Reports, Volume 7, Issue 2 (June 2024) – 11 articles

Aim and background: Periapical lesions, which occur due to the infection and necrosis of dental pulp, are a significant dental pathology that poses risks to oral and systemic health. These lesions often require interventions such as root canal treatment or periapical surgery. Recent research has focused on the effectiveness of biocompatible materials, including mineral trioxide aggregate, bioceramics, and leukocyte-platelet-rich fibrin (L’PRF), in improving healing outcomes. This report presents the application of leukocyte-platelet-rich fibrin (L’PRF) derived from the patient’s autologous blood to enhance bone healing. Case description: A 61-year-old woman with well-controlled hypertension and good oral hygiene visited the dental clinic due to a painless swelling near her upper left central incisor. After examination, it was determined that she had a periapical granuloma. The patient underwent successful root canal retreatment and apical surgery, during which leukocyte-platelet-rich fibrin was applied. After 30 months, she experienced significant improvement with no symptoms and substantial bone regeneration. Conclusion: Clinical evidence and this case study indicate that leukocyte-platelet-rich fibrin (L’PRF) may enhance healing post periapical surgery. Further research, including more extensive and longer-term randomized trials, must confirm L’PRF’s effectiveness and refine treatment protocols. Clinical significance: L’PRF enhances bone healing post periapical surgery. Clinicians should consider integrating L’PRF in periapical surgeries, ensure diligent follow-up, and inform patients of its long-term advantages. Further randomized trials are needed to refine L’PRF clinical guidelines. Full article

Background: Resistant bacteria causing urinary tract infections (UTI) are becoming increasingly common worldwide. Patients suffering from such UTIs are often elderly, with complex medical backgrounds, and require prolonged hospital stays due to the frequent need for intravenous antibiotics. The alternative hospital-at-home (HAH) option for such patients should, therefore, be explored. Methods. We present our experience in the treatment of patients with extended-spectrum beta-lactamase (ESBL) infections treated through our HAH service. Results: Eleven such patients were included in our HAH service between February 2022 and December 2023 (median age: 79 years; 64% females; 57% had diabetes mellitus in their background). Of these patients, 27.2% had urinary instrumentations and 81.8% had a history of previous UTIs, of which 77.7% had resistant bacteria. The most common pathogen (7 out of 9 patients) was Escherichia coli. All eleven pathogens were resistant to ceftriaxone and ciprofloxacin. The mean length of hospitalization was 5 ± 2 days. Eight patients (72.7%) did not experience recurrent UTIs. Only two patients (18.2%) experienced acute kidney injury, which resolved during their HAH stay. Two patients died during a 30-day follow up from causes unrelated to their UTI. Conclusions: Treatment of patients presenting with urinary tract infections with resistant ESBL pathogens in the setting of a telemedicine-assisted, hospital-at-home setting is both effective and safe. Full article

Background: Lung cancer, particularly small-cell lung carcinoma (SCLC), often presents with respiratory symptoms. However, atypical manifestations including jaundice and abdominal pain can obscure the diagnosis, leading to challenges in early detection and treatment. Case Presentation: A 49-year-old male, with a history of smoking and diagnosed with Chronic Obstructive Pulmonary Disease (COPD), presented to the emergency department with a 3-day history of jaundice and a 3-week duration of mild abdominal pain. Initial investigations, including blood tests, showed hyperbilirubinemia and elevated lipase and amylase levels. An abdominal ultrasound was performed and revealed a hypoechoic, inhomogeneous mass in the head of the pancreas and multiple liver masses, suggesting a cephalo-pancreatic formation with liver metastasis. Further diagnostic procedures, including upper endoscopy and ERCP, followed by a TAP CT scan, identified a large mediastinal-pulmonary mass with invasion into major vessels and extensive metastasis. The immunohistochemical analysis of a duodenal ulcer biopsy confirmed a diagnosis of duodenal metastasis from a small-cell neuroendocrine lung carcinoma. Conclusion: Our case highlights that while rare, the possibility of metastatic spread should be included in the differential diagnosis when obstructive jaundice occurs in the context of high-risk factors for lung cancer. Full article

