bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pressure sore at an unusual site: the bilateral knee – a case report
Authors: Acharya Pawan , Poudel Bipin , Shrestha Shubham , Maharjan Bunu 
Published: August 2023

Introduction and importance:
A pressure ulcer is a skin and soft tissue injury that commonly occur on bony prominences like the ischium, sacrum, heel, malleolus, and occiput but the knee is not the usual site for pressure ulcers. Here, the authors present a case of a pressure ulcer over an unusual site, the knee.

Case presentation:
The authors reported a case of a 66-year-old male, last seen 5 days ago by his son, who was found on the floor (with the knee on the ground) and was brought to the hospital. The patient had no history of mobility issue. On initial assessment his vitals were unstable but Glasgow Coma Scale 15/15 and CT head and ECG were unremarkable. On knee examination, there was bilateral grazing and bruising diagnosed as grade 3 and grade 4 pressure sore in the right and left knee, respectively. The pressure ulcer was managed adhering to the principles to remove all pressure, keep the ulcer clean, prevent further injury, and regular dressing by tissue viability nurses. On 17 March 2023, the patient was discharged from the hospital to a care home after his condition improved.

Clinical discussion:
A comprehensive review of the medical literature found no other reports of pressure sore at knee. A few published articles showed pressure sore as a complication of prone positioning. It is postulated that fall and long-term lie on the knees have developed this pressure ulcer.

Conclusion:
The Clinicians should be vigilant to check for pressure ulcers especially in all the bony prominences in any patients having an unwitnessed fall.
An unusual site for hydatid cyst on ovary misdiagnosed as an ovarian cyst: a case report
Authors: Bdeiwi Hassan , Sultan Hala , Mezketli Zaher , jouma Al-hejazi Tala , Trissi Mazen , Kellawi Kinda , Zayat Roula , Al-Hammod AbdulMehdi 
Published: August 2023

Introduction and importance:
A hydatid cyst is a parasitic infection that can occur in multiple organs of the body, mostly in the liver. The ovary is one of the very rare locations for those cysts.

Case presentation:
The authors report a case of a 43-year-old woman with a primary hydatid cyst, the patient presented with left lower quadrant abdominal pain for 2 months. Ultrasound of the abdomen showed evidence of a multivesicular, fluid-containing cystic lesion in the left adnexa. The mass was excised and a hysterectomy with total left salpingo-oophorectomy was performed. Histopathology confirmed it to be a hydatid cyst.

Clinical discussion:
The clinical presentation of an ovarian hydatid cyst can differ, ranging from asymptomatic for years to dull pain if it compresses on the neighbouring organs or tissues, it may even cause a systemic immunological reaction if it ruptures.

Conclusion:
Cyst excision when possible is the best treatment, percutaneous sterilization techniques, and drug therapy may also be applied in certain cases.
Spontaneous fundal rupture in an unscarred uterus in a female with twin pregnancy after in-vitro fertilization: a case report
Authors: Mainali Sumnima , Devkota Sagar , Elsaghi Marwan Abd Elglil Elsayed , Soloman Badewa Olaitan , Bharati Bishal , Yadav Priyanka 
Published: August 2023

Introduction and importance:
Spontaneous uterine rupture in an unscarred uterus is very rare. It is found to be rarer after in-vitro fertilization. It is associated with significant morbidity and mortality if not diagnosed and treated promptly.

Case presentation:
Thirty three years female with twin pregnancy following in-vitro fertilization after 11 years of marriage presented to emergency department with lower abdominal pain at 36 weeks 3 days of gestation and was planned for emergency caesarean section for precious twin pregnancy in labour.

Clinical findings and investigation:
She was vitally stable and on palpation of abdomen, there was generalized tenderness along with guarding. All the investigations were within normal limits.

Intervention and outcome:
Emergency caesarean section was performed under subarachnoid block which revealed a 6×2 cm fundal uterine rupture with no active bleeding which was repaired in layers. The babies were extracted with a lower uterine segment incision. First twin cried immediately after birth while the second one needed resuscitation and mechanical ventilation due to perinatal asphyxia.

