Journal of Surgery and Medical Case Reports
Journal of Surgery and Medical Case Reports is an open access platform for the dissemination of high-quality, peer-reviewed case reports and original articles in the field of surgery and related medical disciplines. The journal seeks to contribute to the advancement of surgical knowledge by publishing innovative case studies, clinical observations, surgical techniques and outcomes, thereby fostering collaboration and knowledge exchange among surgeons, physicians, researchers, and healthcare professionals worldwide.
Menstrual-Cycle-Aware Functional Training in Women: A Conceptual Model for Rehabilitation and Performance Optimization
Physical rehabilitation and sports medicine have historically relied on research conducted predominantly in male samples, leaving the specifics of female physiology outside the analytical frame. This article argues that the menstrual cycle is a key biological regulator of physical performance, recovery and injury risk in women and that it should be incorporated as a structural element in functional training and rehabilitation protocols. We present a conceptual model the Phase-Oriented Training Framework (PFT-4) organized around the four phases of the menstrual cycle: menstrual, follicular, ovulatory and luteal. The model synthesizes evidence on hormonal influences on muscle strength, ligamentous laxity, neuromuscular control, metabolism and recovery. The article contributes to rehabilitation medicine, sports physiology and clinical practice by proposing diagnostic nomenclature and a clinical decision matrix for rehabilitation physicians, coaches and sports physiotherapists. Empirical validation of the model including the development of psychometric instruments and longitudinal outcome studies is identified as a priority for future research.
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Austere Management of Traumatic Thyroid Cartilage Laceration in a Peripheral Military Medical Unit: A Case Report
Background: Laceration of the thyroid cartilage can often be accompanied by trauma to tracheal rings. Hence securing the airway, followed by repair of the thyroid cartilage should be the approach for managing such injuries in emergency. Case Summary: 23 yrs old male reported with alleged history of self-inflicted deep laceration on the anterior aspect of the neck through a sharp object. After securing the airway and applying compression on the wound, patient was taken to operating theatre, and the wound was evaluated under general anesthesia. Intraoperatively, bilateral anterior jugular veins and left external jugular vein were lacerated along with the thyroid cartilage. All the vessels were ligated and thyroid cartilage repair was performed using non absorbable sutures after aligning the cartilage anatomy. Conclusion: Lacerated thyroid cartilage requires urgent surgical repair as it forms a large part of the laryngeal framework and may be associated with compromise of the airway.
Duodenal Perforation Presenting as Acute Appendicitis (Valentino Syndrome) in a Resource Limited Setting: A Case Report
Background: Right lower abdominal pain is a frequent emergency presentation with varied differential diagnoses. Valentino syndrome describes a perforated gastric or duodenal ulcer presenting as acute appendicitis due to tracking of gastrointestinal contents to the right iliac fossa. Case Summary: A 28-year-old male presented with obstipation, non-bilious vomiting and acute lower abdominal pain. Examination showed tachycardia, tachypnoea and diffuse abdominal tenderness with guarding. Plain radiograph revealed pneumoperitoneum. Exploratory laparotomy revealed an inflamed appendix with purulent collection in the right iliac fossa, for which appendicectomy was performed. Further exploration identified a perforation at the junction of the first and second parts of the duodenum, which was repaired with a modified Graham patch. The postoperative course was uneventful. Conclusion: Valentino syndrome should be considered in patients presenting with right lower abdominal pain, especially in resource-limited settings where advanced imaging is not readily available. Thorough intra-operative assessment is essential for correct diagnosis and management.
Valentino syndrome, duodenal perforation, acute appendicitis mimic, modified Graham patch.
Allogeneic Mesenchymal Stromal Cell-Based Therapies for Diabetic Foot Ulcers: Systematic Review and Meta-Analysis of Controlled Topical and Local Delivery Trials
Background: Diabetic foot ulcers are a major cause of infection, hospitalization and lower-extremity amputation worldwide. Despite advances in wound care, many ulcers fail to heal, prompting investigation of regenerative biologic strategies. Allogeneic Mesenchymal Stromal Cell (MSC)-based therapies have emerged as an adjunctive approach intended to enhance wound repair through immunomodulatory, pro-angiogenic and tissue-regenerative effects. Objective: To evaluate controlled clinical trial evidence for allogeneic MSC-based therapies administered topically and/or by local injection for improving healing outcomes in diabetic foot ulcers, with emphasis on complete ulcer closure. Methods: A systematic review was conducted to identify controlled clinical trials evaluating allogeneic MSC-based interventions for diabetic foot ulcers compared with standard wound care, placebo, or control dressings. Eligible delivery methods included topical application (cell sheets, hydrogels, dressings) and local injection (perilesional or intralesional). The primary endpoint was complete ulcer closure at approximately 8 to 12 weeks. Secondary outcomes included wound area reduction, time to closure, amputation, recurrence when reported and adverse events. Outcomes were synthesized under a random effects framework with consideration of heterogeneity related to cell source and delivery method. Results: Controlled trials evaluating allogeneic MSC-based therapies demonstrated higher rates of complete ulcer closure and greater wound area reduction compared with control care. Benefits were most consistent for objective wound healing endpoints, while effects on amputation outcomes were less certain due to limited event reporting. No clear signal of increased serious treatment-related adverse events was identified. Conclusion: Controlled clinical trial evidence suggests that allogeneic MSC-based therapies delivered topically and/or locally as an adjunct to standard wound care may improve diabetic foot ulcer healing outcomes compared with control care. Larger randomized trials with standardized ulcer classification, uniform wound care protocols and consistent outcome reporting are needed to define optimal cell source, delivery strategy and durability of ulcer closure.
