concierge medicine may offer partial solutions but raise concerns regarding equity and access. Structural reforms in reimbursement, regulation, and practice support are necessary to preserve a diverse and sustainable physician workforce.
A Patient with Recurrent Pyelonephritis and Renal Stones Associated with a Bochdaleks Hernia Involving the Proximal Ureter Treated by a Robot Assisted Approach and Retrograde Intrarenal Surgery: A Case Report
Background: Bochdalek hernia is a congenital posterolateral diaphragmatic defect that facilitates displacement of intra-abdominal organs into the thoracic cavity. It constitutes the most prevalent subtype of congenital diaphragmatic hernia with presentation in adulthood being uncommon and often incidental. Right-sided Bochdalek hernias occurs less frequently than left-sided lesions, and involvement of the ureter within the hernia sac is exceedingly rare. Case Presentation: We present a 68-year-old female patient with a history of recurrent urinary tract infections and right renal stones secondary to impaired drainage of her right kidney resulting from an abnormal course of her right proximal ureter into a Bochdalek’s hernia. Management of this case required appropriate imaging to confirm the diagnosis, and the application of minimally invasive endourology techniques for a successful outcome. Conclusion: This case highlights the importance of recognising unusual anatomical variations that can promote urinary stasis and to provide insight into minimally invasive surgical approaches to management.
The Effects of Pythagorean Self-Awareness Intervention on Patients with Panic Disorder: A Randomized Controlled Trial
Introduction: Panic Disorder constitutes one of the most common anxiety disorders, and is characterized by recurrent, unexpected panic attacks accompanied by multiple psychophysiological symptoms. Previous studies examining the effects of cognitive-behavioral interventions and other stress management techniques have yielded mixed findings. Materials and Methods: This randomized controlled study aimed to evaluate the effects of the Pythagorean Self-Awareness Intervention (PSAI), a novel, non-pharmaceutical, stress management technique, on symptom severity, quality of life, emotional and cognitive characteristics, lifestyle factors, and stress-related biological markers in patients with panic disorder. Standardized questionnaires were administered at baseline and 8 weeks after the intervention to assess quality of life, perceived stress, depression, health locus of control, and anxiety. Sleep quality, lifestyle parameters, and hair cortisol concentrations were also evaluated. Results: A total of 60 patients were randomly assigned to either the intervention group (n=30), which participated in the 8-week PSAI program, or the control group (n=30). Participants in the PSAI group demonstrated significant improvements across most outcomes. Large effect sizes (> 0.5) were observed for internal locus of control, perceived stress, and cortisol levels. Improvements were also found in secondary outcomes.
Refractory Polyradiculoneuritis Responsive to Cyclophosphamide: A Case Report of a Patient with a History of Diffuse Large B Cell Lymphoma and CAR-T Cell Therapy
Background: Polyradiculoneuritis is a rare but serious neurological condition with diverse etiologies, including autoimmune, paraneoplastic, and therapy-induced mechanisms. In oncologic patients, particularly those with hematologic malignancies and prior immune-directed therapies, diagnosis and treatment can be especially challenging. Case presentation: We report on a 69-year-old woman with acute onset and rapid progression of a polyradiculoneuritis with a history of B-cell lymphoma and chimeric antigen receptor (CAR)-T cell therapy. While response to standard glucocorticoid, intravenous immunoglobulin, or plasma exchange was insufficient, the patient was successfully treated with cyclophosphamide (CYC). Conclusions: This case highlights the importance of considering autoimmune polyradiculoneuritis in immunotherapy-exposed patients with rapidly progressive neuropathy. When first-line treatments fail, and histopathology shows T-cell predominance, CYC may be an effective therapeutic option.
Past, Present and Future of TKA: An Expert Opinion or Point of View
Total knee arthroplasty (TKA) has come a long way from the first resection arthroplasty performed by Ferguson in 1861 to the cutting-edge technology utilized today. From removing bone to improvement function, to interposition arthroplasty in 1863, and introducing an ivory hinged prosthesis fixed with Plaster of Paris in 1891, it has indeed been a checkered journey. The mid-20th century saw the introduction of the metallic mold hemiarthroplasties fitted to femoral condyles and hinged prosthesis made initially of acrylic and then cobalt chromium, which were used till the late 1960s. Their high failure rate was on account of large bony resections and lack of sound kinematics.
