https://www.clinsurggroup.us/journals/global-journal-of-medical-and-clinical-case-reports A Peertechz Open Access Journal en-us 26 Nov, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-286.php Diarrhea is not a solitary illness but is a part of different conditions. It is characterized by a rise in gut movements and an augmented liquidity of stools. Diarrhea can be acute or chronic concerning the duration of symptoms, and infectious or non-infectious concerning etiology. The differential diagnosis is noticeably large and consequently, the diagnostic tools and pathway are very multifaceted. We present the case of a 74-year-old male, with a history of acute abdominal pain, diarrhea, and fever. Several exams were made but only an examination of the stool samples came back positive for Anisakis. It is a risen infection due to augmented consumption of undercooked fish. Most cases are overlooked because of the wide-ranging variety of symptoms that make the diagnosis challenging. The diagnosis is based on the endoscopy or laparotomy. In symptomatic patients’ physical removal of the Anisakis larva using an endoscope is often curative, while anthelmintics, such as albendazole, can be used although they are not extremely efficacious. Though it is an unusual infection, clinicians should be conscious of it in patients with gastrointestinal symptoms. 20 Nov, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-285.php Acute inflammation of the lung tissue, despite the constantly declared reports on the achievement of success in the treatment of these processes, remains one of the urgent problems of modern medicine, having turned in recent years into a subject of concern and unpredictability of the final results. The reason for this state in solving this problem is the inattention to a number of side effects of antibiotics, which still play the role of the main therapeutic agent for these diseases. The hope for a narrowly targeted antimicrobial action of these drugs leaves aside the classical canons of medical science. All the noted facts indicate the decisive role of didactic education under the influence of antibiotics in choosing adequate and effective solutions. 20 Nov, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-284.php Scurvy is a disease caused by vitamin C deficiency, although it is rare in the modern world, it can occur in vulnerable populations: children and adults with eating disorders, residents of the Arctic who do not have their own fruits and vegetables, and people with low social status. The goal is to use the example of this clinical case to acquaint doctors with the variable clinical manifestations of vitamin C deficiency in children, in order to increase vigilance and timely prescription of cheap and affordable drugs. A clinical case of scurvy is described in a 4-year-old child with an autism spectrum disorder who is selective in food, with laboratory-confirmed vitamin C deficiency. The girl was hospitalized in the pediatric department of the Volyn Regional Territorial Medical Association for the Protection of Motherhood and Childhood with complaints of acute lameness and a hemorrhagic rash on the skin, which had been bothering her for the past 6 months. During the past six months, she was treated on an outpatient basis - however, her condition persisted without improvement. Due to the rarity of the disease, the “diagnostic odyssey” was long. After numerous laboratory and instrumental examinations, the child was diagnosed with scurvy, and the appointment of therapeutic doses of vitamin C led to a complete recovery. Conclusion: Although scurvy is rare in the modern world, it can develop in vulnerable populations. In children with acute lameness, it is important to collect a nutritional history. If the diet consists mainly of products poor in vitamin C, and the symptoms are typical for scurvy, it is worth examining the patient for the level of ascorbic acid in the blood. 08 Nov, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-283.php The paper presents the results of studies on the effect of additives on crystallization in solutions simulating the composition of human blood plasma. Synthesis from prototypes of human blood plasma in the presence of organic and inorganic additives was carried out, and it was found that the obtained solid phases consisted of octacalcium phosphate, B-type carbonate hydroxyapatite, and vitlocite. The effect of additives (magnesium ions, alanine, and glycine) on the crystallization of calcium phosphates was studied. It was found that the presence of additives in the model solution reduces the crystallite size and the fraction of carbonate hydroxyapatite in the solid phase. The bioactivity of synthetic samples was studied, and kinetic characteristics were established. A study of thermal transformations. 05 Nov, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-282.php Medical textiles of a self-inflating air mattress bed and belt include an air chamber and a foam panel therein. The air chamber is defined by top and bottom sheet panels and a valve allowing air passage into and out of the air chamber. The foam panel includes the field of airflow passage there through, and the top and bottom sheet panels are mechanically coupled directly together via the apertures in the foam panel of the air mattress conducted to improve sleep quality. This study investigated the effect of variations in the surface characteristics of mattress beds and belts on pelvic fracture patients’ sleep quality. The present study developed a mattress bed and belt whose rigidity can be varied by controlling the amount of air in its air cells. To investigate the effect of the variable rigidity of the air mattress bed and belt on pelvic fracture patients’ sleep quality, participants (women, ages 13-45) were instructed to sleep on the air mattress bed and belt under different conditions, and their sleep quality was subjectively and objectively investigated. Subjectively, sleep quality is assessed based on the participants’ evaluations of the depth and length of their sleep. Objectively, medical textiles for pelvic fracture patients and mattress bed and belt specifications are estimated using the sleep stage information obtained by analyzing the movements and brain waves of the participants during their sleep. A subjective assessment of the sleep quality demonstrates that the participants’ sleep was worse with the adjustment of the air mattress bed and belt. 19 Jul, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-281.php The Markov Models of genomic elements are newly considered. The representation of the fundamental matrix of the Markov model is newly theorised. The order of magnitude of the initial conditions for the elements of the transition probabilities is newly hypothesised. The model is compared with a sub-Hidden Markov Model of genomic events. The chosen representation of the states is newly proven to consist of an enveloping algebra. The new condition is posed on the Markovian feature of the originating chain from the study of the elements of the loci of the state space; in this case, the choice of the representation of the probability matrix is analytically spelled out, and Monte Carlo methods are not necessitated. 30 Apr, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-280.php Background: Mediastinal teratomas are rare tumors and the majority of them are mature teratomas, benign lesions characterized by slow growth and low malignant potential. Signs and symptoms are infrequent; hence the diagnosis is often incidental. Complicated cases are rare and are traditionally treated with elective surgery. Our case report presents a patient with a teratoma complicated by pericardial fistulization requiring emergency surgery: the only case described in the literature. Case presentation: A 36-year-old male with no relevant medical history reported acute thoracic pain. Chest CT scan shows a mediastinal mass (compatible with cystic teratoma) compressing the superior vena cava, the heart, and pericardial involvement. The patient was first subjected to pericardiocentesis and then an en-bloc resection of the mediastinal lesion was performed via sternotomy. Discussion and conclusion: Mediastinal lesions require an accurate differential diagnosis, despite the diagnosis often being incidental in the absence of clinical symptoms. Conversely, if symptomatic, complicated cases can lead to life-threatening situations, where the exeresis of such lesions might require urgent, complex, and multidisciplinary surgical intervention. 