Unsolicited Prayer to patients by Migrant Healthcare Practitioners: A Medico-Legal and Ethical Perspective
In recent years, several migrant healthcare practitioners in the United Kingdom have reportedly faced disciplinary action, dismissal from employment or deportation from the country for unsolicited prayers for patients. These incidents occur despite the fact that many patients and healthcare workers have reported finding comfort in prayer, which may also support individuals and families in coping with illness or significant life events. The question of whether healthcare workers should pray with or for patients remains the subject of ongoing debate within the broader landscape of spiritual care in clinical settings. This is against the backdrop of research finding which indicates that nurses are frequently asked by patients to offer them prayer or provide them with spiritual support as part of holistic care [1,2].
Copyright (c) 2025 Journal of Surgery and Medical Case Reports
Peak Expiratory Flow Rate (PEFR) Changes as a Predictive Measure of Respiratory Sequalae in Individuals with Severe Obesity
The purpose of this research study is to examine if use of peak expiratory flow rate (PEFR) can be used as a predictive measure of possible respiratory sequalae in individuals living with severe obesity. Totals were taken during each therapy session (3-5 times per week depending on specific patient needs). When a significant decrease of >50 LPM was noted, medical interventions were implemented by their primary Provider and non-pharmacological interventions were implemented in the course of the patrticipant’s Speech Therapy treatment sessions. This method resulted in improved PEFR following both pharmacological and non-pharmacological interventions, with 71% (10/14) of the participants not requiring a transfer to acute care for higher levels of care.
Prevalence and Prevention of Needle Stick Injuries Among Nurses in Tertiary Care Hospitals of Peshawar, Pakistan
Context: Needle Stick Injuries (NSIs) are a major occupational hazard for healthcare workers, particularly nurses, who are at risk of exposure to blood-borne pathogens such as hepatitis B virus, hepatitis C virus and human immunodeficiency virus. Objective: To assess knowledge, attitudes and practices regarding NSIs among nurses in tertiary care hospitals in Peshawar and to identify preventive strategies and associations with demographic variables. Methods: A cross-sectional study was conducted at Khyber Teaching Hospital and Northwest General and Teaching Hospital, Peshawar. A total of 216 nurses were recruited through convenient sampling (118 from Northwest Hospital and 98 from Khyber Teaching Hospital). Data were collected using a self-structured questionnaire and analyzed with SPSS version 21. The main outcome measures were levels of knowledge, attitudes and practices regarding NSIs and their associations with demographic characteristics. Results: Most nurses (73.6%) reported not experiencing an NSI. Awareness of transmission risks was high (93.9%), with 86.6% demonstrating positive attitudes and 79.2% reporting excellent preventive practices. Almost all participants (99.5%) were knowledgeable about preventive strategies. Significant associations were found between gender and practice level (p = 0.000), designation and attitude level (p = 0.006), qualification and practice level (χ² = 10.522) and infection control training and knowledge level (χ² = 22.179). Conclusion: NSIs were relatively uncommon among the study group, with high levels of knowledge and preventive awareness. Institutional training and support are essential to sustain and strengthen safe practices among nurses.
Colchicine-Associated Hypoglycemia in Diabetic Dialysis Patients: Observations from a Tanzanian Dialysis Unit: A Case Reports
Background: Colchicine is widely used for the treatment of acute gout flares due to its anti-inflammatory properties. Beyond this traditional role, colchicine has been implicated in modulating various physiological systems, including glucose metabolism. Notably, it exhibits a biphasic effect on blood glucose levels causing hypoglycemia at lower doses and hyperglycemia at higher doses. However, its impact on glycemic control in diabetic patients undergoing dialysis remains poorly characterized. Case report: We report two cases from the Dialysis Unit at Kilimanjaro Christian Medical Centre (KCMC) in northern Tanzania involving two Black African diabetic males aged 66 and 62 years with End-Stage Renal Disease (ESRD) on maintenance hemodialysis. Both patients experienced a notable and reproducible decline in blood glucose levels following colchicine administration for gout flares. The hypoglycemia occurred in the absence of other identifiable precipitating factors and resolved upon withholding colchicine. Discussion: These observations raise important questions regarding the potential glucose-lowering effects of colchicine in dialysis dependent diabetic patients. The exact mechanism remains unclear but may involve colchicine’s influence on insulin sensitivity, hepatic glucose production or inflammatory pathways that indirectly affect glucose metabolism. Given the already high risk of hypoglycemia in ESRD patients, these findings warrant careful consideration and further investigation. Conclusion: Colchicine may have an under recognized hypoglycemic effect in diabetic patients undergoing dialysis. Clinicians should be alert to this potential interaction, particularly in patients with poor glycemic reserve. Further research is needed to elucidate the mechanisms involved and assess whether colchicine could be repurposed as an adjunctive agent for glycemic control in selected ESRD populations.