A Comprehensive Analysis of Dermatological Manifestations in Lower Limb Para-Athletes
In this article, a critical evaluation of current evidence is presented on the prevalence, mechanisms, prevention, and management of sportrelated skin complications in amputee athletes using lower limb prostheses, highlighting emerging technologies aimed at improving skin health and athletic performance. Skin complications were highly prevalent, affecting 34%-77% of lower limb prosthesis users, with even greater frequency among athletes. The most common conditions included maceration, friction blisters, pressure ulcers, contact dermatitis, verrucous and epidermal hyperplasia, and bacterial or fungal infections. Key risk factors encompassed poor prosthetic fit, elevated activity levels, increased perspiration, prolonged wear, inadequate hygiene, and hot or humid environments. Mechanical loading and shear stress at the socket–skin interface, compounded by moisture and heat retention, were central pathophysiologic drivers. Prevention and management strategies emphasize meticulous prosthetic fitting, consistent hygiene practices, routine skin inspection, and prompt intervention for early lesions. Multidisciplinary collaboration among dermatologists, prosthetists, and rehabilitation specialists improves detection and management outcomes. Recent innovations including vented liners, temperature-regulating materials, antimicrobial coatings, and sensor-based “smart prosthetics” show promise in reducing friction, heat, and infection risk, though evidence in athletic populations remains limited. Cutaneous complications in amputee athletes are common, multifactorial, and preventable. Optimal prosthetic fit, athlete education, and coordinated interdisciplinary care are essential for minimizing morbidity and maintaining athletic participation. Technological advancements such as real-time pressure and temperature monitoring, antimicrobial materials, and adaptive socket systems may transform prevention strategies, but further sport-specific, longitudinal research is required to validate their clinical impact and guide evidencebased practice.
Pyoderma gangrenosum is an uncommon neutrophilic skin disorder that varies in presentation. The presence of ulceration is common and diagnosis is often based on exclusion of other entities. A wide variety of treatment options exist; however, cure is often still difficult. The presence of underlying systemic disease must be considered. Herein, we report an atypical case of pyoderma gangrenosum and review current therapeutic modalities.
Transfusion-dependence Anemia in a Middle-Age Woman under longlasting therapy with Eslicarbazepine and Quetiapine: A Case Report and Drug-related Erythroid Toxicity review
Antiepileptic and antipsychotic drugs are related with the development of different hematological toxicities both in short and long-term therapies. We present a case report of a patient with secondary structural focal epilepsy and behavioral disorder under prolonged therapy with eslicarbazepine and quetiapine who developed a 3-year long-lasting severe and recurrent hyporegenerative transfusion-dependent anemia. Recombinant-human erythropoietin and corticosteroids were successfully used in each relapse of severe anemia. Eslicarbazepine was first gradually replaced by lacosamide with hematological improvement and after a new relapse quetiapine was also replaced by paliperidone. After complete discontinuation of both eslicarbazepine and quetiapine a 1-year lasting therapy-free sustained hematologic recovery has been achieved without further relapses. This is the first case in the literature to directly associate eslicarbazepine, as previously carbamazepine, with erythroid toxicity and also points to quetiapine for central hematological toxicity. Our clinical observation underscores the importance of considering drugs as a possible cause of anemia in patients under prolonged antiepileptic and antipsychotic therapies especially in combination regimens.
A Case Series of Lung Transplant Recipients Who Developed Life Threatening Diarrhea from Cryptosporidium Contaminated Water Supply
Background: Cryptosporidium is a protozoan known to cause acute gastroenteritis. Solid organ transplant recipients are at increased risk of infection but reports of infection in lung transplant recipients are limited. In September 2023, the Baltimore City Department discovered low levels of Cryptosporidium within the Druid Lake Reservoir. We present three cases of cryptosporidiosis in lung transplant recipients at our institution and report their disease course, response to treatment, and potential affiliation with the reservoir contamination. Methods/Results: Chart reviews were conducted on the three cases of cryptosporidiosis in lung transplant recipients at our institution between 2023 to 2024. Case 1: 47-year-old female from near Baltimore with a bilateral lung transplant (BLTx) for bronchiectasis presented with severe sepsis from Cryptosporidium diarrhea and C. dificile colitis. She was started on nitazoxanide and oral vancomycin and discharged on hospital day 7. Case 2: 60-year-old male from Baltimore with a redo BLTx presented with septic shock due to Cryptosporidium diarrhea and was upgraded to the ICU. He started on norepinephrine drip, steroids, broad-spectrum antibiotics, and nitazoxanide. He was discharged home on hospital day 19. Case 3: 35-year-old male with a BLTx for cystic fibrosis presented with severe sepsis, renal failure and electrolyte derangement due to Cryptosporidium diarrhea and was upgraded to the ICU. He was started on nitazoxanide and discharged on hospital day 4. Conclusion: To our knowledge, this represents the largest case series of Cryptosporidium in lung transplant recipients. It is important to include cryptosporidiosis on the differential for these patients.