Conclusion:
Even though rare in a previously unscarred uterus, uterine rupture can present in different forms and thus, requires vigilant evaluation of the patient and prompt intervention to avoid significant maternal or foetal morbidity and mortality.
Percutaneous management of complicated empyema thoracis using pigtail, report of a case from University Hospital of Nepal: a case report
Authors: Mainali Sumina , Yadav Binay , Koju Naman , Karki Aashish , K.C Narendra , Bista Dhanupa 
Published: August 2023

Introduction and importance:
Empyema thoracis is a condition characterized by the accumulation of pus in the pleural cavity of the lungs. Empyema thoracis is a cause of high mortality in man and its occurrence is increasing in both children and adults. Traditionally, chest tube drainage has been a preferred method of treatment, but recent studies have shown that pigtail catheter drainage is a more effective and less invasive alternative. Image-guided drainage is also preferred over blind drainage, and alternative drainage sites are being explored. These management changes have improved patient outcomes and reduced the risk of complications.

Case presentation and clinical discussion:
A 66-year-old female presented with complaints of cough, fever, and chest pain. A clinical examination was done and relevant investigations were sent. She was then treated in the line of left-sided empyema thoracis. A pigtail catheter was inserted into the loculated empyema via the left 9th intercostal space through a posterolateral approach with ultrasonography guidance.

Conclusion:
The main aim of this article is to provide an overview of a rare management approach for empyema, a condition characterized by the accumulation of pus in the pleural cavity of the lungs. In this case report, the authors have focused on pigtail catheter drainage over traditionally performed chest tube drainage, and image-guided drainage has been performed over blind drainage ensuring accurate placement and reducing the risk of damage to surrounding tissues. Another notable change in empyema management is the shift in drainage sites from the safety triangle to other sites based on the site of loculations under ultrasonography guidance.
Leukoencephalopathy with vanishing white matter disease: a case report study
Authors: Kami Atefe , Langari Alale , Gharib Mohammad H. , Ghelichi-Ghojogh Mousa , Hosseini Parmis S. , Hosseini Seyed A. 
Published: August 2023

Introduction and importance:
Vanishing white matter (VWM) is a neurological disorder that has an autosomal recessive mode of inheritance. VWM is caused due to a mutation in in any of the five genes of eukaryotic translation initiation factor 2B (eIF2B). The etiology is unknown.

Case presentation:
The authors report two cases of VWM disease. In the first case, an 8-month-old female child, brought to the pediatric clinic with seizure and loss of consciousness. The second case was a 24-month-old girl, presented with weakness, a disability to walk and swallow, and poor feeding. Her brain MRI demonstrated cystic changes (white matter rarefaction) in supratentorial peri-ventricular white matter and genetic testing result showed an EIF2B3 gene mutation.

Clinical discussion:
Leukoencephalopathy with VWM, also known as Cree encephalopathy is caused by mutations in the EIF2B gene. The disease is inherited in an autosomal recessive fashion. There are various agents leading to symptoms and signs of VWM disease. Physical stress like head trauma even in a mild degree, infections, and febrile diseases can be mentioned as causes of VWM. The eIF2B complex, plays a role as an important factor in the regulation of protein synthesis in cells under different conditions.

Conclusion:
As a conclusion, genetic counseling could be recommended to all individuals with VWM disease and their family members for next pregnancies and possible precautions for consanguineous marriages.
Microsurgery for drug resistance epilepsy due to temporal lobe lesions in a resource limited condition: a cross-sectional study
Authors: Tran Van Dinh , Nguyen Bac Thanh , Van Dong He , Nguyen Tuan Anh , Nguyen Phuong Xuan , Van Vu Hoe , Chu Hung Thanh 
Published: August 2023

Introduction:
Epilepsy is a prevalent neurological condition that affects individuals of all ages and genders worldwide. Surgical intervention for drug-resistant epilepsy has been found to improve quality of life, with patient independence being of utmost importance.

Methods:
The study was a retrospective and prospective cross-sectional study of 35 cases of drug-resistant temporal lobe epilepsy. All patients were operated on by the primary author between May 2018 and September 2022. The study evaluated various factors including clinical characteristics, electroencephalogram, magnetic resonance imaging, surgical outcomes, and histopathology.

Results:
The success rate of the surgeries (74.3%) is similar to those reported in high-income countries. 51.4% underwent selective amygdalohippocampectomy for cases that localized to the mesial temporal lobe. Lateral/neocortical lesions underwent lesionectomy (48.6%). Our study found a complication rate of 17.1%: meningitis (8.5%), trainset focal paralysis (2.9%), and soft tissue infection (5.7%). There were no mortalities.