12 Feb, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-279.php Background: The COVID-19 pandemic priorities have focused on prevention by detection and response. National governments’ prevention response decisions are based upon detection statistics from PCR (polymerase chain reaction) tests that are used to define numbers of (i) COVID-19 infected persons, (ii) COVID-19 hospitalisations, and (iii) COVID-19 deaths. These statistics assume a priori that PCR tests are nigh 100% true detectors of COVID-19 infections. Here we will provide an alternative interpretation, along with the compelling evidence, that false positives have distorted to some degree the statistics of the primary outbreaks, and account for almost the whole of the 2nd and subsequent apparent COVID-19 outbreak peaks in various countries. Methods: We extract from the published literature on PCR-test outcomes graphical data that reveals the evidence for a very large percentage of false positive results. We review the role of exosomes in the immune response to all respiratory viral infections and its effect on PCR tests. We hypothesise that exosomes, triggered by all viral respiratory infections, are largely responsible for positive outcomes from PCR tests for COVID-19. We test our alternative interpretation for consistency with the empirical epidemiological trends as published by the World Health Organization (WHO). The Scientific Method is used to direct our research efforts. Findings: We find that PCR testing data for the second and following waves of the COVID-19 pandemic indicate that these waves are mainly artefacts of false-positive results. We find that this interpretation provides a more consistent explanation of the known epidemiology of COVID-19 than the hitherto consensus notion of extremely contagious and rapidly mutating viruses. Interpretation: The RNA (ribonucleic acid) code detected in PCR tests, previously attributed to SARS-CoV-2, belongs instead to a respiratory-virus-induced immune system response by human cells that liberate exosomes, and that vitiate PCR test results. PCR tests have zero specificity in vivo due to the exosome RNA. PCR tests exhibit excellent specificity in vitro on pure samples of other respiratory viruses. The low success rate of vaccines in preventing COVID-19 is explained by the inexact identification of the SARS-CoV-2 RNA. 02 Feb, 2024 https://www.clinsurggroup.us/articles/GJMCCR-11-278.php Posterior Reversible Encephalopathy Syndrome (PRES) is an entity that has gained importance in recent years. The diagnosis is clinical-radiological. Clinically, the patient presents neurological alterations such as headache, decreased level of consciousness, seizures, and visual disturbances. Radiologically, it includes cerebral oedema, predominantly of the white matter of parietal-occipital regions on magnetic resonance imaging. Multiple situations can trigger this condition, including high blood pressure, immunosuppressants, steroids, and chemotherapy well-known risk factors. An early diagnosis and adequate treatment are essential to avoid the appearance of sequelae in these patients. This case consists of a patient diagnosed at 11 years of age with a bifocal non-germline tumour in the brain who, after treatment with chemotherapy, presented a clinical deterioration with instability compatible with septic shock. Subsequently, he presented a sudden alteration in the level of consciousness accompanied by hypertension and renal failure, which was suspected of PRES after a brain CT imaging test. 27 Nov, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-277.php The study was conducted to assess the level of adoption of improved cassava processing technologies by cassava processors in Oyo State, Nigeria. A multistage sampling technique was used to select 190 cassava processors in Oyo state. Data was collected through an interview guide while descriptive statistics was used to achieve the objectives. The mean age of the respondents was estimated at 47 years and 90.00% of the respondents were married. The mean household size and years of experience were 6 persons and 11 years respectively. The majority (64.21%) had a secondary occupation (64.21%) while 66.32% of the respondents received credit. Only 7.37% of the respondents received information from extension agents. About 92.63% get information from other sources like radio, fellow professors, friends, and relatives. The major constraints encountered by the respondents include inadequate credit facilities, inadequate extension contact high cost of cassava tubers, and high costs of hiring cassava processing machines. Therefore, extension services on improved cassava processing technologies should be intensified in the study area by offering services, especially in aspects that show low adoption in this study like the mechanical peeler and fryer. 08 Nov, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-276.php Background: The aim of this study is to compare the effect of Bone Morphogenetic Proteins (rhBMP), carried on a gelatin sponge scaffold in comparison with the Xenograft BioOss® in the management of bone defects. Case presentation: The case is a one-year-old rabbit that had 4 identical holes 5*5 mm within the femur bone, BMP2 was placed within the first hole with a gelatin sponge, and the second defect was left empty. A gelatin sponge was placed alone within the third hole, and a BioOss® graft was placed within the last defect. The radiographic evaluation was conducted (1 and 2) months after the surgical work, and the histological assessment was conducted two months after the surgical work. Results: The results of the radiographic evaluation found that healing the BMP2 hole was better than healing in the empty and the gelatin sponge group holes. There was no big difference between the healing in the holes filled with rhBMP2 with gelatin sponge and the healing in the holes filled with BioOss®. Conclusion: The use of a gelatin sponge impregnated with Bone Morphogenetic Proteins improves and accelerates the healing of bone defects and is comparable to the effectiveness of using a BioOss® graft. 16 Oct, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-275.php Background: Columellar skin necrosis is a rare complication of Septorhinoplasty procedures. However, it is more frequent in patients who undergo multiple revision procedures and have poor skin quality. Therefore, some patients require wound care immediately post-operation. Dressing of the columellar region is difficult due to the location and anatomical configuration. Case presentation: In this paper, we present a case of partial necrosis of the columellar skin following an open Septorhinoplasty procedure which was noted on the first post-operative day. Improving circulation to the affected area was the key target of the treatment approach. Conclusion: A topical hemoglobin-based oxygenating spray (Granulox, SastoMed GmbH, Georgsmarienhütte, Germany) was applied immediately on the columellar skin wound as it is a simple and easy dressing material and can lead to healing without obvious scarring. Key points Question: Would an early, minimally invasive intervention with a hemoglobin-based oxygenating spray in a patient who was diagnosed with partial columellar skin necrosis 24 hours post revision Septorhinoplasty - without the need for surgical management provide a satisfactory outcome? Finding and meaning: The treatment yielded a good aesthetic outcome in a short duration with no significant side effects and demonstrated the ease of treating a difficult complication without the need for more surgeries. 14 Oct, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-274.php People’s Daily life and physical health are often plagued by viruses and bacteria. The novel coronavirus epidemic several years ago has seriously affected the global economy and social life. In addition to vaccination, ecologically safe and long-term and effective disinfection methods are very necessary. Ozone is an efficient and broad-spectrum bactericidal disinfectant, and the trace level of ozone in the atmosphere can make many viruses and bacteria lose their biochemical activity and infectivity. Nature produces trace amounts of ozone in the air through lightning to achieve the purpose of purifying the ecological environment. The product of ozone decomposition is oxygen, without secondary pollution. Ozone sterilizer has been widely used in epidemic prevention and control in intensive breeding farms and has achieved remarkable effects. If the concentration and action time can be accurately controlled, then ozone can effectively eliminate pathogens without harming normal cells in the human body. Therefore, the use of mini household ozone disinfectors for personal epidemic prevention and health care is a topic worth serious research. Shanghai Finerule Company has done a lot of tentative work in this respect and has achieved some good results. 