Successful Early Rescue with Isatuximab Plus Carfilzomib-Dexamethasone (ISA-KD) in Daratumumab-Refractory Newly Diagnosed Multiple Myeloma (NDMM) Patients with “No Washout Period”: A Real-World Clinical Experience in A Case Series and Literature Review
Introduction: Anti-CD38 monoclonal antibodies, such as daratumumab and isatuximab, are key agents in multiple myeloma treatment. However, sequential use without a washout period remains controversial due to resistance concerns. Methods: We conducted a retrospective, real-world study of five newly diagnosed multiple myeloma (NDMM) patient’s refractory to daratumumab-based induction. Between June 2022 and December 2024, patients from two Spanish centers received isatuximab-carfilzomibdexamethasone (ISA-KD) immediately after daratumumab failure. Results: All patients achieved rapid, deep responses, enabling autologous stem cell transplantation in two cases. Conclusion: These findings suggest that immediate anti-CD38 switching
A Critical Analysis of the Clinical Use of Incretin-Based Therapies: Efficacy and Adverse Events
Obesity is a major public health challenge in the United States, despite widespread implementation of regulated diet plans, exercise programs, behavioral interventions, and surgical procedures. The emergence of incretin-based therapies, particularly GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) receptor agonists, has transformed the therapeutic landscape for initially type 2 diabetes and now obesity. Beyond their metabolic effects, incretin therapies exert meaningful cardiovascular, gastrointestinal, and neuroprotective actions. Semaglutide, a GLP-1 receptor agonist, and tripeptide, a dual GLP-1/GIP agonist, demonstrate substantial weight reduction, improved glycemic control, and reductions in cardiometabolic risk factors. Tirzepatide consistently produces greater weight loss effects than semaglutide, likely due to synergistic dual-receptor effects. However, these therapies are accompanied by adverse effects, most commonly gastrointestinal disturbances, and, less frequently, gallbladder disease, pancreatitis, or rare ophthalmologic concerns. Long-term safety data remain limited, particularly in older adults, pediatric patients, pregnant women, and individuals with comorbid disease. Emerging evidence also suggests potential roles in cancer prevention, hypertension, and neurodegenerative disease. As the indications for incretin-based therapies continue to expand, longer-duration trials and more diverse study populations will be essential to fully examine their long-term clinical effects. Though these agents hold considerable promise, careful and informed use remain vital.
Copyright (c) 2025 Archives of Clinical and Medical Case Reports
Liver Transplantation in Childhood-Disputable Indications for Retransplantation in the Adulthood
Background: A 25-year retrospective analysis of pediatric liver transplantations after transition to the adulthood service was carried out with the special emphasis on patient’s survival, differences in survival related to age, gender, type of donation (deceased vs living), transplantation technique, type of biliary anastomosis and indications for retransplantation. A few controversial indications for retransplantation were discussed in more detail. Material and methods: A group of 39 pediatric recipients were analyzed using current data and data provided by the national transplant registry. Survival was censored at 25 years of observation. Kaplan-Meyer cumulative mortality was calculated; statistical significance of survival was analysed using log-rank test. Results: The probability of 25-year survival in the study group was 75%. A course without complications was recorded only in 12.8% of recipients. Neither sex, age at transplant, type of transplantation technique, type of biliary anastomosis nor the type of donation (deceased vs. living) influenced survival. Retransplantation was considered in 30% of pediatric recipients and performed in 12.8% of them. Conclusions: Major indication for retransplantation was recurrent sclerosing cholangitis. Transplants were refused by noncompliant recipients who developed chronic rejection and graft loss. Vascular complications such as diffuse portal vein thrombosis make decisions for retransplantation the most difficult and controversial.
Parotid Gland Enlargement: A Diagnostic Challenge
Parotid swelling may develop secondary to infections or systemic disorders such as diabetes mellitus. This report describes a 51 year old man presenting with Recurrent Parotitis associated with inadequate glycaemic control. Diagnosis was established through clinical examination, imaging and laboratory investigations. Therapy consisted of broad spectrum antibiotics, supportive measures and improved blood sugar management, leading to a marked recovery. This case illustrates how systemic disease can influence salivary gland pathology and stresses the need for multidisciplinary care for long term success.