Respiratory Muscle Strength Training for Bariatric Patients - A Personal Perspective
The purpose of this research study is to examine how a respiratory training protocol, consisting of: Respiratory muscle strength training, oropharyngeal exercises and diaphragmatic breathing support training affect the outcomes, both quality of life (QOL) and physiological measures, experienced by morbidly obese bariatric patients who are long-term residents at a skilled nursing facility in Scottsdale, AZ. Osborn Health and Rehabilitation focuses on meeting the short-term and long-term needs of individuals with diverse health needs. However, this facility focuses its long-term rehabilitative care on morbidly obese (Bariatric) patients, with a tailored program of both Physical Therapy and Occupational Therapists trained in the specialized needs of this population. As such, they previously identified a deficit in the program that included breath support training. The primary investigator (PI) was tasked with developing a supplemental voice and breath support training program to address their specialized needs. All participants in this research study are current patients of the Osborn Bariatric Program and informed consent was provided by all participants. Data collection occurred via survey completed by the participants, followed by a thematic analysis (Guest, Macqueen, & Namely, 2011) performed to identify and code the developing themes for future analysis. A review of the themes generated indicate that the participants placed value on QOL measures more than physiological measures and all identified what they reported as “positive changes” and “improvements” that they attributed to participation in breath support and vocal training treatment.
Respiratory Muscle Strength Training (RMST)
Oropharyngeal and diaphragmatic exercises
Effectiveness of 'O'-Arm Navigation-Assisted In-Out-In Pedicle Screw Technique for the Treatment of Congenital Scoliosis: A Study of 17 Cases
Objective: To investigate the efficacy and safety of internal fixation of narrow varicose vertebrae using the lateral In-Out-In screw technique with the assistance of the "O" arm navigation system in 17 patients with congenital scoliosis. Methods: A retrospective analysis was conducted on the clinical data of 17 patients with congenital scoliosis who underwent internal fixation surgery at Luohe Central Hospital from January 2019 to January 2021. During the procedure, the "O"-arm navigation system was utilized to assist in the placement of pedicle screws for narrow and variant vertebrae using the In-Out-In technique. Pedicle screws were inserted into the normal pedicles with the assistance of the "O"-arm navigation system for internal fixation to correct lateral and posterior convex deformities. Post-screw placement, the accuracy of screw placement was evaluated using the "O"-arm machine scan. After satisfactory correction, residual gaps between vertebral bodies were filled with bone grafts, and the surfaces of transverse processes and other posterior structures within the fusion range were decorticated before bone grafting. Preoperative Cobb angles of lateral and posterior convexities, as well as intraoperative details and the success of single-stage screw placement, were recorded. Follow-up was conducted until December 2023, documenting occurrences of postoperative complications such as spinal cord injury, cerebrospinal fluid leakage, wound infection, screw and rod loosening or displacement, and fractures. Full-length anteroposterior and lateral X-rays of the spine were obtained at 1 week and 1 year postoperatively to record Cobb angles of lateral and posterior convexities and calculate the correction rate. Patient or caregiver satisfaction with surgical outcomes was assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire. At the final follow-up, the bone fusion status was evaluated using the Eck fusion grading system. Results: (1) The mean operative time was (184.0±43.2) minutes, with an intraoperative blood loss of (632.0±192.7) ml. The highest instrumented vertebra was T5, and the lowest was S1. The mean number of fixed and fused segments was (9.0±2.7). A total of 216 pedicle screws were inserted, comprising 152 pedicle screws and 64 lateral pedicle screws, all successfully placed in a single attempt. Intraoperative "O"-arm scans revealed that all screws were positioned close to the inner wall of the pedicles and did not breach the vertebral canal. (2) Follow-up was conducted until December 2023, with a mean follow-up duration of (28.0±3.4) months. None of the 17 patients experienced complications such as spinal cord injury, cerebrospinal fluid leakage, wound infection, screw or rod loosening, displacement, or fracture. In 17 patients, the preoperative Cobb angle for lateral convexity was (57.8±6.6) °, and for posterior convexity was (44.0±9.6) °. At 1 week postoperatively, the Cobb angle for lateral convexity was (12.6±4.2) °, and for posterior convexity was (15.3±2.4) °. At 1 year postoperatively, the Cobb angle for lateral convexity was (15.3±2.4) °, and for posterior convexity was (15.4±2.3) °. The differences between preoperative and postoperative angles were statistically significant, while the differences between angles at 1 week and 1 year postoperatively were not statistically significant. At 1 week postoperatively, the correction rate for lateral convexity was (77.6±8.6) %, and for posterior convexity was (63.9±8.4) %. At 1 year postoperatively, the correction rate for lateral convexity was (76.8±7.1) %, and for posterior convexity was (63.6±8.6) %. There were no statistically significant differences in comparison between the two time points (t=0.272, P=0.789; t=0.123, P=0.904). The SRS scores of the 17 patients at baseline (71.8±4.2), 1 week postoperatively (83.1±4.4), and 1 year postoperatively (84.7±3.8) showed statistically significant differences (F=291.43, P<0.001). The baseline SRS score was lower than those at 1 week and 1 year postoperatively (P<0.05), but there was no significant difference between the scores at 1 week and 1 year postoperatively (P>0.05). At the final follow-up, all 17 patients achieved grade Ⅰ fusion. Conclusion: The In-Out-In screw technique for the treatment of congenital scoliosis using the "O"-arm navigation system for navigation-assisted internal fixation can safely insert the screws for the treatment of narrow variant lateral pedicles, which provides solid internal fixation, good orthopedic effect, and fewer complications.
