bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thoracic spinal tuberculosis in a 2.5-year-old child treated by surgical procedure with a transthoracic approach: a case report
Authors: Kitaz Mohammad N. , Alosman Majd A. , Jawish Abdelrazzak , Alothman Fadi , Alali Kutaiba , Wereekia Mahmoud , Abbas Walaa , Kadi Mohamad , Morjan Mohamad 
Published: April 2023

Introduction and importance:
Pott’s disease is a form of extrapulmonary tuberculosis (TB) and has a global increase in incidence. The diagnosis should be made early to avoid neurological deficiency or deformity of the spine.

Case presentation:
A 2-year-old and 6-month-old boy was admitted with fever and unspecific generalized pain, the examination revealed mild hyperreflexia in the lower extremities, isotope scan showed increased uptake in the T8 vertebra. MRI demonstrated destruction in the T8 vertebra with kyphotic deformity and abscess anterior to T7, T8, and T9 levels with an epidural abscess at the T8 level extending to the spinal canal and compressing the spinal cord. The patient underwent a surgical procedure with a transthoracic approach, the decompression of the spinal canal was performed through T8 corpectomy, the reduction of kyphosis was performed and the internal fixation with a dynamic cylinder and lateral titanium plate was carried out. Microbiologic examination suggests Mycobacterium tuberculosis.

Clinical discussion:
Pott’s disease (spinal TB) is extremely rare in the young children population, and surgical treatment is reported only in a few reports, and it is considered a technical challenge. There are several surgical approaches during childhood, for upper thoracic spinal TB, the posterior approach is easy, minimally invasive, safe, reliable, and effective. But it had the worst outcomes. In contrast, the anterior approach provides direct access to the lesions.

Conclusion:
More research are needed to detect the best choice in the management of thoracic spinal TB in children.
Adrenocortical carcinoma in a 10-month-old infant: A literature review and a rare case report
Authors: Al-Ghotani Basel , Alabdallah Ebaa , Shaaban Venus , Nemer Farah , Alsneeh Amal , Sharif Fawaz AL , Dalati Husam , Mansour Marah 
Published: April 2023

Introduction and importance:
Adrenocortical carcinoma (ACC) in children is a rare condition. The annual incidence of ACC is extremely low, with only 0.2–0.3 cases per million children. The clinical presentations of ACC are numerous, such as terminal hair appearance, pubertal progress, hypercortisolism, enlarged clitoris, acne, systemic arterial hypertension, weight gain, and voice change.

Case presentation:
A 10-month-old female infant presented by her parents to the Department of Endocrinology with a mass on the right adrenal gland and Cushing’s syndrome symptoms. Surgery was performed. The death occurred after two times resuscitation due to sudden cardiac arrest.

Clinical discussion:
The adrenal gland consists of two distinct parts. Different types of tumors arise from each part of the adrenal gland. The most common tumor in adrenomedullary tumors was neuroblastoma which accounted for 60.4% of adrenal tumors. ACC in children is a rare condition. The etiology of ACTs is unclear.

Conclusion:
This case emphasizes that early diagnosis has a considerable role in preventing major complications. Also to advise considering ACC as a differential diagnosis when similar symptoms are found in an infant.
Severe hepatitis E infection in pregnancy: a case report
Authors: Jha Kritika , Tandukar Alina , Aryal Roshan , Shrestha Prezma , Bajracharya Sunita , Bista Kesang D. 
Published: April 2023

Introduction and importance:
Hepatitis E virus causes self limiting hepatitis most of the times but, during pregnancy it can lead to severe hepatitis along with various complications thereby increasing the mortality.

Case presentation:
A 27-year-old woman gravida two, para one at 38 weeks and 6 days of gestation presented with multiple episodes of nonbilious vomiting, severe dehydration, and later developed right upper quadrant abdominal pain. The patient had a positive serological test for the hepatitis E virus, and liver enzymes were severely elevated. Under supportive treatment she delivered a healthy baby, and her liver enzymes returned to normal levels after 2 weeks of delivery.