Nutraceutical Approach for the Management of Diabetic Neuropathy
Painful diabetic neuropathy (pDN) is a common type of peripheral neuropathic pain and it's defined as pain that is a direct consequence of abnormalities in the peripheral somatosensory system in individuals with diabetes. Antidiabetic drugs improve the glycemic profile but do not act on the symptoms of pDN, while the drugs commonly used for the symptoms of diabetic neuropathy (antidepressants and anticonvulsants) cause several side effects including dizziness, constipation, somnolence and loss of appetite, so it’s important to have nutraceutical tools capable of delaying or reducing the pharmacological approach. The aim of the present retrospective clinical survey was to evaluate the effect of Epiderali® plus in patients undergoing therapy with hypoglycemic drugs showing symptoms of diabetic neuropathy not well controlled with the pharmacological treatments (T0 score for motion questionnaires). After three months of treatment and still up to six months with Epiderali® plus of treatment the blood parameters were controlled without collateral interactions with pharmacological treatments. Moreover, using three different standardized questionnaires all the symptomatology related to motion, pain and quality of life was significantly improved. After a more complex clinical investigation it could be possible to consider Epiderali® plus as novel therapeutic tool for the management of motorial neuropathy and pain in patients with diabetes neuropathy.
Complete and Durable Response in Metastatic Uterine Leiomyosarcoma with Multimodal Therapy: A Case Report
Background: Uterine leiomyosarcoma (LMS) is a rare, aggressive malignancy (1-2% of uterine cancers) [1] often initially misdiagnosed as benign fibroids. There is no reliable preoperative method to distinguish LMS from leiomyoma, and the diagnosis is typically confirmed post-hysterectomy on pathology [1]. LMS frequently metastasises hematogenously (commonly to the lungs, liver, and peritoneum) [1,10], and the prognosis of advanced disease is poor (5-year survival rate is ~15- 20%) [1,10]. The standard treatment is total hysterectomy; the benefit of adjuvant therapy remains unclear, although chemotherapy and radiation are often attempted in high-risk cases [7,8]. LMS can express hormone receptors, suggesting a potential benefit of endocrine therapy in select cases [2,5]. Case: We present the case of a 54-year-old woman with a history of a rapidly enlarging “fibroid” who underwent hysterectomy and was found to have high-grade LMS with metastatic spread. The tumour was strongly positive for oestrogen, progesterone, and androgen receptor. Postoperatively, she received pelvic radiation, combined ovarian suppression (goserelin) plus antiandrogen (bicalutamide) hormonal therapy, and targeted kinase inhibitor pazopanib. This regimen was chosen in lieu of conventional chemotherapy, given the tumour’s receptor profile. Outcomes: The patient achieved complete metabolic remission on PET-CT three months after treatment. She has remained disease-free on maintenance therapy with goserelin, bicalutamide, and pazopanib for over 24 months of follow-up, with no evidence of recurrence. Conclusion: This exceptional response in patients with metastatic LMS highlights the potential of an individualised multimodal approach. Exploiting hormone receptor positivity with endocrine therapy and incorporating targeted anti-angiogenic therapy (pazopanib) achieved an outcome rarely observed in advanced LMS. Ongoing surveillance is paramount. This case underscores the importance of multidisciplinary, personalised strategies and encourages further research on hormonetargeted and innovative therapies for uterine LMS.
Mobile Cloud-Based 12-Lead ECG Transmission during Helicopter Transport of STElevation Myocardial Infarction Patients
Delayed reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) is associated with high mortality rates. Although mobile cloud-based 12-lead electrocardiogram (MC-ECG) systems have shown promise in reducing treatment delays, their implementation remains limited in regions where geographic and institutional constraints hinder timely interventions. This study aimed to evaluate the effectiveness of helicopter emergency medical services (HEMS) equipped with an MCECG system in reducing the time to reperfusion and improving shortterm outcomes in patients with STEMI. This retrospective observational study included patients with STEMI transported via HEMS in Fukushima Prefecture between July 2022 and August 2024. The inclusion criterion was confirmation of ST elevation by a flight physician using MC-ECG at rendezvous points (RPs) with subsequent percutaneous coronary intervention (PCI) at a receiving facility. The measured outcomes included the time from symptom onset to emergency medical service contact, contact with the flight physician, transport times, door-to-balloon time (DTBT), and 30-day survival. Among the 1,087 HEMS dispatches, 15 STEMI cases met the inclusion criteria. The median patient age was 59 years, and 80% of the patients were men. The median DTBT was 57 min and the 30-day survival rate was 100%. Air transport was significantly faster than predicted ground transport (median 12 vs. 61 min, p < 0.01). The integration of MC-ECG into the HEMS enabled the rapid diagnosis and transport of patients with STEMI to PCI-capable facilities, achieving DTBT within guideline-recommended timeframes and excellent short-term outcomes. This approach may be particularly beneficial in geographically dispersed regions with limited cardiological resources.