29 Sep, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-273.php Background: A Placental Site Trophoblastic Tumor (PSTT) is a rare form of gestational trophoblastic disease and usually manifests itself with abnormal uterine bleeding and elevated β-hCG serum levels even months or years after any antecedent pregnancy event. Typically, tumors are confined into the uterus and secrete lower levels of β-hCG compared with other Gestational Trophoblastic Neoplasia (GTN). They can be detected sonographically like heterogeneous solid mass in the uterine cavity with minimal to high vascularization, but sometimes they develop into myometrium without endometrial involvement. To the best of our knowledge, uterine biopsy is the only way to make a reliable diagnosis, but for these reasons sometimes Dilation and Curettage (D&C) or hysteroscopy are not exhaustive. Their final diagnosis is histopathological and often very difficult due to their rarity, thus many times they directly present metastasis symptoms (mainly pulmonary) or paraneoplastic syndromes. Case presentation: A 37-year-old woman with the purpose of a second pregnancy, after seven weeks of amenorrhea, complained irregular bleeding and metrorrhagia. The patient underwent transvaginal ultrasound (US) and a lesion of 50 mm was found in myometrium, its echostructure was inhomogeneous and richly vascularised (CS4) with rear acoustic reinforcement. It was associated with slightly elevated serum levels of β-hCG. The patient performed a hysteroscopy with simultaneous tru-cut biopsy of the lesion under US guidance and a placental site trophoblastic tumor was diagnosed by histological examination. Conclusion: In this paper we suggest a novel method to perform the PSTT diagnosis. A tru-cut core biopsy allows a deep and precise biopsy with less invasivity and low risk of bleeding or uterine damage. Our case study shows that the employment of this novel technique can help in the diagnosis through a targeted sampling of the myometrium even in those cases in which the endometrial cavity is not involved. 26 Sep, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-272.php Guillain-Barre syndrome and myasthenia gravis are common in the Intensive Care Unit (ICU) and are not always easy to diagnose in the emergency department. The short-term risk is the occurrence of respiratory muscle paralysis, which must be monitored by repeated measurement of vital capacity, and the existence of respiratory impairment requires transfer to intensive care. Apart from specific therapeutic options (plasma exchange, intravenous immunoglobulins and anticholinesterase agents), management is mainly symptomatic. Our work is a retrospective study, concerning 23 cases of neuromuscular diseases in the ICU from a period from 2018 to 2022. The various epidemiological, clinical, paraclinical, therapeutic, and evolutionary data were collected from the files of the Intensive Care Department A1 of the Hassan II University Hospital of Fez for the study. Osteomas of the paranasal sinuses are benign, often asymptomatic, tumors that progress very slowly. Endocranial development of an osteoma can breach the dura mata, allowing air to enter the cranium producing pneumocephalia which leads to severe neurological deficiencies. Pneumocephalia is an exceptional complication of osteoma. 03 Jul, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-271.php The most common causes of intracranial air are head trauma and neurosurgical procedures. Less common etiologies include infection due to gas-forming organisms, mucoceles, tumors, congenital neuroenteric cysts, and dural defects. Here, we present a case of an ethmoidal sinus osteoma associated with pneumocephalus. Osteomas of the paranasal sinuses are benign, often asymptomatic, tumors that progress very slowly. Endocranial development of an osteoma can breach the dura mata, allowing air to enter the cranium producing pneumocephalia which leads to severe neurological deficiencies. Pneumocephalia is an exceptional complication of osteoma. 23 May, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-270.php Venous Air Embolism (VAE) can occur in patients while injecting contrast material, we have reported a case of a 26 yrs old patient who came with the complaint of abdominal pain, vomiting, and fever with no known Co-morbid. CT whole abdomen with contrast was performed and the patient was injected with contrast, which resulted in an air embolism. On administration of contrast, air is seen in the hepatic vein which was not seen on plain and delayed images. 93 ml of contrast material was intravenously injected by hand and followed by a drip infusion of 100 ml of contrast material. 21 Mar, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-269.php A 79-year-old man presented with gait dyspraxia approximately 2 days after receiving the first dose of the AstraZeneca COVID-19 vaccine (AZ-COVID-19-vax). He had no previous active issues and was currently on no medications. Physical examination revealed a 4/5 pyramidal weakness of lower limb musculature with loss of sensation up to the inguinal ligament. 27 Jan, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-268.php Introduction: Osteoarthritis (OA) is the most common chronic condition of the joints that leads to pain, stiffness and disability. Aim: The aim of this study was to determine the effectiveness of a sensory-motor exercises program and the photobiomodulation on pain, muscle strength, severity of the injury and dynamic balance of women with knee osteoarthritis. Method and Materials: Thirty-two women were randomized in sensory-motor exercises associated with the placebo photobiomodulation group (SMAG) and sensory-motor exercises with the active photobiomodulation group (SMPG). The pain, knee flexor and extensor peak torque, severity of the injury and dynamic balance were evaluated with the numeric pain rating scale, cell roll, Knee Injury and Osteoarthritis Outcome Score and timed up and go, respectively. Subjects were administered sensory-motor exercises, strengthening exercises and photobiomodulation via cluster applied at the end of each training session for 8 weeks, 2 times/week. Results: There was no significant improvement in the knee flexor and extensor peak torque, meantime, there was a significant linear positive correlation in the sensory-motor exercises program associated with the placebo photobiomodulation group (p = 0.002) at the end of treatment. A significant improvement in the severity of injury (p = 0.002) and dynamic balance (p = < 0.001) was observed in both groups. Furthermore, the level of pain showed a significant improvement in the sensory-motor exercises program associated with the placebo photobiomodulation group (p = 0.043). Conclusion: Sensory-motor exercise program promotes beneficial effects on the severity of the injury and dynamic balance and its association with photobiomodulation was able to produce an extra effect in pain relief. However, adding photobiomodulation to routine exercise regimes for subjects with knee osteoarthritis should be investigated. 25 Jan, 2023 https://www.clinsurggroup.us/articles/GJMCCR-10-267.php Refractory pruritus associated with Essential Thrombocythemia (ET) is rare. Herein, we present the first report of resistant pruritus responsive to ruxolitinib in an ET patient with a calreticulin mutation. 30 Dec, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-266.php A 64-year-old male patient presented to the Emergency Room (ER) of our hospital with complaints of precordial pain associated with profuse sweating for the past 8 hours. 17 Dec, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-265.php Objective: To understand the meaning of the ambiguities of being a caregiver experienced by family caregivers of people with Alzheimer’s disease and health workers inserted in community Mutual Help Groups. Method: a study based on the ontology of Maurice Merleau-Ponty’s experience based on the notion of the body itself. It is revealed by the participation of 12 women, family caregivers, and health workers, members of community mutual aid groups, in the city of Jequié, Bahia, Brazil. The production of the experiential descriptions took place in three Focus Group meetings, during April and December 2019, whose resulting material was submitted to the Ambiguity Analysis. Results: The results reveal the ambiguities of taking care mobilized by the tradition of fulfilling social, cultural, and religious duties. Inserted in the groups, they experience openness to the other, reconfiguring “doing for doing” in “doing for pleasure” in care practices, becoming another. Conclusion: the experience of caring as an obligation, which was previously expressed by anguish, sadness, and illness, after insertion in the group, opens up to the experience of the other and makes care a manifestation of otherness, which privileges the care of the self to care from the other. The study points out the group strategy in health services as a possibility of transforming social actors in the community in the context of Alzheimer’s disease. 