Clinical discussion:
Although the hepatitis E virus usually causes self-limiting hepatitis, it can quickly progress to severe hepatitis, liver failure, and even death during pregnancy. Immunological change with a Th2 biased response and increased hormonal levels during pregnancy could possibly facilitate the development of severe liver damage. No particular drug has been approved for the treatment of hepatitis E viral infection in pregnant women, and the commonly used drugs are contraindicated due to the risk of teratogenicity. Supportive therapy and intensive monitoring are the core management techniques for hepatitis E virus infection in pregnant women.

Conclusion:
Due to the high mortality risk, pregnant women should try to avoid possible exposure to the hepatitis E virus, but once infected, symptomatic therapy is the mainstay.
Post-traumatic lateral abdominal wall hernia: a case report
Authors: Abdelali Mabrouk , Chaouch Mohamed Ali , Ben Jabra Sadok , Saad Jamal , Ben Mansour Maha , Chakroun Sawsen , Khouni Yasmine , Aguir Fadwa , Achour Asma , Zrig Ahmed , Noomane Faouzi , Maatouk Mezri 
Published: April 2023

Introduction and importance:
Traumatic abdominal wall hernia (TAWH) also known as blunt abdominal TAWH is uncommon. The clinical diagnosis is difficult. The authors present a case report of posthigh-energy abdominal blunt trauma causing a TAWH.

Case presentation:
A 36-year-women, with unremarkable past medical history, was presented to the Emergency Department after a stuck in high-speed two automobiles. She was hemodynamic, respiratory, and neurologically stable. The BMI was 36 kg/m². The abdomen was not distended with an ecchymotic lesion on the right flank. The thoracic abdominal and pelvic computed tomography (CT) scan revealed a rupture in the lateral abdominal wall muscles with a TAWH in the location of the skin ecchymoses. There was no visceral lesion or intraperitoneal fluid. A conservative treatment was indicated. The follow-up was uneventful, with hematoma resorption and no cellulitis or abscess. The patient was discharged after 1 week. An abdominal repair will be planned using a mesh.

Clinical discussion:
TAWH is a rare entity. The best imaging modality for diagnosis is the CT scan allowing classification of the hernia and a screen for other injuries. The presence of an isolated TAWH must lower the threshold to closely monitor or to operatively explore, given the high rate of false-negative findings at imaging features.

Conclusion:
TAWH should be suspected behind any blunt abdominal trauma with high energy. CT scan and ultrasound were helpful for diagnosis and the only curative treatment is surgery to avoid complications.
Small bowel intussusception in an adult secondary to gastrointestinal stromal tumor: a rare case report
Authors: Basukala Sunil , Karki Sabin , Maharjan Suman , Banmala Sabin , Shrestha Melina , Jayswal Mukesh , Shrestha Kala 
Published: April 2023

Introduction and Importance:
Intussusception is a rare surgical condition in adults less commonly confined to small bowel. Adult intussusception is an indication of surgical resection due to possibility of ischemia and malignant pathological cause like gastrointestinal stromal tumor (GIST) as in this case.

Case presentation:
A 32-year-old male presented with abdominal pain and vomiting for 3 days. Vitals parameters and abdominal examinations were normal. Abdominal ultrasonography revealed target sign suggesting ileoileal intussusception in right lower quadrant. Abdominal contrast-enhanced computed tomography of abdomen showed features suggestive of ileoileal intussusception. Diagnostic laparoscopy was done which was later turned to laparotomy for segmental resection and anastomosis of ileum for ileoileal intussusception. Polypoidal growth noted in the resected section of ileum was found to be GIST (CD117 and DOG-1 positive) which was considered to be the lead point. Patient recovered well during postoperative period and later referred to oncology clinic for chemotherapy.

Clinical discussion:
Intussusception and subsequent obstruction are very uncommon presentation in a patient with GIST because of their tendency to grow in an extraluminal fashion. As intussusception is rare in adult, high level of suspicion and proper imaging technique plays important role in diagnosing the condition.