Association Between Lipid Profile and The Clinical Course of Influenza
Background: Influenza remains a major cause of morbidity and mortality worldwide. Identifying biomarkers associated with disease severity could improve risk stratification and patient management. Aim: The aim of this study was to investigate the association between lipid profile and the clinical outcomes of influenza infection, especially among adults who were either admitted to the hospital or were treated as outpatients after being diagnosed with influenza in the emergency department (ED). Results: The median age of the total cohort was 59.9 ± 20.7 years, with 47.8% being male and 52.2% female. Patients in the hospitalized group were significantly older than those managed as outpatients (70.2 ± 15.6 vs 40.1 ± 23.1 years, p=0.002). Among all lipid parameters, only Low-Density Lipoprotein (LDL) levels were significantly lower in hospitalized patients compared to outpatients (76.6 ± 30.3 vs 98.4 ± 22.6 mg/dL, p=0.038). To assess the impact of treatment, lipid values measured upon admission were compared with those recorded after clinical recovery. No significant changes were detected in any lipid marker, including Total Cholesterol (TC), LDL, High-Density Lipoprotein (HDL), and Triglycerides (TG), indicating that the treatment course did not substantially alter lipid levels. No significant correlations were identified between White Blood Count (WBC) and TC, HDL, LDL, or TG, with Pearson correlation coefficients ranging from -0.08 to 0.17. When lipid levels were analyzed in relation to patient age, TG demonstrated a weak positive correlation with age (r=+0.08). Triglycerides were the best severity predictor (AUC=0.87), followed by C-Reactive Protein (CRP) (AUC=0.85). A comparison between the influenza cohort and 32 healthy control subjects revealed significantly lower levels of TC, HDL, and LDL among patients with influenza (all p < 0.001 for TC and LDL, and p=0.002 for HDL). Triglyceride levels did not differ significantly between the two groups (p=0.681). Conclusion: LDL shows a consistent inverse correlation with hospitalization and age. Triglycerides have high discriminatory ability for severe influenza infection. These findings highlight the potential role of lipid profile -particularly LDL and TG—as indicators of disease severity and proliferated immune response in influenza infection. The observed differences warrant further investigation in larger and more diverse patient populations.
Clinical Evaluation of Budesonide Therapy in Patients with Microscopic Colitis - A Retrospective Cohort Study
Objectives: Budesonide is the first-choice therapy to achieve and maintain clinical remission in microscopic colitis (MC), however the optimal duration of therapy is still unclear. This study aimed to evaluate budesonide therapy in a single-center cohort with long-term follow-up, focusing on relapse rates and steroid dependency. Methods: All patients with histologically proven MC at the Catharina Hospital between February 2009 and May 2018 were retrieved from the Dutch histopathology database. Patients were categorized into different budesonide regimen groups. The primary outcome was medication free clinical remission related to budesonide therapy. Second, duration and dosage of budesonide therapy and immuno-modulating therapy in refractory MC was evaluated. Results: In total 89 MC patients were included. Median follow-up was 34.8 months (IQR 17.6-63.0). Fourteen patients (16%) achieved clinical remission either without medication or following non-steroid therapy. Seventy-five patients (84%) were treated with budesonide, of whom 27 (36%) with a single and 17 (19%) with intermittent budesonide courses. Following induction therapy, 69 patients (92% achieved remission. However, during long term follow-up 42 (56%) experienced at least one relapse, indicating the need for maintenance treatment in many cases. Only 27 (36%) of all 75 budesonide treated patients were able to maintain budesonide free clinical remission. Forty-one (54.7%) had chronic/ relapsing MC and seven (9.3%) needed immunomodulators. Conclusions: Budesonide is effective as induction therapy for patients with MC. Many patients need budesonide-maintenance, in contrary to the treatment guidelines. We suggest guiding budesonide therapy by clinical symptoms rather than by a fixed time frame.