09 Dec, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-264.php Introduction: Pharyngeal airway space has become an important criterion for diagnosis and treatment planning and this has led to a paradigm shift towards soft tissue evaluation for orthodontic diagnosis and treatment planning, The aims and objectives of the study were to evaluate and compare upper pharyngeal airway space in Cleft Lip & Cleft Palate patients who underwent orthodontic treatment under different treatment modalities like Camouflage treatment & Maxillary Advancement. Methods: This is a retrospective cephalometric study in which 20 Pre-treatment Cephalograms and 20 Post-treatment Cephalograms of Cleft Lip and Palate patients were taken. Orthodontic treatment involving Camouflage therapy and Maxillary Advancement were studied in each respective group. The Cephalogram was traced on Matt acetate paper and the pharyngeal airway space was measured using the McNamara analysis method. Results: Statistically significant difference was observed in the Pre-treatment and Post-treatment mean values in both groups, where the Post-treatment mean was higher than the Pre-treatment means in both groups. A highly significant mean was noted in the Cleft Surgical group as compared to the Camouflage (xiii) group, where, the post-treatment upper airway mean was higher in the Cleft Surgical group than the Cleft Camouflage group. Conclusion: There is a significant increase in upper pharyngeal airway space in patients with CLCP treated with Maxillary Advancement and Camouflage modality. The significance is comparatively more in the Maxillary Advancement group than in the Camouflage group. 11 Nov, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-263.php Plasma cell dyscrasias are a group of entities characterized by neoplastic proliferation of a single clone of plasma cells, typically producing a monoclonal Immunoglobulin [1]. 09 Nov, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-262.php Otosclerosis is an otologic disease characterized by disordered resorption and deposition of the otic capsule bone. It can lead to progressive conductive, mixed or sensorineural Hearing Loss (HL). In rare cases, it manifests itself with a tendency for massive bone resorption with subsequent formation of cavities (“cavitating otosclerosis”). Cavities can sometimes realize communication between the Cerebrospinal Fluid (CSF) at the Internal Auditory Canal (IAC) and the cochlear duct. In these uncommon cases, a “third-window” phenomenon may be established as a concomitant cause of conductive HL. Therefore, the feasibility of stapes surgery should be evaluated, without underestimating the risk of gusher complications. In this report, we discuss the case of a female patient affected by cavitating otosclerosis realizing a connection between IAC and cochlear duct, with mixed hearing loss. 12 Oct, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-261.php It has been shown that behavioral therapy has effects on stress and also cortisol levels. This study investigated the impact of self-care stress reduction strategies on the cortisol levels of 59 urine samples. Stress behavior was evaluated by using written responses (questionnaire). Results indicated that transcendental meditation was statistically associated with the lowering of cortisol levels. Meditation can relax the mind, leading to a reduction in stress. From this study, stress and cortisol levels do have a direct correlation with one another. The data from this small pilot study raise the question of its utility as a stress marker in cardiac rehabilitation. 21 Sep, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-260.php Background: General health is closely related to oral health. Communication is made simpler and a person’s dignity and individuality are enhanced by optimum dental health. The working conditions of soft drink industry employees affected their oral health. Objective: To determine the level of oral condition and treatment requirements for soft drink employees in Bareilly City. Method: 175 employees of soft drink factories participated in cross-sectional research. The individuals gave their informed consent and we received ethical approval. The 2013 WHO Oral Health Assessment Form for Adults was used to get the findings. Results: The findings indicate a higher frequency of oral health issues among soft drink industry workers, including dental caries, gingivitis, periodontal pockets, loss of attachment, fluorosis and tooth erosion. Conclusion: According to the survey, these soft drink industry employees have poor oral health and require more dental care than usual. 02 Sep, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-259.php Introduction: Bipolar dislocation of the clavicle is an uncommon injury that is a simultaneous dislocation of the ipsilateral acromioclavicular joint and sternoclavicular joint. This injury is rare with fewer than fifty documented cases. Case report: We have reported the case of a forty-three-year-old bike trauma with posterior dislocation of the acromioclavicular joint and fracture of the medial part of the clavicle. Considering the young age of the patient and his requirement for high physical activity, we opted for the operative treatment. First, the patient was operated on with open reduction and stabilization of the acromioclavicular joint with 2 k. wires. So, thanks to conservative treatment at the medial fractures we had a good result. Conclusion: In light of current evidence, no important advice can be made about the treatment of bipolar clavicle fractures. We assume that the restoration of the anatomy of the acromioclavicular and sternoclavicular joints should be the aim of the treatment for this rare injury. Nevertheless, the treatment of a bipolar clavicle injury depends on different factors: injury pattern, age of the patient, daily activities, and comorbidity. 17 Aug, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-258.php Small bowel obstruction following internal herniation under the external iliac artery after total hysterectomy with pelvic lymph node dissection is a rare entity. We describe a case of strangulated internal hernia between the right external iliac artery and the psoas muscle as a late complication after 3 years of radical hysterectomy with pelvic lymphadenectomy. Retroperitoneal closure may be an appropriate procedure to effectively prevent such internal hernias. the emergency CT scan was used to diagnose a flange occlusion in the context of the situation. it was only during surgical exploration that the cause of the occlusion was revealed as an internal hernia. a resection of the ischemic bowel was performed with retroperitonealization of the artery. 17 Aug, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-257.php A previously healthy 17-year-old boy was admitted to our emergency department for fever, pharyngitis with cervical lymphadenopathy, abdominal pain, and vomiting for three days. On admission, he was afebrile and his vital signs were normal. Yet, following another vomiting episode, he developed another bout of abdominal pain. C-reactive protein was normal, haemoglobin 14.1 g/dl, WBC 15 x 103/µL, platelets 138 x 103/µL, AST 522 U/L, ALT 341 U/L, total bilirubin 4.75 mg/dl, with direct bilirubin 3.4 mg/dl; LDH level 689 U/L. 16 Aug, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-256.php Hydatidosis is a cosmopolitan parasitic disease that presents a real public health problem, especially in endemic countries of which Morocco is part. The objective of the present work is to analyze the clinical, paraclinical, therapeutic, evolutionary, and prognostic aspects of disseminated peritoneal hydatidosis with multiple localization. Peritoneal hydatidosis represents the whole of the phenomena due to the seeding, essentially secondary, of the peritoneal serosa by Echinococcus Granulosus larvae. Peritoneal hydatidosis is characterized by its polymorphic symptomatology, and the diagnosis is based on a combination of epidemiological, clinical, biological, and imaging findings. We report a case of a particular form of peritoneal hydatidosis in the department of visceral surgery I of the ibn rochd hospital in Casablanca. Our patient was admitted for management of disseminated peritoneal hydatidosis. The clinical examination, apart from an epigastric crust, was unremarkable. The biological work-up showed a slightly disturbed liver balance and the hydatid serology was strongly positive. The preoperative diagnosis of HP was established by CT scan showing a supra- and sub-mesocolic peritoneal hydatidosis with a multi-cystic spleen and a liver with a type V segment V hydatid cyst measuring 4 cm by 6 cm. The treatment consisted of a total cystectomy of the hydatid cysts, almost 100 cysts with multiple peritoneal and parietal locations, one of which was fistulized in the skin, associated with a total splenectomy, retrograde appendectomy, and a disconnection of the cholecysto-duodenal fistula with duodenal closure and a retrograde cholecystectomy associated with a choledecotomy with the extraction of 3 stones at the level of the choledochus and drainage of the VBP by Kehr drain. The postoperative course was simple and the patient was discharged on the sixth day with adjuvant treatment with albendazole for three months. Through this observation and in the light of the data in the literature, we were able to insist in our present work on the diagnostic difficulties generated by this unusual location of the hydatid cyst as well as the considerable contribution of imaging (CT++) allowing both a positive and very precise topographic diagnosis. We were also able to focus on surgical treatment as an indispensable pillar of the management of this disease as well as the increasingly fundamental role of medical treatment, particularly in the prevention of recurrences. 