Conclusion:
Ileoileal intussusceptions due to GIST are a rare clinical entity in adult intussusceptions and generally have a vague variable clinical presentation thus requiring high index of clinical judgement and suspicion with judicious use of imaging.
Alagille syndrome: an orphan disease in Colombia and summary of recent advances in treatment and survival – a case report
Authors: Echeverri-Mejía Camila , Ríos-Orozco Sergio U. , Lozada-Martínez Ivan D. , Narvaez-Rojas Alexis R. 
Published: April 2023

Introduction:
Alagille syndrome has been described as a multisystemic clinical spectrum caused by an autosomal dominant genetic disorder. Although it is estimated that there is 1 case per 100 000 live births, the prognosis for survival and quality of life for these patients is varied but tends to be negative. In Colombia, this condition is considered an orphan disease with difficult management due to the lack of specialized centers that have all the medical specialties and subspecialties. Some reports state that no more than 30 cases have been published in this country.

Materials and methods:
The authors report a case of a male baby who, at 8 days old, he was taken to the general practitioner’s outpatient clinic for persistent jaundice. At 3 months of age, he was reviewed by the pediatric gastroenterology department, which requested liver and biliary tract scintigraphy, showing atresia of the biliary tract, hepatomegaly, and the absence of a gallbladder.

Results:
Liver transplantation is the definitive solution. However, in low- and middle-income countries, where there are no well-established organ transplantation programs, the prognosis for these patients is presumed to be worse.

Conclusion:
Alagille syndrome is a rare disease that requires an accurate and early diagnosis and timely multidisciplinary management to reduce the impact of multisystemic complications. It is necessary to advance in transplant programs in low- and middle-income countries, to provide a solution to cases where there are no other therapeutic alternatives, and to contribute to the quality of life of the affected patient.
Systemic lupus erythematosus disease activity and neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: a cross-sectional case–control study
Authors: Abdalhadi Safaa , Khalayli Naram , Al-Ghotani Basel , Kudsi Maysoun 
Published: April 2023

Background:
Systemic lupus erythematosus (SLE) is an autoimmune disease with unknown etiology. It involves multiple organs and presents as varying clinical manifestations such as renal involvement (nephritis) and hematological disorders.

Materials and Methods:
One hundred sixty people, divided equally into two groups: SLE patients, diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria, and healthy controls matched in age and gender, attending the University Hospitals between April 2019 and January 2021. White blood cells count, neutrophils count, lymphocytes count, platelet count, erythrocyte sedimentation rate, C-reactive protein, serum complements (C3 and C4), anti-double-stranded deoxyribonucleic acid, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the SLE disease activity by using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was compared between the patient group and the control group. Demographic data were collected from all participants, and data on the disease, including disease durations and disease activity, were only collected from the patients.

Results:
The age of the patients was 30.49±10.979 years, while it was 34.54±13.710 years in the control group (P=0.249). In all, 90% were females and 10% were males in the patient’s group, while 85% were female and 15% were males in the control group. NLR and PLR were significantly higher in SLE patients compared to healthy control. A significant relation was found between SLEDAI and NLR and PLR.

Conclusion:
The NLR and PLR are correlated with disease activity while also being cost-effective.
Nephrotic syndrome presented as a portal vein thrombosis: a case report
Authors: Jeele Mohamed Osman Omar , Adan Abdisamad M. 
Published: April 2023

Introduction:
Nephrotic syndrome (NS) is a clinical disorder characterized by significant proteinuria, hypoalbuminemia, hyperlipidemia, edema, and other complications. Urinary loss of clotting inhibitors, zymogens, and plasminogen; increased hepatic synthesis of fibrinogen and lipoproteins, and hemoconcentration due to fluid loss are some of the factors which predispose NS patients to hypercoagulable states like portal vein thrombosis.

Case presentation:
In the presenting case report, we described a 21-year-old woman with no history of NS and a hypercoagulable state who presented to our emergency department with severe generalized abdominal pain and lower limb edema. She was subsequently diagnosed with NS complicated with portal vein thrombosis and was admitted to our internal medicine unit. After 2 weeks of treatment, the patient was discharged in good health.