The Impact of the COVID-19 Pandemic on Patients Diagnosed with Chronic Inflammatory Demyelinating Polyradiculoneuropathy – Three-Year Follow-Up
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) is a neurological disorder characterized by autoimmune disruption of the peripheral nervous system, resulting in progressive weakness and sensory disturbance in the extremities. Following the COVID-19 pandemic, many illnesses demonstrated unpredictable progression due to infection with SARS-CoV-2. This study aimed to evaluate the impact of the pandemic on patients with CIDP over a three-year period. We conducted a prospective study on 11 adult CIDP patients, assessing muscle strength using the Medical Research Council (MRC) sum score, sensory symptoms and functional disability with the Inflammatory Neuropathy Cause and Treatment (INCAT) disability score and overall Quality of Life (QoL) through a numerical rating scale (0–100) supplemented by a COVID-19–specific questionnaire. Results showed that 55.1% of patients were concerned about the pandemic, primarily due to fears of relatives or friends being infected. Concerns regarding CIDP status included difficulties in drug availability, limited hospital access and possible worsening of clinical presentation due to comorbidities. QoL correlated with age (rho = –0.58, p < 0.01), MRC-SS at testing (rho = +0.44, p < 0.05) and INCAT disability score at testing (rho = –0.60, p < 0.01). Patients with greater fear of COVID-19 had significantly worse QoL compared to those with little or no fear (54.1 ± 16.9 vs. 70.3 ± 17.9, p < 0.05). Our findings suggest that the COVID-19 pandemic had a significant negative impact on patients with CIDP, with contributing factors including the direct effects of the virus, psychological distress and restrictive measures that worsened disease progression.
Purulent Peritonitis Masked by Disease-Modifying Therapy: A Case Report
We report the case of a 70-year-old woman with relapsing-remitting multiple sclerosis on dimethyl fumarate therapy who presented with acute abdominal pain. Despite severe infection, her initial laboratory tests were misleading due to treatment-related lymphocytopenia. Imaging and surgical exploration revealed purulent peritonitis with a pelvic abscess. This case emphasizes the importance of early imaging and prompt intervention in immunocompromised patients with atypical abdominal presentations.
Real-World Outcomes of 25 Indian Patients Treated with Tirzepatide for Weight Loss: A 20-Week, Resource-Constrained Case Series
Background: India faces a rapidly growing obesity epidemic, with 40.3% of adults classified as overweight or obese, yet access to advanced anti-obesity medications remains severely limited by both cost and regulatory constraints. Tirzepatide, a novel dual Glucose-Dependent Insulinotropic Polypeptide (GIP)/Glucagon-Like Peptide-1 (GLP-1) receptor agonist, has demonstrated unprecedented weight loss efficacy in global clinical trials, though real-world evidence in resource-constrained settings remains limited. Methods: This retrospective case series analyzed 25 consecutive adults (BMI ≥27 kg/m²) who initiated tirzepatide therapy between March-July 2025 at a high-volume urban metabolic clinic in India. Due to cost constraints and local practice patterns, treatment duration was limited to 20 weeks maximum. Primary outcomes included percentage weight loss, glycemic control (HbA1c) and safety parameters. Results: Participants (mean age 41 years, 52% female) had baseline weight 99.4±16.1 kg and BMI 32.3±3.9 kg/m². After 20 weeks, mean weight loss was 11.3 kg (11.9%), with 72% achieving ≥10% weight reduction. Significant improvements were observed in HbA1c (-0.55±0.32%), systolic blood pressure (-14.5±4.2 mmHg) and LDL cholesterol (-52.0±8.1 mg/dL). Gastrointestinal adverse events occurred in 60% of patients but were predominantly mild and transient. Treatment completion rate was 84%, with cost cited as the primary barrier to continuation. Conclusions: In this real-world Indian cohort, short-course tirzepatide therapy demonstrated clinically meaningful weight loss and metabolic improvements comparable to international standards, despite abbreviated treatment duration. However, prohibitive costs limit broader accessibility, highlighting the urgent need for health policy interventions to improve access to effective obesity pharmacotherapy in developing economies.