22 Jul, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-255.php The aim of the present study was to evaluate the hepatoprotective effect of total saponins and tannins of Dialium guineense stem bark in Wistar rats exposed to carbon tetrachloride (CCl4). Adult male Wistar rats (n = 25) weighing 160 – 180 g (mean weight = 170 ± 10 g) were randomly assigned to five groups (5 rats per group): normal control, CCl4 control, silymarin, total saponins, and total tannins groups. With the exception of normal control, the rats were exposed to CCl4 (a single oral dose of 1.0 mL/kg body weight, bwt). Rats in the silymarin group were administered 100 mg/kg bwt silymarin (standard hepatoprotective drug), while those in the two treatment groups received 150 mg/kg bwt of total saponins or tannins orally. Treatment lasted 28 days. Activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and Alkaline Phosphatase (ALP), as well as levels of Total Protein (TP), bilirubin, and albumin, were measured in plasma. The results showed that there were no significant differences in the concentrations of TP among the groups (p > 0.05). The activities of the liver enzymes, as well as levels of bilirubin and albumin, were significantly higher in the CCl4 control group than in the normal control group, but they were reduced by extract treatment (p < 0.05). These results indicate that CCl4 negatively impacted the integrity of the liver cells, and total saponins and tannins of D. guineense stem bark conferred some level of protection on the organ. 30 May, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-254.php 27 May, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-253.php Actinic cystitis hematuria is a frequent complication after pelvic radiotherapy, present in approximately 5% of patients exposed to this therapy. The management of these cases seems to be a challenge for today’s urologists. In this article, we present the case of a 73- year-old man diagnosed with actinic cystitis after pelvic radiotherapy and admitted to our service with a clinical picture of refractory macroscopic hematuria. During admission, the patient underwent multiple procedures and blood transfusions, without success in controlling hematuria. After a review of the literature, we chose to use Potassium Alum in the patient’s treatment. Under general anesthesia, we performed a cystoscopy with the evacuation of clots and subsequently infused a 1% solution of potassium alum into the bladder at a rate of 200 ml/h for 25 hours. Less than 24 hours after Alum infusion, there were no more clinical signs of hematuria, which remained until hospital discharge. After 6 months of treatment, the patient did not present another episode of hematuria. 07 May, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-252.php Pneumomediastinum is a rare complication described following dental extraction, especially of the third molar. 212 case reports were described in the English literature since 1960. We describe a case report of a 19-year-old girl who presented to the emergency department with subcutaneous emphysema. Investigations showed the presence of pneumomediastinum. The patient was admitted for surveillance with no antibiotic therapy given due to the improvement seen the following day. 30 Apr, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-251.php The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is an important cause of hyponatremia in hospitalized patients and can be caused by a variety of drugs. SIADH is a recognized side effect of 1st generation sulfonylurea (Chlorpropamide) due to its effect on vasopressin secretion. Here we described a 55-year-old woman with uncontrolled type 2 diabetes on glimepiride with SIADH presenting with anorexia, asthenia, and altered mental status. After the withdrawal of glimepiride, these symptoms were improved and sodium level returned to a normal value which demand monitoring of serum sodium level during treatment with glimepiride. 18 Mar, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-250.php A 65-year-old man was diagnosed with multiple myeloma (IgG-Lambda) and was treated with high-dose dexamethasone as induction therapy followed by thalidomide-based regimens. About 18 months after the initial diagnosis, the patient presented a first relapse which was treated with the LCD protocol (Lenalidomide, Cyclophosphamide, Dexamethasone). 09 Mar, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-249.php Gastrointestinal Stromal Tumors (GISTs) are rare tumors of the digestive tract. The small intestine is the second most frequent localization of GIST after the stomach. We report a case of the ileal stromal tumor. The patient was admitted with a picture of hemorrhagic shock due to massive rectal bleeding. The fiberscope performed after stabilization was not objectified at the origin of the document while the CT scan objectified a mass of tissue density at the level of the right iliac fossa. Given the increasing evolution with the recurrence of patients to a target of a laparotomy for diagnostic and therapeutic purposes objectifying the tumor of the right iliac fossa at the expense of the ileum. The surgical procedure consisted of a major segmental resection of the tumor with ileo-ileal anastomosis. The anatomopathological study confirmed the diagnosis of the stromal tumor with good evolution. Through a general review of the literature, we have described the various clinical, para-clinical, anatomopathological, prognostic, and current therapeutic aspects specific to these tumors. 01 Feb, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-248.php The SARS-CoV-2 pandemic has grown into a major global concern with huge efforts to combat the spread. Exaggerated inflammatory response plays a major role in which was the rationale to use corticosteroids to treat patients. However, multiple studies showed an association between opportunistic and bacterial infections with corticosteroid therapy. We report a case of a 76 year old patient diagnosed with COVID-19 treated with 10 days Dexamethasone and Remdesivir who presented with abdominal symptoms with eosinophilia. Biopsy and stool studies revealed Strongyloides stercoralis larvae. The patient was treated with 2 doses of Ivermectin with significant clinical resolution. Clinician should have high clinical suspicion for Strongloydiasis in patients who have lived or visited endemic areas and for patients with unexplained eosinophilia. Prompt treatment with Ivermectin is crucial for confirmed cases and high risk cases where obtaining a diagnosis is unfeasible. 24 Jan, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-247.php Antimicrobial Resistance (AMR) poses an increasing threat to global public health and is projected to be one of the greatest challenges of healthcare in the future as the costs of healthcare, morbidity, and mortality will increase. AMR is likely to complicate many routine procedures such as elective surgery in the future. Together, healthcare professionals need to be aware of the significance antimicrobial resistance poses and make changes needed to mitigate the danger as a result of one of the most important developments in medicine. 19 Jan, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-246.php Spondyloarthropathies are known to affect the interleukin (IL)-17 activation pathway as a basis of their pathology, as is apparent from the literature. Recent studies established the vital role of IL-17 in the treatment of Systemic Lupus Erythematosus (SLE). This article aims to demonstrate the efficacy and safety of IL-17 in the treatment of both spondyloarthropathies and SLE by presenting two cases. The first case concerns a 30-year-old woman who was initially diagnosed with SLE. In the course of the disease, she developed spondyloarthritis and genital psoriasis. She was initially medicated with secukinumab but maintained severe genital psoriasis, the reason it was changed to ixekizumab with great improvement. The second case refers to a 40-year-old woman who previously had spondyloarthropathy with D12 enthesitis and sacroiliitis. Initial treatment with adalimumab led to a lupus-like syndrome, with persistent high systemic inflammatory response syndrome and extreme fatigue. Because of the recrudescence of axial complaints, secukinumab was started and the patient evolved with a global clinical response. Thus, the authors present two cases of spondyloarthropathy and SLE that document the efficacy and safety of IL- 17 blockers, which can lead to the incorporation of these agents in the treatment of SLE. 04 Jan, 2022 https://www.clinsurggroup.us/articles/GJMCCR-9-245.php Facial artery a branch of external carotid artery rarely develops an aneurysm due to its superficial location and small size that mostly leads to complete dissection rather than laceration of the vessel. Pseudo-aneurysms develop in the superficial temporal arteries in this region. Rupture of this aneurysm can lead to extravasation of blood within the adjacent soft tissues resulting in hemorrhage in some cases. Only a few cases of facial artery aneurysms have been reported in publications. We are therefore discussing here a case of left facial artery pseudoaneurysm secondary to trauma and its radiological imaging findings on CT angiogram. 