Conclusion:
Additional evaluation for newly onset NS with venous thrombosis should be needed in the presence of severe abdominal pain and lower limb edema even in a patient without a previous history of NS.
The challenging presentation of gastric cancer during pregnancy with krukenberg tumor: a case report
Authors: Chen Han-Ying , Lee Chien-Nan , Lin Shin-Yu 
Published: April 2023

Introduction:
The incidence of ovarian tumors in pregnancy is around 0.05%. Primary ovarian cancer and metastatic malignancy are rare in pregnancy, and women often delayed in diagnosis.

Importance:
This is the first case ever reported on gastric cancer diagnosed during pregnancy presenting with a Krukenberg tumor and mimic ovarian tumor torsion, cholecystitis. By reporting this case, we could sensitize physicians to be more vigilance of abnormal abdominal pain in pregnant women.

Case presentation:
A 30-year-old female came to our hospital at the 30th week of gestational age due to preterm uterine contraction and worsening abdominal pain. A cesarean section was performed due to preterm uterine contraction and intolerable abdominal pain suspected to be ovarian torsion. Microscopic examination of the ovarian specimen showed signet-ring cells. The patient was diagnosed with gastric adenocarcinoma at stage IV after complete surveillance. Postpartum chemotherapy consisted of oxaliplatin and high-dose 5-fluorouracil. The patient died 4 months after delivery.

Clinical discussion:
Malignancies during pregnancy should be kept in mind while encountering atypical clinical presentations. Krukenburg tumor is rare in pregnancy and gastric cancer is the most common cause. Early diagnosis of the gastric cancer in the operable stage is the key to a better prognosis.

Conclusion:
Diagnostic examinations for gastric cancer in pregnancy could be performed after first trimester. Treatment should be introduced after balancing maternal-fetal risks. Early diagnosis and intervention are crucial to decrease the high mortality rate of gastric cancer in pregnancy.
Successful management of Herlyn–Werner–Wunderlich syndrome in a 17-year-old virgin girl in the challenging socio-cultural-logistic setting of Syria: a case report
Authors: Martini Nafiza , Alabdallah Ebaa , Al-Ghotani Basel , ALAWAD IEMAN , Tawashi Nazih 
Published: April 2023

Introduction and Importance:
Herlyn–Werner–Wunderlich syndrome (HWWS) is a rare developmental anomaly of the female reproductive system caused by a failure of fusion during Mullerian duct development. The triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis characterizes HWWS. The most common presenting symptoms are dysmenorrhoea, pelvic pain, primary infertility in later years, and an abdominal mass due to hematometrocolpos.

Case Presentation:
A 17-year-old girl presented to the authors’ department with recurrent low back pain, which was neither responsive to analgesics nor associated with urinary complaints, vomiting, or fever. Imaging techniques confirmed she had the triad of uterus didelphys, obstructed hemivagina, and right renal agenesis.

Clinical Discussion:
The genital system is the same for males and females before 6 weeks of pregnancy. HWWS is a rare congenital disorder as a result of the failure of fusion during Mullerian duct development. It consists of a didelphic uterus, hemivaginal septum, and unilateral renal agenesis.

Conclusion:
Shame and social stigma associated with virginity continue to endanger the lives of many girls in Syria. To complicate matters further, the low resources in Syria produced by war pose a difficult challenge in managing many gynecological conditions, including HWWS, like this case, in which endoscopic technologies were not available, necessitating open surgery while keeping in mind preserving hymen intactness. So, the authors indicate that preserving virginity could be conducted even though the approach is open surgery by very careful intervention and experienced surgeons.
Incidental finding of multiple diffuse large B-cell lymphomas masquerading as jejunojejunal intussusception with unexplained pleural effusion: a case report
Authors: Liu Kuang-Ting , Chang Yueh-Ching , Lin Yu-Chieh , Chang Junn-Liang 
Published: April 2023

Introduction:
Primary non-Hodgkin’s lymphoma of the gastrointestinal (GI) tract is rare. It is aggressive and necessitates early diagnosis and management. Simultaneous primary GI lymphomas are unusual with rarely reported cases.

Case presentation:
This novel case report describes an 84-year-old man with multiple primary diffuse large B-cell lymphomas (DLBCLs) of the jejunum with disseminating pleural and multiple regional lymph nodes involvement presenting as intestinal obstruction and segments of jejunojejunal intussusception. The patient underwent surgical intervention and adjuvant chemotherapy. Unfortunately, the patient suffered from multiple organ failure and died 4 months after surgery.