Holistic Management of Treatment-Resistant Hidradenitis Suppurativa: A Cost-Effective Alternative to Biologics - A Case Report
Background: Adalimumab, the sole FDA-approved biologic for Hidradenitis Suppurativa (HS), demonstrates limited long-term efficacy with treatment resistance developing in approximately 40-60% of patients, while costing ₹240,000-360,000 annually in India. This case explores the potential of holistic intervention as a cost-effective alternative. Case Presentation: A 54-year-old female with severe HS experienced no improvement after two years of adalimumab therapy, presenting with open wounds, purulent discharge and significant pain affecting quality of life. Following adalimumab discontinuation, a comprehensive holistic protocol was implemented including complete dairy elimination, stress management through yoga and exercise, lymecycline 408mg daily for one month with antioxidant supplementation for six months and sequential topical therapy (benzoyl peroxide wash, mupirocin until wound healing, then isotretinoin 0.025%). Outcomes: Complete wound healing was achieved within 8 weeks, with sustained remission for 6 months representing the longest disease-free period in the patient's history. No adverse effects were reported and significant improvement in mental state and motivation was observed. Total treatment cost was approximately ₹2,000 (<5% of adalimumab therapy). Conclusion: This case demonstrates that evidence-based holistic approaches can achieve superior clinical outcomes to expensive biologics in treatment-resistant HS, offering a reproducible, cost-effective therapeutic paradigm with potential for widespread healthcare implementation.
A Rare Case of Rhupus Syndrome: Evolution from Systemic Lupus Erythematosus with Secondary Immune Thrombocytopenic Purpura to Rheumatoid Arthritis Overlap
Background: Rhupus syndrome is a rare overlap syndrome characterized by coexistence of Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA). The syndrome has an estimated prevalence of 0.01-2% among patients with rheumatic diseases and presents unique diagnostic and therapeutic challenges. Case Presentation: We report a case of a 31-year-old female who initially presented in September 2023 with fever, heavy menstrual bleeding, thrombocytopenia and positive Antinuclear Antibodies (ANA). She was diagnosed with SLE complicated by secondary Immune Thrombocytopenic Purpura (ITP) and treated with Intravenous Immunoglobulin (IVIG), hydroxychloroquine and oral corticosteroids. After two years of stable disease, she developed symmetric polyarthritis with morning stiffness and significantly elevated rheumatoid factor (166.64 IU/mL), leading to the diagnosis of rhupus syndrome. Discussion: This case illustrates the natural progression from SLE with secondary ITP to the development of erosive rheumatoid arthritis, a rare but well-documented phenomenon. The patient's clinical course demonstrates the classic temporal pattern where SLE manifestations precede RA symptoms by several years. Laboratory findings including elevated inflammatory markers, positive anti-nuclear antibodies and significantly elevated rheumatoid factor support the diagnosis of rhupus syndrome. Conclusion: Rhupus syndrome remains a diagnostic challenge requiring high clinical suspicion. Early recognition and appropriate management with disease-modifying antirheumatic drugs can help prevent joint destruction and improve long-term outcomes. This case adds to the limited literature on the evolution of SLE to rhupus syndrome.
Mental Health Research: A Two-Decade Bibliometric Mini-Review (2000–2024)
This mini review summarizes key findings from a bibliometric study covering mental health research from 2000 to 2024, comprising 483 publications from 279 sources. The original study examined publication growth, influential journals, prolific authors and institutions, global collaboration patterns, thematic evolutions, and trending topics. Notably, research output surged after 2018, with Psychiatric Services, BMC Psychiatry, and The Lancet as leading journals. Prominent contributors included Alonso J and Haro J, while the University of Toronto and Harvard University emerged as key institutional hubs. Co-occurrence and thematic mapping revealed four dominant themes mental health services, depression, public health policy, and socioeconomic determinants alongside emergent focus areas such as COVID-19’s mental health impact and cognitive behavioural therapy. This review highlights the progression from policy and system-level studies to more intervention-oriented, global, and socially contextualized research, while highlighting the need for greater cross-national collaboration and inclusion of low and middle-income countries.
Combined Lesser Curvature Gastrointestinal Stromal Tumor Excision and Sleeve Gastrectomy in a Bleeding Obese Patient: A Case Report
Gastrointestinal Stromal Tumors (GIST) are the most frequent submucosal lesions encountered in the gastrointestinal tract. Once encountered in the stomach, they pose several challenges in resection based on their location. Some reports have observed an increased occurrence of GISTs in obese patients, however, a correlation has not been established. Some cases of fundus Gastrointestinal stromal tumor excision during sleeve gastrectomy en-mass have been reported, however, lesser curvature GIST pose a unique challenge of fashioning the sleeve. We highlight a challenging case of excising a GIST involving the lesser curvature, followed by a sleeve gastrectomy involving the greater curvature which resulted into a unique challenge of ensuring a proper anatomical low-pressure sleeve, following endoscopic calibration. Laparoscopic excision of a gastrointestinal stromal tumor and sleeve gastrectomy involving different anatomical regions of the upper stomach can be safely performed, even in our settings, despite the challenges of fashioning a low-pressure vertical sleeve.
Gastrointestinal stromal Tumors,Sleeve gastectomy, Laparoscopy.