22 Dec, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-244.php There is an abundance of useful verbal information and recommendations on how to make the best choice when referring a patient for surgery or when seeking the right surgeon for your own operation. 27 Oct, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-243.php Background: The understanding of Craniometry with its associated craniometric points and dimensions have found immense applicable relevance in anthropology and neuroscience, ranging from growth determination, estimation of cranial deformities, personal biological profile identification and facial reconstructive surgeries, analysis of evolution of the human species in archeology as well as age variations. Objective: The aim of this study was to evaluate the craniometric dimensions among adults’ subjects in Eastern Nigerian State. Methods: Research data was collected from Computed Tomography scans in the Radiological Department of Federal Medical Centre, Umuahia, Nigeria with strict adherence to inclusive and exclusive factors. A total number of 150 human CT scans were used in the findings. Craniometric parameters were calculated - derived from the two and three coordinate points for linear and angular measurements respectively. Results: Results revealed that age group 36-45 had the lowest cranial parameters and age group 56-65 had the highest cranial parameters. Conclusion: It was concluded that cranial parameters does not increase as age increases throughout life. The study findings will be useful to the anatomists, anthropologists and neuroscientists. 18 Oct, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-242.php Xanthomas are benign cutaneous manifestations of extracellular lipid accumulation. Eruptive xanthoma is characterized by the acute, widespread presentation of a papular rash and usually involves the back, buttocks, and extremities. Eruptive xanthoma is associated with hyperlipidemia, hypertriglyceridemia, and an increased long-term risk of atherosclerotic cardiovascular disease. We present a case of eruptive xanthoma accompanied by severe hypertriglyceridemia (10,164 mg/dL) in which the course of the disease was reversed following implementation of lipid-lowering pharmacotherapy. 07 Oct, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-241.php Mastocytosis is a disorder of clonal proliferation of the mast cells, which can be cutaneous or systemic. Abnormal mast cell infiltration comprising multifocal compact clusters or cohesive aggregates can affect one or more organ systems. Cutaneous mastocytosis is a relatively uncommon condition in the pediatric population. We report a case of 9 month infant presented with multiple papular and vesicular skin rashes since 6 months of age. On clinical examination Darier’s sign was negative. The serum tryptase levels were within normal limits. Clinical differential diagnoses were benign cephalic histiocytosis vs cutaneous mastocytosis. Skin biopsy revealed a mononuclear cell infiltrate in the papillary dermis reaching up to the dermo-epidermal junction. Toluidine blue staining highlighted the metachromatic granules. CD117, CD30 IHC stains were positive which confirmed the diagnosis of cutaneous mastocytosis. This case is presented to highlight the histomorphology and the special stains in cases of mastocytosis. 17 Sep, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-240.php The extradigestive manifestations of chronic inflammatory bowel disease most often affect the articulations, skin, eyes, liver and bile ducts. Renal involvement is rare, and manifests as kidney stones, glomerulonephritis, tubulointerstitial nephritis, and secondary amyloidosis. In this context of chronic inflammatory bowel disease, in particular ulcerative colitis, renal involvement is very often secondary to nephrotoxicity of the basic treatment of digestive pathology, and very rarely an authentic extradigestive manifestation of intestinal disease. We report a case of IgA nephropathy as an extra-digestive manifestation of ulcerative colitis. The objective of this study is not to neglect the IgA nephtopathy as an extradigestive manifestation of IBD which, even though rare, remains a condition to be looked for by clinicians during the follow-up of IBD. 09 Sep, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-239.php Background: Injuries occurring while running barefoot and shod has been a topic of concern for a long time due to the increased interest in recreational running. This research focused on the ankle and foot complex injuries in shod and barefoot running groups. The objective was to find the pattern of ankle and foot complex injuries and if any other aspects such as type of running or the frequency of training for marathons affect the occurrence of injuries. Methodology: 100 participants (83 shod and 17 barefoot) between the age of 18-60 years filled a self-made questionnaire on ankle and foot related injuries via electronic medium (Google form). Results: Plantar fasciitis, ankle sprain and peroneal tendinitis are the most common injuries in the ankle and foot complex. This can be attributed to by the reduced training frequency leading to ankle sprain and peroneal tendinitis. Majority participants were found to have a rearfoot strike pattern attributing to an increased risk of plantar fasciitis. Conclusion: Ankle sprain, plantar fasciitis, peroneal tendonitis, flat feet and metatarsal stress fractures are most commonly occurring. More research on this topic is encouraged with objective measurements. 08 Sep, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-238.php Background: Miliary Tuberculosis (MTB) is a potentially lethal disease if not diagnosed and treated early. Miliary tuberculosis infection in childhood remains a significant health problem in developing countries. Clinical manifestations are non-specific and therefore the condition may bemuse even the most experienced clinicians. Infective Endocarditis (IE) remains a lethal valvular heart disease and can be fatal if not treated promptly. Coagulase-negative staphylococci and oral streptococci are common causative organisms. Both conditions can be fatal independently but can present in the same patient. Since fever is a common symptom in both, one infection may mask the other. Tuberculous Endocarditis (TBE) is another rare entity with few documented cases and often presents with a miliary tuberculosis picture, especially in endemic countries. Case presentation: We report the case of a 9-year-old immunocompetent girl who presented with history of congenital heart disease, fever, malaise, and anemia for a duration of two months. Transthoracic Echocardiography (TTE) revealed a 10x7mm vegetation on the anterior mitral valve leaflet along with Mitral Stenosis (MS) mild Mitral Regurgitation (MR) and a Patent Ductus Arteriosus (PDA). Blood cultures grew streptococcus viridans. She was started on broad spectrum antibiotics but continued to be febrile along with drenching night sweats. Chest CT was consistent with miliary tuberculosis and a subsequent sputum for GeneXpert® test was positive. She was subsequently started on Anti-Tubercular Treatment (ATT). An eight week follow up showed resolution of the vegetation, improvement in symptoms, resolution of anemia and weight gain. Conclusion: This is a rare case of MTB and IE in an immunocompetent patient, without severe valvular destruction. MTB although rare should remain on the differential especially in endemic countries and in patients reporting a long duration of symptoms. MTB and IE can present in the same patient and must be differentiated from TBE since the management of the case differs. 