Conclusions:
The article showcases an international collaborative effort that demonstrates the possibility of providing highly effective and safe surgical care for temporal lobe epilepsy even in low-resource environments. The authors hope that this model can be replicated in other areas with similar resource limitations.
Fahr’s syndrome with hypoparathyroidism, thrombocytopenia, and seizure: a rare case report
Authors: katwal Shailendra , Bhandari Sushmita , Ghimire Aastha , Ghimire Prasoon 
Published: August 2023

Introduction and Importance:
Fahr’s syndrome, also known as bilateral striatopallidodentate calcinosis is a rare neurological disorder that is characterized by abnormal deposition of calcium in the basal ganglia, cerebellar dentate nuclei, and cerebral cortical white matter. The authors report an extremely uncommon case of Fahr’s syndrome with thrombocytopenia, hypoparathyroidism, and seizure.

Case Presentation:
A 32-year-old male was brought with a repeated history of twitching of hands, tingling sensation, and uncontrolled seizure despite medications.

Clinical Discussion:
Computed tomography findings showed bilateral basal ganglia, cerebellar dentate nuclei, and subcortical cerebral white matter calcifications. Laboratory studies revealed reduced levels of calcium, parathyroid hormone, and thrombocyte count. Based on these investigations Fahr’s syndrome probably due to hypoparathyroidism with thrombocytopenia was diagnosed. The patient was initially treated with intravenous calcium gluconate and platelet transfusion followed by oral calcium supplementation.

Conclusion:
Fahr’s syndrome due to hypoparathyroidism should be suspected in any patient with neurological symptoms and hypocalcemia. Seizures in the patient of Fahr’s syndrome with thrombocytopenia could be very detrimental due to the risk of intracranial hemorrhage. Hence, treatment should be started as early as possible.
Uncertain significance mutation in the POLR3B gene in a Syrian boy with leukodystrophy: a case report
Authors: Hamdan Zulfiqar , Alasmar Diana 
Published: August 2023

Introduction:
4H leukodystrophy, one of the POLR3-related leukodystrophy, is a rare hereditary brain white matter disease with characteristic clinical presentation and imaging findings. Hypomyelination, hypodontia, and hypogonadotropic hypogonadism is mainly presented in patients with 4H leukodystrophy.

Case presentation:
A 4-year-old boy presented in the neurologic clinic with delayed psychomotor development and progressive neurologic symptoms that started from the age of 20 months. Physical examination revealed ataxic features and a global development delay. The MRI was significant for hypomyelination. The most common causes of leukodystrophy were rolled out. He was referred to an inherited metabolic disease specialist under suspect of inborn metabolic errors because of laboratory analysis, which showed elevated levels of lactic acid, pyruvate, 4-Hydroxy-Phenylactic acid, 3-Hydroxy propionic acid, and decreased levels of PCO2, HCO3, total CO2, 25-Hydroxyvitamin D. These results were unspecific and mitochondrial disease was highly suspected. However, the genetic study was requested to get a defined diagnosis and treatment; the whole exon sequencing result showed a homozygous variant of uncertain significance mutation; related to an amino acid change from Ile to Thr at position 1002 in the POLR3B gene, which helped us to reveal the final diagnosis, and the genetic counseling were recommended for the next pregnancies.

Conclusion:
POLR3-related Leukodystrophy is a very rare disease. The early diagnosis should be raised depending on clinical history and MRI findings after other conditions were rolled out, and the confirmed diagnosis depends on the genetic study.
Unattended uterine prolapse during pregnancy in a low-income setting: a case report
Authors: Taha Walaa , Zabad Kareem , Nahhat Fouad , Kurdi Bashar 
Published: August 2023

Introduction:
Uterine prolapse (UP) is rare during pregnancy. It sometimes leads to serious complications such as abortion, preterm labor, and maternal death. The main risk factor for UP is previous vaginal childbirth and is usually managed conservatively. However, surgery should be considered in cases of unavailability or failure of conservative approaches.

Case presentation:
A 34-year-old Gravid4Para3 pregnant woman in the 33rd week of gestation presented with refractory vaginal pain. She had a remarkable history of second-degree UP. Upon presentation, the anterior and posterior cervical lips were swollen, bluish, and protruding through the vagina. Considering the severe pain, the alarming examination findings, and the impossibility of pushing back the protruding mass, a total vaginal hysterectomy was performed. The postoperative pathological study revealed a massive hemorrhage with edematous changes in the vaginal cuff and cervical mucosa in addition to features of placenta accreta, placenta previa, and placenta abruption.