A Case of Saccharomyces cerevisiae Blood Infection in a Full-Term Newborn Unrelated to Feeding
Introduction: Cerevisiae is a probiotic micro-organism whose use in food is known to have beneficial effects on digestion and several gastrointestinal disorders. However, while probiotics are commonly used, they can be dangerous for certain people, especially those with immuno-compromised systems, who can develop fungemia and subsequently die. This case report describes a case of fungemia in a newborn baby that was not diet-related (lactation). Case presentation: We present for the first time a case of S. cerevisiae fungemia isolated in a blood culture from a two-hours-old newborn who presented with vomiting and a disturbance of vital and biological signs immediately after taking formula milk powder containing no probiotics (Nestlé NAN 1). Despite this less severe clinical picture, the symptoms disappeared rapidly after three days, without the need to administer antifungal agents. The isolated S. cerevisiae was probably wild type, as it was sensitive to the antifungal agents tested, and the symptoms resolved after five days, with the baby being discharged from hospital on day 7. Conclusion: The risk of S. cerevisiae fungemia remains present in all newborns with signs of infection, whether they are on an S. cerevisiaebased diet. Transmission of S. cerevisiae that is not diet-related, remains a real challenge, and several studies need to be carried out to elucidate its involvement in fungemia.
Arthroscopic Fixation of ACL and PCL Avulsion with Medial Tibial Plateau Fracture in a Patient with Osteogenesis Imperfecta
Osteogenesis imperfecta is a rare genetic connective tissue disorder resulting in bone fragility. We present a unique case of an avulsion of both the anterior cruciate and posterior cruciate ligaments, along with a medial tibial plateau fracture in a patient with osteogenesis imperfecta and vascular complications. Our case highlights the challenges of managing traumatic knee injuries complicated by bone fragility and vascular risks, underscoring the importance of a multidisciplinary approach for effective fixation.
Monogenic SAMHD1 Aicardi-Goutières Syndrome Type 5; Challenges in Diagnosis and Management: A Case Report
Background: Aicardi-Goutières syndrome is a rare autosomal recessive neurogenetic disorder characterized by progressive neurodegeneration, basal ganglia calcifications, leukodystrophy, and chronic cerebrospinal fluid lymphocytosis. Due to the rarity of the condition, there is a lack of specific guidelines for optimal management of these patients. Through this case, we are reporting a mutation in the SAMHD1 gene in the form of homozygous deletion, which is a rare etiology of AGS. Case Presentation: This report describes an 18-month-old male child with a complex clinical presentation, including microcephaly, developmental delay, quadriplegia, hypotonia, and spasticity. The patient, born to consanguineous parents, was admitted with fever and showed typical neurological features, such as decorticate posturing, a positive Babinski sign, and spastic quadriplegia. Laboratory findings revealed elevated liver enzymes and abnormal lymphocyte distribution. Genetic testing via whole exome sequencing identified a homozygous deletion in exon 2 of the SAMHD1 gene, leading to a pathogenic variant. This mutation is associated with AGS5, contributing to the understanding of AGS genetic variability and emphasizing the importance of early genetic testing for accurate diagnosis. The clinical features align with AGS, supporting the novel detection of SAMHD1 mutations in this context. Conclusion: This case highlights the critical role of whole genome sequencing in early diagnosis, genetic counseling, and management of AGS. It will contribute to the broader knowledge of the disease spectrum, encouraging further research into AGS.
Case Report: Histological Evaluation of Deep Tissue Remodeling After Extended Mode of Fractional RF Microneedling
Fractional radiofrequency (RF) microneedling is commonly used for skin and body rejuvenation by inducing controlled thermal micro-injuries that stimulate collagen and elastin production. However, conventional techniques often cause discomfort, especially when targeting deeper tissues. This case report evaluates the histological effects of the Exion Fractional RF device using its Extended Mode, which creates a thermal gradient reaching deeper layers without full needle penetration. A 40-yearold male subject (BMI 22.9) received a single-pass treatment to the face and abdomen, with insulated microneedles delivering monopolar RF energy at varying depths (1.0–4.0 mm) and intensities (60% and 100%). Biopsies were taken immediately post-treatment, and on Days 7 and 30. Histological analysis using H&E and Masson's trichrome staining revealed a consistent 4-mm thermal gradient in abdominal tissue, with evidence of collagen coagulation and remodeling extending beyond needle depth, while preserving the integrity of the epidermis. By Day 30, early neocollagenesis and signs of adipocyte apoptosis, including membrane disruption and fibrotic changes, were noted. These findings suggest that the Extended Mode enables effective deep tissue remodeling and adipose targeting while minimizing epidermal disruption.