12 Aug, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-236.php Background: This study investigated the effect of planter fascia stretch and heel pad with moist heat in the patients of planterfascitis among subjects aged 20-40. Planter fascia is a thickened fibrous sheet of connective tissue which begins from medial tubercle on undersurface of calcaneus and fans out joining to the metatarsophalangeal joints plates to form longitudinal foot arch. Manual active stretching or passive stretching of planter fascia and Achilles tendon are effective treatment option for patient with planter fasciitis. Aims and objectives: objectives of this study were to see the effect of planter fascia stretch and heel pad with moist heat in the patients of planterfascitis. Material and methodology: This study was quasi experimental study. It took samples by convenient method from 80 subjects among Faisalabad private hospitals community. The study was completed in the duration of 3 months. Data was conducted through convenient sampling from Faisalabad private hospitals. This study explored the effect of planter fascia stretch and heel pad with moist heat on subjects aging 20-40 years old. Subjects were allocated to group A (n=40) and group B (n=40). Group A received treatment as planter fascia stretch and group B received treatment as heel pad with moist heat. Follow up were taken after 4 weeks in 3 month duration study. Results: Statistical Analysis Data were analyzed using SPSS version 23.0. Intragroup comparison of differences between pre and post intervention scores of FFI and FADI was analyzed using independent T Test. The results were considered statistically significant if p values were less than 0.05). No statistically significant difference was observed in pre intervention score between the groups on FADI (p = 0.211) and FFI (p = 0.365), but, statistically significant difference was observed between all the groups on post intervention score with respect to FADI (p=0.000) and FFI (p=.001) as analyzed by independent t test. Conclusion: After applying the entire treatments and measuring pre and post value it conducted that planter fascia stretch has more significant effect on planterfascitis than heel pad with moist heat. 07 Aug, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-235.php Acute Flaccid Paralysis (AFP) is a clinical syndrome characterized by rapid onset of weakness, in the respiratory muscles, swallowing and limbs; and death because of respiratory muscles failure. AFP surveillance is crucial, the clinicians are required to notify AFP cases among children below 15 years old to the epidemiology department with completion of AFP surveillance form. In this study, the researcher analyzed AFP surveillance investigation forms to determine the clinical picture, viral etiology and the incidence of AFP among children under 15 years. Material and method (Study design): The research study conducted through cross sectional study, based on AFP investigation forms in the epidemiology department. Results: The final diagnosis of the cases were as follow, 71.1% “27 cases” were GBS, 10.5 % were Encephalitis, 7.9% were Neuropathy, 2.6% “ one case only” for each of the following Aseptic meningitis, Transverse myelitis, Tuphus fever and Subspinal muscular atrophy. The incidence rate among children less than 15 years old which range from 0.58 / 100.000 in 2006 to 1.2 / 100.000 in 2012; Most of the cases 89.5 % had fully vaccinated and 10.5% had not fully vaccinated due to their ages less than one year, 65.8 “25 cases” had residual weakness, all of the cases classified as discarded according to the expert committee decision; no one case dead, all of the samples sent to the Tal-Hashomir laboratory in the occupied land in 1948 for viral isolation; most of the results 81.6% revealed that no virus isolated, 11.8% isolated ECHO virus, 2.6% isolated Coxsachie virus and 4 % isolated NPEV. Conclusion: No wild polio virus in Palestine which is polio free since 1984 and certified in 2006, our success being attributed to: start of 2 doses of IPV and 5 doses of OPV since 1978, high immunization coverage more than 95% at district level and effective AFP surveillance system in Palestine. The study recommended to encourage polio immunization and all clinicians are required to report all AFP cases and submitting at least two stool samples to the epidemiology department (at least 24 hours apart within 14 days of onset of paralysis). 04 Aug, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-234.php Background: A 60 years-old man presented with an 8-day history of acute onset painless left upper eyelid ptosis covering the pupil entirely. Ptosis can affect unilateral or bilateral. He had no other symptoms; importantly pupils were equal and reactive and eye movements were full. There was no palpable mass or swelling. He had a headache but had no other focal neurological signs or symptoms of fatigue. MRI of brain and Orbits showed no remarkable abnormality detected in brain & orbits. Objectives: Assessment of the homeopathic symptomatic aspects of Gelsemium sempervirens on eyelid ptosis. Showed homeopathy has a major role in the treatment of ptosis. Materials and Methods. The case management was conducted for 3 weeks and only two follow follow-ups were was taken according to the law of homeopathy. Result: Administrating Gelsemium sempervirens 30°C of 5/7 pills orally thrice a day for a week; left eyelid ptosis was improved 60%. The ptosis resolved quickly and the patient remains symptom-free 100% at 3 weeks follow-up by next high potency Gelsemium sempervirens 200C with the same pattern. Conclusion: Acute ptosis may indicate serious pathology. A careful history and examination must be taken. The appropriate management requires recognition of the underlying cause of it. This case presentation highlights the various aspects of ptosis evaluation and management by homeopathy for future study. 28 Jul, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-233.php Tracheo-Oesophageal Puncture (TEP) with voice prosthesis insertion is considered as a gold standard among various voice rehabilitation procedures in laryngectomized patients. It is easily reversible with a high success rate, and the speech, which closely resembles laryngeal speech, develops faster than esophageal speech. However the prosthesis has to be cleaned regularly to ensure proper function as well as longevity of the voice prosthesis valve system. There are not many incidents of the voice prosthesis cleaning brush reported, as the cleaning brush is made to be durable and able to withstand repetitive usage. Hereby we describe an unusual case of a laryngectomized patient who had aspirated a broken tip of a cleaning brush while cleaning his voice prosthesis. The delay in removal of the aspirated foreign body due to technical difficulty had led to lung collapse subjecting the patient to partial lobectomy. We would like to highlight several aspects in this case report, firstly patients should be counselled regarding the proper techniques to clean the voice prosthesis and they should be vigilant during the cleaning process to prevent aspiration in case of accidental broken of cleaning brush. Secondly the incident should be reported to the manufacturer so that the durability of the cleaning brush is reviewed and improvised. Lastly, prompt management of foreign body aspiration should be implied to prevent complications. 27 Jul, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-232.php Introduction: This paper reports a patient who presented with hemiparesis and hemisensory hypo-aesthesia following the AstraZeneca vaccine. Formal neurological assessment diagnosed a conversion reaction. Case report: A 60 year old lady presented with left sided weakness and hypo-aesthesia after her first dose of the AstraZeneca vaccine. She became unable to walk, had blurred vision and a bitter taste. There was no similar previous history. Depression and anxiety were diagnosed in 2007. Physical examination revealed positive Hoover’s signs, without features to suggest either upper or lower motor neurone deficit. She had non-anatomic loss of sensation, across her torso, plus non-anatomical demarcation of decreased trigeminal sensation. She was advised that her most likely diagnosis was that of a non-organic conversion reaction but she did undergo cerebral imaging together with a psychiatric assessment, prior to discharge. Discussion: The AstraZeneca Covid-19 vaccine has received significant publicity regarding potential for clotting. This case highlights the consequences of this concern. Physical examination suggested a non-organic complaint, allowing the provisional diagnosis of a conversion reaction. Advising the patient allowed her to accept that, when all the tests came back normal, it did not reflect lack of knowledge to make a correct diagnosis. The correct procedure is to make a provisional diagnosis (namely conversion reaction) and to exclude differential diagnoses, such as clotting. It is believed that this represents the first reported case of an AstraZeneca Covid vaccination conversion reaction but it is highly unlikely that it will be the last one to be encountered. 22 Jul, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-231.php Introduction: Pyoderma Gangrenosum (PG) manifests as recurrent deep ulceration of the skin and PG is often associated with a variety of systemic diseases, such as Inflammatory Bowel Diseases (IBD), inflammatory arthropathies, hematologic malignancies and hepatitis. There has been neither laboratory finding nor histological feature diagnostic of PG, and diagnosis of PG is mainly made based on the exclusion criteria. Patient and methods: A male patient 21 years old, complained of rectal bleeding of 3 weeks duration. He presented with a large, painful and rapidly progressive cutaneous ulcer in the right flank. Laboratory and microbiological investigations, colonoscopic biopsy and a skin biopsy from the ulcer were performed. Results: An atypical presentation of PG with Ulcerative Colitis (UC) was diagnosed. The PG rapidly resolved after starting treatment with prednisolone and mesalazine and the ulcer healed with scar. After successful treatment the patient suddenly stopped all his treatment and he came back again with rectal bleeding and a rounded, painful and rapidly progressive cutaneous ulcer in each cheek. One month after starting prednisolone and mesalazine treatment, complete healing of both ulcers has occurred. Conclusion: A rare atypical presentation of PG with risk of misdiagnosis and the rapid healing of PG with combination of prednisolone and mesalazine therapy were concluded. 