Conclusions:
UP is a rare but potentially serious condition, especially if it is related to pregnancy. Moreover, managing UP could be challenging in low-income settings, where even simple conservative methods might be unavailable or financially unattainable.
Bilateral Wunderlich syndrome causing Page kidney during pregnancy: a rare case report
Authors: Alsayed-ahmad Zein A. , Roumi Jamal Bakri , Bouzan Dania , Helou Muhammad H. , Albitar Sami 
Published: August 2023

Introduction and importance:
Wunderlich syndrome is a rare and life-threatening condition that is characterized by spontaneous renal hemorrhage into the subcapsular and perinephric regions. This case report describes the diagnosis and management of bilateral Wunderlich syndrome during pregnancy, resulting in Page kidney.

Case presentation:
The patient presented with complaints of left flank pain and breathlessness. After stabilization, an emergency lower cesarean delivery was performed, and a percutaneous drainage procedure was carried out to alleviate the compression on the left kidney. The patient was treated with blood transfusion, methyldopa, and perindopril. Follow-up examinations performed 3 months later revealed a significant decrease in fluid volume surrounding the left kidney.

Clinical discussion:
Lenk’s triad provides the primary description of the classical manifestations of this syndrome. Some instances have been connected to the Page kidney phenomenon. The relationship between pregnancy and Wunderlich syndrome has not been extensively studied, primarily because the symptoms can resemble other complications related to pregnancy. Due to the scarcity of evidence in the literature, there is no definitive guideline for managing Wunderlich syndrome during pregnancy. Consequently, each patient is treated on an individual basis. Conservative treatment is recommended once malignancy has been ruled out.

Conclusion:
The case highlights the importance of considering Wunderlich syndrome as a differential diagnosis in pregnant patients with abdominal or flank pain, a palpable mass, and hypovolemia. Furthermore, the case illustrates the successful management of Wunderlich syndrome during pregnancy.
Secondary thrombocythemia with ST-segment elevation myocardial infarction as the first manifestation: a case report
Authors: Su Ke , Hou Ling , Zhao Jinbo , Li Yuanhong 
Published: August 2023

Introduction:
Secondary thrombocythemia (ST), also called reactive thrombocytosis, is caused by a disorder that triggers increased production by normal platelet-forming cells and is characterized by the abnormally increased number of platelet and megakaryocytes in the bone marrow. Previous reports have found complications from malignant tumors, chronic inflammation, acute inflammation, acute hemorrhage, splenectomy, etc. to be the common causes of ST. However, reports of secondary thrombocytosis caused by antibiotics are limited and there are no reports of secondary thrombocytosis with acute myocardial infarction as the first presentation. If the patient is at high risk of thrombosis, intensive antithrombotic therapy is required. To raise clinicians’ awareness of drug-induced secondary thrombocytosis and to enhance antithrombotic therapy for high-risk patients, this article presented a case of drug-induced secondary thrombocytosis with acute ST-segment elevation myocardial infarction as the primary manifestation.

Case presentation:
An 80-year-old woman was admitted with cardiogenic shock due to post-activity chest pain. She was started on aspirin and clopidogrel antiplatelet therapy, then replaced aspirin with indolibuprofen, which has relatively few side effects. There was no significant decrease in platelet counts during treatment.

Clinical discussion:
Secondary thrombocythemia, characterized by nonspecific symptoms, is difficult to diagnose. Secondary thrombocytosis with acute myocardial infarction as the first symptom is uncommon, but is very urgent and associated with a poor prognosis. What’s more, cause-specific treatment counts for secondary thrombocythemia. Therefore it is important to search for the causal factor of secondary thrombocytosis. Secondary thrombocytosis caused by cephalosporins is rare. There is a need to arouse the attention of clinicians to the ST caused by cephalosporins and to provide a guide of treatment to these patients.