Obstructive sleep apnea (OSA) may be linked to various factors that narrow the upper airways, such as obesity, adenotonsillar hypertrophy and craniofacial abnormalities. Hypothyroidism has also been described as a risk factor for OSA. However, the implication of goiter independently of thyroid function in the occurrence of OSA remains unclear. We present the case of a 66-year-old woman with a large compressive multinodular goiter for whom total thyroidectomy was indicated. During the preoperative assessment, the patient had a body mass index (BMI) of 37.8 kg/m² with symptoms of OSA. Respiratory polygraphy confirmed the diagnosis of severe OSA (apnea–hypopnea index (AHI) = 32), and treatment with continuous positive airway pressure (CPAP) was initiated prior to thyroid surgery. Surprisingly, after total thyroidectomy, OSA symptoms disappeared, and the patient abandoned CPAP therapy. Subsequent respiratory polygraphy after thyroidectomy showed a decrease in AHI to a normal value (AHI < 5). Interestingly, there was no change in BMI or other factors explaining the resolution of OSA, except for thyroidectomy. This case report suggests that goiter can be considered a risk factor for OSA. However, prospective studies are needed to accurately assess the effects of goiter on the occurrence of OSA according to its dimensions and local extension. Full article

Atypical teratoid/rhabdoid tumors (AT/RT) are highly aggressive tumors of the central nervous system (CNS), accounting for 1–3% of all pediatric CNS tumors. In general, AT/RTs are associated with biallelic inactivation of SMARCB1, resulting in the loss of expression of the integrase interactor 1 (INI1) protein. In this report, we describe the clinical course of an infant patient who presented with fatigue, postprandial vomiting, and disability of left side movement. Histological examination revealed classical features indicative of rhabdoid tumors, yet an atypical immunohistochemical profile with preserved INI1 expression was observed. Molecular diagnostics further elucidated the presence of a heterozygous frameshift variant, SMARCA4 c.2693del, p.(Asn898Thrfs*12), underscoring the distinctive genetic foundations of the case. Surgical resection of the tumor was administered with subsequent chemotherapy to the patient, but the condition worsened dynamically, and a decision was made to give the patient palliative therapy. We report on a patient with AT/RT caused by a rare mutation of the SMARCA4 gene and an aggressive course of disease to provide more information and characteristics of these tumors. Full article

Facial nerve palsy is most commonly idiopathic, but it can also result from infections, inflammatory and cerebrovascular disorders, tumors, and trauma. We report the case of a 68-year-old patient who developed iatrogenic facial nerve palsy subsequent to dermatological cryosurgery on the right cheek. Remarkably, a full recovery occurred within 8 weeks. Drawing upon the promising outcome of this case and the existing literature on neuropathies linked with cold application in sports injuries, we propose neurapraxia as the probable pathomechanism underlying cryotherapy-induced nerve damage. Full article

Background and objective: Lung cancer is increasingly common, and accurate diagnosis is important for personalized treatment. Ultrasound-guided percutaneous fine-needle aspiration (FNA) is a useful method to obtain a specimen for a histological diagnosis of peripheral lung lesions. The aim of this study is to evaluate the diagnostic accuracy and complication rate of the procedure performed by pulmonologists. The result is compared with that of ultrasound-guided core needle biopsy performed by radiologists. Methods: We retrospectively evaluated the diagnostic accuracy and complication rates of pulmonologist-performed ultrasound-guided FNAs of lung lesions in the period of 1 August 2019 to 30 June 2021 (pulmonologist group) and radiologist-performed ultrasound-guided core needle biopsies (CNBs) of lung lesions in the period of 1 January 2010 to 31 December 2014 (radiologist group). A logistic regression analysis was used to identify independent influence factors associated with diagnostic accuracy in the pulmonologist group and in the combination of both groups. Results: In a 23-month period, pulmonologists in a tertiary center performed 113 episodes of ultrasound-guided fine-needle aspiration for peripheral lung lesions. The diagnostic accuracy and complication rates were 80.4% and 5.3%, respectively, compared to 86.8% and 7.4% in a historical cohort consisting of 68 episodes of ultrasound-guided core needle biopsies performed by radiologists in the same hospital. Lung lesions located in the upper lobe were predictive of successful diagnoses. Conclusions: An ultrasound-guided fine-needle aspiration by a pulmonologist is an easily accessible and reliable method to obtain specimens for histological diagnoses. Full article