Attachment type and threat responses correlate via insecure attachments being more prone to display submissive threat responses and behaviours. Pinning the blame on parenting and childhood experiences for dictating our reactions, especially rape responses and the larger social effect on what contributes to the victim mentality and prevents people from speaking out against attackers. Genetics and the nervous/ parasympathetic nervous system are also looked into as causes for the submissive responses that is found more in women and especially those that are insecurely attached. There is a link between theories such as the critical period for an explanation as to why rape responses may be naturally selective in the same way rape behaviour is, the maladapted or incomplete internal working model therefore may cause a regression to a self-soothing primal state which utilises these behaviours for survival.
Unicystic Ameloblastoma from Aggressive to Conservative Treatment: A Case Report
In this study, we proposed the successful conservative treatment of a unicystic mural ameloblastoma associated with an impacted tooth. Mural ameloblastoma is a subtype of unicystic ameloblastoma characterized by the expansion or infiltration of tumor nodules into the fibrous wall of the cyst. Our conservative approach preserved the integrity of the inferior alveolar nerve as well as mandibular functionality and resulted in a good aesthetic outcome. The conservative treatment consisted of an initial marsupialization followed by the enucleation of the lesion and restoration of the defective side with xenograft bone material.
Managing of Rhinoscleroma in Children: Medical vs. Surgical Treatment - What is the Optimal Approach? - A Case Report -
Introduction: Rhinoscleroma is a chronic infection caused by Klebsiella rhinoscleromatis, rare in Morocco but endemic in parts of Africa and the Americas. It is linked to poor hygiene, immunodepression, and contact with infected individuals. The disease affects the upper respiratory tract, spreading through inhalation of contaminated droplets and can cause significant nasal and respiratory obstruction. Case presentation: A 10-year-old male presented with a 4-years history of nasal obstruction and purulent rhinorrhea. Clinical examination revealed a mass in the right nasal cavity, causing septal deviation and complete obstruction. CT and MRI confirmed the mass, extending to both sides without bone destruction. A biopsy was performed and revealed rhinoscleroma. The patient underwent surgical excision. The histopathological analysis confirmed the diagnosis. The clinical evolution was favorable, with complete resolution of the mass and relief of nasal obstruction, all without long term antibiotic treatment. No recurrence was observed during follow-up. Conclusion : the main takeaways are that surgery alone was sufficient, with no need for postoperative long term antibiotic therapy , contrary to the literature. The patient had full recovery with no recurrence. Surgery is a viable alternative to long-term medical treatment, especially in children or when antibiotics are contraindicated.
A Case Study on Gossypiboma: Identifying a Hidden Surgical Adversary
Gossypiboma is a rare but dangerous surgical complication that can be explained as a retained foreign body mass of cotton (sponge, abdominal mop or gauze) within the body following a surgical treatment. According to estimates, retained surgical items occur in 1 in 5500 to 1 in 18,000 surgical procedures, making them a rare complication. Owing to its serious medicolegal implications it remains underreported leading to a blurred clinical spectrum. This fact is also depicted in our case which presents an array of nonspecific symptoms painting a picture of possible malignancy. Wilson documented the first retained foreign body following a laparotomy in 1884. The case study focuses on a young fertile woman who had subtotal hysterectomy with bilateral internal iliac ligation in a tertiary care hospital. Following the procedure, she experienced acute abdominal pain because of a retained abdominal mop. The abdominal mop moved transmurally and became lodged in the ileocolic junction. Following the removal of the intra-luminal abdominal mop and abdominal closure, she experienced uneventful post-operative time period. This case emphasizes the need of following surgical standards and how even tiny mistakes can have serious consequences. This demonstrates the necessity of combining technology and medicine, leading to the adoption of innovations like electronic counting and sponges with Radio-Frequency Identification (RFID) tags to reduce human error.
Treatment of Penile Melanosis with Timedsurgical Mixed Peeling 0.5: Case Report
We developed the 0.5 mixed peeling technique to remove facial and body blemishes and it has now been used to treat penile melanosis. Mixed peels include three standardized physicochemical techniques using specific diathermic currents and resorcinol. Resorcinol in aqueous solution is effective only on de-epithelialized, microperforated or permeabilized skin, not intact skin. Timedsurgical de-epitelialization is used for extensive and deep hyperpigmentation, depigments normal pigmented skin in two treatments and eliminates lip wrinkles, roughness and festoons of the lower eyelids in a single treatment. Micro perforation or Electroporo Cosmesis is used for extensive superficial pigmentations, melasma, erythrosis and roughness of the face and body. The 0.5 mixed peel with permeabilization treats individual blemishes that lighten while decreasing the number of melanocytes without the risk of permanent hypopigmentation.