Conclusion:
After a thorough analysis of the pertinent literature, we discovered that several retrospective studies demonstrated the effectiveness of cytoreductive therapy in significantly reducing platelet counts. Based on this finding, we prescribed hydroxyurea to our patient, which led to a gradual decrease in platelet count and ultimately resulted in a return to normal levels.
The comparison of anastomosis strength and leakage between double-layer full-thickness and single-layer extramucosal intestine anastomosis
Authors: Warsinggih  , Akil Fardah , Lusikooy Ronald E. , Ulfandi Devby , Faruk Muhammad , Hendarto Joko , Jalil Muhammad R. , Sinangka Andi A.M. , Abdi Amirullah 
Published: August 2023

Background:
Various intestine anastomosis techniques have been studied and used, but which is best is still debated. In our center, double-layer full-thickness intestine anastomosis was still considered as standard. However, a single-layer extramucosal intestine anastomosis has shown favorable results. This study created an anastomotic model to compare the anastomosis strength and leakage between double-layer full-thickness and single-layer extramucosal intestine anastomosis.

Methods:
This experimental study was performed in 20 randomized healthy male pigs, to be included either in Group A (Single-layer extramucosal intestine anastomosis) or Group B (Double-layer full-thickness intestine anastomosis). Enterotomy followed by an end-to-end anastomosis suture was performed in the jejunum. Fourteen days after the operation, any anastomosis leakage and its location was documented. The anastomosis strength was evaluated using manometry. Data were compared between groups using the Mann–Whitney U and Fischer Exact test, considering a significance level of P<0.05.

Results:
The overall mean intraluminal anastomotic bursting pressure was 4,257±1,185. Group A had a higher intraluminal anastomotic bursting pressure but was not statistically significant compared to group B (4.726±0.952 vs. 3.787±1.252 kilopascals, P=0.063). One leakage (5%, antimesenteric area) occurred in Group A and three leakages (15%, antimesenteric and mesenteric area) occurred in Group B. However, statistical analysis with Fischer exact showed no significant difference of leakage rate between those groups (P=0.291).

Conclusions:
The anastomosis strength and leakage did not differ significantly between the single-layer extramucosal intestine anastomosis group and the double-layer full-thickness anastomosis group. However, the location of leakage was most common in the antimesenteric area in the double-layer full-thickness anastomosis group.
The Effects of Angiosome Morphology on Choke Vessels and Flap Necrosis in a Rat Multiterritory Perforator Flap
Authors: Xi Shanshan , Zhao Jingfeng , Kang Ruochen , Wang Xinyue , Zhang Qingling , Jin Pan , Cheng Sheng 
Published: August 2023

Background
Although the angiosome concept has been proposed for a long time, very few studies have been done on its morphology. Our study investigated the effects of angiosome morphology on choke vessels and flap necrosis in a rat multiterritory perforator flap.

Methods
Seventy-two male Sprague-Dawley rats were randomly divided into 3 groups (n = 24/group). The flap contained the right iliolumbar, posterior intercostal, and thoracodorsal angiosomes (TDAVs), termed angiosomes I, II, and III, respectively. Only the posterior intercostal artery and iliolumbar vein were preserved in group 1, whereas only the posterior intercostal artery and vein were preserved in group 2, and only the posterior intercostal artery and thoracodorsal vein were preserved in group 3. Distances from angiosome II to angiosome I (II-I), angiosome II to angiosome III (II-III), angiosome I to the caudal side of the flap (I-caudal), and angiosome III to the cranial side of the flap (III-cranial) were measured. Arteriography, flap necrosis, average microvascular density, and vascular endothelial growth factor expression were evaluated.

Results
The II-I distance was significantly greater than that of II-III (3.853 ± 0.488 versus 3.274 ± 0.433 cm, P = 0.012), whereas the distance of I-caudal resembled that of III-cranial (1.062 ± 0.237 versus 0.979 ± 0.236 cm, P = 0.442). The iliolumbar and posterior intercostal angiosomes were multidirectional, whereas the TDAV was craniocaudal and unidirectional. Seven days after the operation, the choke arteries had transformed into true anastomotic arteries. Flap necrosis was lowest in group 3, followed by group 2, and highest in group 1 (10.5% ± 2.4% versus 18.3% ± 3.5% versus 25.5% ± 4.6%, P < 0.01), whereas group 3 showed the highest microvascular density and vascular endothelial growth factor expression, in contrast to groups 2 and 1, with the lowest.

Conclusions
The choke vessel adjacent to the craniocaudal and unidirectional TDAV significantly blocked venous return. Increasing venous return may reduce the necrosis.