A rise in fungal infections has been observed worldwide among patients with extended hospital stays because of the severe infection caused by the new coronavirus pandemic. A 62-year-old female patient was admitted with a severe form of Coronavirus disease 2019 (COVID-19) and spent four weeks in the intensive care unit (ICU) requiring mechanical ventilation support before being moved to a tertiary hospital for further testing. Aspergillus fumigatus filamentous fungus, Candida spp., and positive bacteriology for multidrug-resistant Klebsiella pneumoniae and Proteus mirabilis were identified by bronchial aspirate cultures. The patient’s progress was gradually encouraging while receiving oral antifungal and broad-spectrum antibiotic therapy along with respiratory physical therapy; but ultimately, thoracic surgery was necessary. Long-lasting tissue damage and severe, persistent inflammatory syndrome were the two main pathophysiological mechanisms that led to significant outcomes regarding lung lesions that were rapidly colonized by fungi and resistant flora, cardiac damage with sinus tachycardia at the slightest effort, and chronic inflammatory syndrome, which was characterized by marked asthenia, myalgias, and exercise intolerance. Full article

The amnion rupture sequence is a rare condition occurring early in pregnancy, resulting in complex fetal anomalies by disrupting normal embryonic development. The prevalence of amnion rupture sequence is reported to be 1.16 in 10,000 live births. This article explores the uncommon case of early amnion rupture leading to fetal encephalocele, suspected in the first trimester. Despite the variable and intricate nature of anomalies associated with this condition, cranio-facial and abdominal defects are frequently observed. Genetic testing was conducted, with normal results supporting our theory of amnion rupture. The patient decided to terminate the pregnancy, and the anatomopathological results confirmed the findings. This article discusses the diagnostic challenges, emphasizing the importance of timely identification through advanced imaging techniques. Full article

West Nile Virus (WNV) is an arbovirus endemic to many countries and has caused over 56,000 cases, with 2776 deaths in the U.S. from 1999 to 2022. WNV occurs most often in the fall, typically affecting elderly populations in states like Nebraska and Arizona. Currently, supportive care is the only management for WNV. Our case is a female patient in her mid-70s in an intermountain state who presented in the fall with WNV meningoencephalitis and experienced a delay in care due to the unique clinical presentation. This demonstrates the importance of early inclusion of WNV in the differential for altered mental status, especially with WNV risk factors, and expedition of supportive care. Doing so could potentially reduce antibiotic duration and hospital costs. Full article

This case report provides us with insight on how blood glycemia affects refraction, vergence and accommodation in a single diabetic patient. A 21-year-old type I diabetic woman was the subject studied in this report. Refraction, near and far fusional vergence ranges, near point of convergence, monocular accommodative facility, amplitude of accommodation, lag of accommodation, and near and far phoria, were measured before and after controlled caloric intake and insulin injection. Measurements were taken a total of 10 times, once a week for 10 consecutive weeks. Blood glycemia levels were provided by a measuring device that was attached to the patient’s body at all times. Statistically significant differences were found in the glucose levels before and after lunch, p = 0.041, sphere refraction of the right eye, p = 0.016, but not in the left eye, p = 0.051. Accommodative facility in both right and left eyes, p = 0.019, p = 0.028, respectively, and amplitude of accommodation, p = 0.016, p = 0.019, right and left eyes, respectively were statistically different before and after insulin injection. In a 21-year-old subject with type I diabetes, a diminution in blood glucose levels influences refractive myopic state, and is associated with a decrease in accommodative facility and in amplitude of accommodation. Full article