Comparative Analysis of Prehospital Response Times in Ischemic Stroke Cases: A Study from Verona Province
Abstract: Ischemic stroke represents one of the most significant causes of morbidity and mortality worldwide, with early recognition and timely prehospital intervention playing a crucial role in improving overall patient outcomes. In Italy, stroke continues to be the second leading cause of death, with an annual incidence estimated to range between 95 and 290 cases per 100,000 inhabitants. Given the substantial burden of this condition, optimizing prehospital management is of paramount importance. Methods: A retrospective observational study was conducted analyzing 1,051 emergency cards from the calendar year 2023 with a final diagnosis of ischemic stroke. After applying exclusion criteria, 944 cases were evaluated, managed by different emergency medical services: nurse-staffed ambulances (MSI, n=762), helicopter emergency medical services (HEMS, n=20), physician-staffed ambulances (MSAn=33), and medical -care services (n=129). Primary outcomes measured were time on target for each service type and the impact of advanced airway management on these times. Comparative analysis was performed between different service types and between intubated vs. non-intubated patients. Results: Both nurse-staffed (average: 22 min) and physician-staffed ambulances (average: 18 min) demonstrated significantly shorter time on target compared to medical car (average: 41 min for intubated patients, 29 min for non-intubated patients). HEMS maintained comparable times to nurse-staffed ambulances (average: 21 min for non-intubated patients, 25 min for intubated patients). The overall intubation rate for ischemic stroke patients was 1.23% (13/1,051), with similar rates between HEMS (10%) and road-based physician services (9%). Orotracheal intubation increased time on target by an average of 4 minutes for HEMS teams and 12 minutes for road-based physician teams. Conclusions: In conclusion, when responding to patients with a suspected ischemic stroke who are not expected to require advanced airway management, the most efficient and time-sensitive emergency medical response options are ambulances that are staffed either by nurses (MSI) or by physicians (MSA). These types of vehicles enable prompt on-scene assessment, stabilization, and transportation to an appropriate medical facility without unnecessary delays.
The neurobiological and naturally selective roots of autism revolve around the testosterone effect, the extreme male brain theory and various post-hoc hypotheses that state the advantages of neurodivergence in the ancestral plain. Then reverting to a modern-day context, testosterone and lower-functioning autism cases are on the decline, however, neurodivergence as a whole is on the increase. Papers on the inbreeding of hominid ancestors explain the overlap of neurodivergent genes such as Attention-Deficit Hyperactivity Disorder (ADHD) and autism. Then it comes to an ultimatum that without the inhibition of testosterone, autism returns to its naturally selective roots in an information-based, individualistic society and shows that we as a society must become far more educated and understanding of neurodivergence as it will continue to become increasingly common as we are all integrated into the spectrum.
Attention-deficit hyperactivity disorder
Transcatheter Sinus Venosus ASD Closure: A Case Series of First Ever Transcatheter Closure of the Defect in Pakistan
Superior sinus venosus atrial septal defect is a direct communication between the right and left atrium located above the fossa ovalis below the junction of the superior vena cava and the right atrium. It is associated with partial anomalous pulmonary venous drainage, especially of the right upper and middle pulmonary veins. Over the years, surgical repair of the defect has been primary approach to close that defect. However, since 2014, percutaneous closure of the defect has gradually become a safe and effective alternative to surgery in carefully selected patients, although worldwide experience remains limited. This case series highlights three cases of first ever transcatheter sinus venosus atrial septal defect closures in Pakistan. Understanding the anatomy of the crossroads formed by the Right Upper Pulmonary Vein (RUPV) ostium, the SVC orifice, the Right Atrium (RA), and the Left Atrium (LA) above the level of the unroofed atrial septum is key to appreciating the procedural concept. This article provides a comprehensive, up-to-date description of percutaneous management of SVD, detailing preprocedural screening, multimodality imaging for case planning and guidance, and procedural steps. It also summarizes a comprehensive overview of the contemporary clinical outcomes of the transcatheter SVD closure. It also underscores the importance of the fact that transcatheter closure of this defect can easily be achieved, significantly reducing patient’s morbidity as opposed to open heart surgery. We believe that modified techniques along with growing experience of interventionalists all over the world will further enhance safety and expand the role of transcatheter closure of SVD.
Efficacy of Three-Dimension Curved Angle Plate versus Two Miniplates in Mandibular Angle Fracture Fixation
In this study, we proposed to determine the superiority or inferiority of the 3-D fixation method and two miniplate fixation methods in mandibular angle fractures. The purpose of this study was to evaluate the efficacy ofa3Dcurved angle strut plate and two miniplates in mandibular angle fracture fixation. The aim of this study was evaluate the efficacy of three dimension curved angle strut plate versus two miniplates in mandibular angle fracture fixation. Sixteen patients requiring internal fixation of the mandibular angle fractures divided into two groups eight in each group, group I was treated with using 3D curved angle strut plate. Group II was treated using two 2-mm miniplates. The results of this study suggested that there are statistically significant in time elapsed between plate adaptation and definitive fixation (min) between two groups. Conclusions: The 3D curved angle plate has relatively few or no postoperative complications compared to other techniques.
Is Navigation a Game Changer in Single Level Transforaminal Lumbar Interbody Fusions (SL-TLIFs)?