Clinical discussion:
Obstruction and perforation are rare and life-threatening complications of GI lymphoma. Multiple DLBCLs of the jejunum are rare. Moreover, primary GI-DLBCL that initially presents with pleural effusion or with intestinal perforation is uncommon. This report aims to remind clinicians that lymphoma should be considered when assessing the cause of unexplained pleural effusion, especially when the available examination data cannot be confirmed by clinical manifestations.

Conclusion:
Through this case report, the authors learn that clinical manifestations, morphological characteristics, immunophenotypes, and molecular biological characteristics are vastly different and important. This poses the biggest challenge before surgery and should not be ignored.
Case report: utilization of Z-Point fixture “Trans-nasal” implants
Authors: Oh Simon , Zelig David , Aalam Alexandre Amir , Kurtzman Gregori M. 
Published: April 2023

Background:
Severe bone loss in the anterior maxilla poses challenges to implant placement, especially when treating the entire arch. Utilization of zygomatic implants may not allow positioning of the implant platform anterior enough to properly support the full arch prosthesis, leaving an anterior cantilever in some clinical cases.

Importance:
Placement of implants into the trans-nasal bone between the pneumatized maxillary sinus and nasal fossa allows utilization of an extralong implant in this residual bone to augment zygomatic implants placed distal to this for better support of a full arch prosthesis.

Case presentation:
A typical case is presented with insufficient alveolar height for traditional implant placement in the anterior maxilla following extraction of the dentition related to bone loss resulting from periodontal disease. Review of the anatomy and technique for placement of implants into the Z-point area for trans-nasal implants.

Clinical discussion:
This article discusses the utilization of trans-nasal implants into the Z-point and the technique for placement in this residual bone with a case example.

Conclusions:
The Z-point implant aids in the elimination of the anterior cantilever that may be present due to the most anterior the platform for the zygomatic implant can be placed. Trans-nasal implants should be considered as part of the treatment plan in severely resorbed maxillary arches to allow better implant to spread and load management during functioning.
An interesting case of unintentional vitamin D toxicity in an infant due to erroneous supplement concentration: a case report
Authors: Kharal Nikita , Kadel Anuradha , Sapkota Srijana , Pokhrel Prakash , Baidya Sujata , Lamichhane Machhindra , Sharma Arun K. , Tuladhar Eans T. , Sharma Vijay K. , Niraula Apeksha 
Published: April 2023

Introduction and importance:
Despite the rare occurrence of vitamin D toxicity in infants, increased use of vitamin D formulations as well as incorrect supplement concentration by manufacturing pharmaceutical companies, has contributed to an increased incidence of vitamin D toxicity. Over-the-counter vitamin D preparation constitutes variable concentrations that can render life-threatening consequences in children.

Case presentation:
Here, we present a case of a 2.5-month-old infant presenting with failure to thrive. The clinical presentations were nasal blockage, noisy breathing, poor feeding, lethargy, dehydration, and fever for 3 days with decreased appetite. Her urine culture report showed a urinary tract infection. The biochemical evaluation demonstrated raised total serum calcium (6.0 mmol/l) and serum 25-hydroxy vitamin D (>160 ng/ml) with suppressed parathyroid hormone concentration (3.7 pg/ml), which was the major concern to the clinicians. On ultrasonographical examination, nephrocalcinosis was observed. Further evaluation unveiled that the vitamin D supplement administered to the infant constituted a deucedly high dose of 42 000 IU instead of the recommended dose of 0.5 ml of 800 IU.

Clinical discussion:
The patient developed vitamin D toxicity after consuming a mega dose of vitamin D supplements due to a manufacturer error.

Conclusions:
Hypervitaminosis D has severe life-threatening consequences like failure to thrive in otherwise healthy-born infants. Regular monitoring of vitamin D supplements administered in infants by medicinal practitioners and strict supervision of all stages of the production process by pharmaceutical companies is crucial to prevent complications from supplement overdose.