Introduction: Spinal surgery involves different techniques and treatment strategies. Intraoperative navigation by 3D tomography (IoCT) is used to facilitate the insertion of pedicular screws. Better accuracy has been demonstrated by several studies when using navigation compared to fluoroscopy. However, no study as far as we know, investigated the operative outcomes of navigation during single-level transforaminal interbody fusion (SLTLIF). Objectives: Our goal was to evaluate the impact of Computer Assisted Navigation during SL-TLIF in terms of operative time, hospitalization, blood loss and number of surgical revisions up to 6 months postoperatively when compared to fluoroscopic guidance. Methods: This is a retrospective, single center, case-control study. Patients submitted to SL-TLIF between 2016 and 2020 with fluoroscopy (Fluoro) or loCT navigation (Nav) were evaluated. We excluded traumatic, oncological, infectious, minimally invasive cases, anterior and lateral cases and all those performed on more than one level. Demographic, clinical, and surgical data were collected. Results: One hundred and seventy-six patients were included, 54 (30.68%) in the Nav group and 122 (69.32%) in the Fluoro group. A statistically significant difference in operative time (OT) was reported (Nav 185.93 Vs. Fluoro 163.24, p=0.003), with an average OT of 170 min. The revision rate was also significantly different, with 8 revisions of surgery in the Fluoro group and none in the Nav group (6.6% of GF patients, p=0.050). No statistically significant difference was found for blood loss (Nav 270.83 ml vs. Fluoro 277.28 ml p=0.827) and hospitalization time (days) (4.31 for Nav vs. 4.65 for Fluoro p=0.302). Discussion: Despite the increase in operative time in the Nav group, navigation does not involve increased blood loss or longer hospital stay. We observed a lower rate of reoperation in the Nav group during the first 6 months postoperatively. Conclusions: The use of IoCT navigation is safe, effective, and provides advantages even when used to perform single level TLIF.
Hystero-Laparoscopic Communication of Right Non-Communicating Horn of Robert’s Uterus in a 16-Year-Old Girl with Severe Dysmenorrhea and Hematometra: A Case Report
Introduction: Robert’s uterus, first described in 1970, is a rare variant of a complete, oblique septate uterus characterized by a non-communicating hemi-cavity and a contralateral unicornuate cavity. This anomaly can lead to obstructed menstrual flow, resulting in hematometra and associated complications such as hematosalpinx and endometriosis. We report a case of Robert’s uterus in a 16-year-old girl, highlighting the restoration of uterine anatomy. Case Details: A 16-year-old girl presented with severe dysmenorrhea and prolonged menstrual flow since menarche. Previous MRI indicated a Mullerian duct anomaly with a non-communicating rudimentary horn. After initial management involving hystero-laparoscopy and drainage of hematometra, she experienced recurrent dysmenorrhea. A second hystero-laparoscopic procedure revealed adhesions, and the non-communicating horn was surgically communicated with the main cavity. The patient was discharged with oral contraceptives, and follow-up ultrasound showed a normal-sized uterus and regular, pain-free menstruation. Discussion: Robert’s uterus arises from incomplete resorption of the uterine septum, leading to unique anatomical features and potential complications, including subfertility. Traditional management has included laparotomy; however, minimally invasive techniques like hysteroscopy and laparoscopy are now preferred due to reduced surgical trauma and better preservation of fertility. Conclusion: Robert’s uterus is a rare anomaly that requires awareness among healthcare providers when evaluating young women with severe dysmenorrhea or suspected endometriosis. Timely diagnosis and appropriate management are essential to prevent severe complications and preserve future fertility, with hysteroscopic resection offering promising reproductive outcomes.
Managing a Traumatic Scalp Wound with Adequate Hydration with Mineral Oil: Case Report
Scalp reconstruction primary management include primary closure as well as local flaps. We present a 2-year-old male patient brought to the emergency room presenting a traumatic frontal laceration and a scalp wound located at the left temporal area. He was taken to the operative room; wounds were washed and sutured with a two-plane closure and a Penrose drainage was used. In the first post operative day the flap became ecchymotic, for which hydration with mineral oil was increased. At the 4th post operative day, the flap started to enhance its color becoming reddish. Patient was discharged at his 7th day, after removing the frontal stiches and Penrose. Temporal wound stiches were withdrawn posteriorly showing an adequate healing process. Scalp wound reconstruction represents a great challenge for any plastic or reconstructive surgeon, in which the main goal is to achieve an aesthetic outcome with the minor donor morbidity.
Intrauterine Device Migration to the Broad Ligament: A Case Report and Comprehensive Review of Complications
Intrauterine devices (IUDs) are among the most commonly used contraceptive methods, with approximately 150 million users worldwide, particularly in developing regions. Although generally safe and effective, IUDs can occasionally lead to complications, such as uterine perforation and migration into adjacent structures. We report the case of a 45-year-old woman who presented with chronic pelvic pain following IUD insertion. Ultrasound imaging confirmed an abnormal location of the device, and laparoscopy subsequently revealed migration of the IUD into the broad ligament. This case emphasizes the need for clinicians to consider IUD migration in patients presenting with pelvic pain post-insertion, highlighting the importance of timely diagnosis and minimally invasive surgical management.