09 Jun, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-230.php A seventy-one old male patient with no previous Hx of mental disorders including alcohol use and with no family Hx of mental disorders was admitted to psychiatric ward due to acute aggression, agitation, excessive irritability and lack olf sleep. He suferred from myasthenia gravis for years and was treated chronically with ambenonium 20 mg daily. Because of comorbidity of uveitis with macular edema he received treatment with prednisolone 70mg daily. Because of acute psychotic symptoms the treatment with olanzapine up to 20mg/d was introduced without effect. The treatment was switched to haloperidol 10mg/d with gradual improvement of patient’s behaviour. He was discharged from the hospital with indication to continue psychiatric, ohpthalomogic, and neurological outpatient care. 03 Jun, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-229.php Merkel cell carcinoma is a rare, but highly malignant and fast growing skin-cancer with high recurrence-rates, deriving from endothelial and neuroendocrine tissues. For advanced Merkel cell carcinoma prognosis is poor [1] and even under cytotoxic chemotherapy there is only a median progression-free survival of only 3 months [2,3]. Even though Merkel cell carcinoma frequently shows lymphatic metastases, it almost never shows cerebral involvement [1]. To our knowledge there are only twelve reported cases of cerebral metastases. Furthermore this is the first reported case of complete response in a patient with advanced Merkel cell carcinoma Stage IV with brain metastases under combined treatment with pembrolizumab and radiotherapy. 03 Jun, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-228.php COVID-19 is the emerged pandemic disease of mankind. This disease yet has no proven therapy. Measures like the use of a vaccine, chemical spray, disinfectants, antiseptics, and supportive therapies could help control this disease that is caused by a coronavirus. Further effective control and prevention measures are urgently demanded to save the life of billions of the world’s human population. Especially having effective, and affordable vaccine that can be supplied as per its demand to all humankind is the priority at present. 10 May, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-227.php A case of a 71-year-old man with previous Transient Ischemic Attack (TIA), treated with stent implantation due to right internal carotid artery stenosis. The procedure was complicated by stenosis and kinking of the vessel distal to the stent and thrombus formation. The flow in the stented artery was not restored. A massive stroke occurred. The man died on the 3rd day after the procedure. 03 May, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-226.php We report the case of a knife penetrating wound from the hypopharynx-cervical esophagus area to the posterior mediastinum in a 91-year-old patient. The surgical approach for this patient required a transoral examination with direct laryngoscopy and a right cervicotomy. Although it was not necessary to perform a thoracotomy, the position of the knife, stuck towards the posterior mediastinum, made the presence of an interdisciplinary team in the operating room necessary. 30 Apr, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-225.php Purpose: This research aims to reinforce the credibility of the PICI-1 psychodiagnostic instrument by making some corrections that are immediately evident in several clinical cases. Among all, the proposed case represents the clearest and most effective example. Methods: Clinical interview and administration of the MMPI-II, PICI-1 and PSM-1. Results: On the basis of specific clinical observations, evident in the proposed cases, the following corrections to the basic PICI-1 model have been suggested: 1) at the diagnostic level: the diagnosis must take into account the first two highest levels of dysfunctional traits, considering the next three lower levels as elements of psychotherapeutic interest. In the hypothesis of dysfunctional hyperactivation, the diagnosis should be re-evaluated at the end of the psychotherapeutic pathway; 2) on the unitary diagnosis: the diagnosis takes into account, in its final formulation, the primary disorder (P, main diagnosis), co-primary disorders (M, mixed diagnosis), comorbidities (C), secondary disorders (S), and tertiary traits (T); 3) on the symptomatic persistence of symptoms and on the plasticity of the personality: mindfulness can aid change, as long as it is real, concrete, and current, and the complained of dysfunctional traits have not been present for a long time (more than 1 year, anyway); 4) on absorptions: anxiety disorder absorbs somatic disorder, phobic disorder, and manic disorder, the latter becoming specific traits of anxiety (main) disorder; psychotic disorders absorb all other neurotic disorders. Conclusions: The results obtained from the two proposed clinical cases suggest the following modifications to the model. These corrections actually facilitate the psychological course and the diagnostic interpretation of the patients, who were able to alleviate their suffering to an acceptable level of tension, without pharmacological support. 26 Apr, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-224.php We report a case of a 41-years-old female with a sporadic abdominal wall desmoid tumor. After a period of 12-months observation, chemotherapy was given with Doxorubicin and Dacarbazine to facilitate minimal surgery. The patient received 4 cycles of chemotherapy. Treatment was well tolerated and resulted in a significant reduction of the tumor size from 48mm to 25mm, 48% reduction. The tumor was surgically resected, and the histopathology from the resected specimen revealed a partial pathological response. At 6 months post-surgery, there is no recurrence or surgical complications. 23 Apr, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-223.php Introduction: Fish bone Foreign Body (FFB) accidental ingestion is a most common presenting complaint for patients attending the emergency department. It is more frequently lodged within the oropharynx and the oesophagus. However, fish bone impacting in the respiratory system is extremely rare; accounting for 14% of reported cases, with approximately few cases reported in the literature involved the lower airway. Patient concern: A 27- year-old man presented clinically as a case of chest infection with a 5-day history of palpitation, right pleuritic chest pain and shortness of breath. Diagnosis: We report a case of atypical presentation of FFB ingestion. Although patients with foreign bodies’ ingestion sometimes presented with cough, there are a wide spectrum of clinical symptoms, especially those with lower airway FFB; where imaging findings are not usually spotted in the emergency department to point to the diagnosis. Intervention: Swab for COVID-19 was negative and the initial chest X-ray showed poor inspiratory effort and no air space opacity. Although CT pulmonary angiography for pulmonary embolism was negative, an incidental finding suggestive of foreign body was reported in the right lower lung region. Outcomes: The foreign body was distal within the lung parenchyma; therefore, there was no need for urgent surgical intervention and there should be a 1-month outpatient clinic follow-up and patient was discharged on antibiotic. Conclusion: Although fish bone ingestion is a common food related foreign body ingestion, cases can often present a diagnostic dilemma and can be easily misdiagnosed or mistaken for other diagnoses. Therefore, vigilant and thorough history taking, and the consideration of a FFB in the differential diagnosis is essential. 22 Apr, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-222.php Sepsis is a common clinical emergency and critical illness, whose prevention and treatment are mainly to protect organ functions. Glycocalyx is a polysaccharide-protein composite structure on the surface of endothelial cells, which has the functions of protecting cell barriers and maintaining organ perfusion. It may protect the organ function, and prevent the infected patients from progressing to sepsis by monitoring of glycocalyx in the serum. This article mainly summarized the cause of PSCC and the possible role of glycocalyx in PSCC to provide reference for clinical intervening. 16 Mar, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-221.php Subvesical bile ducts (formerly known as “Ducts of Luschka”) are a rare entity associated with bile leaks due to their proximity to the gallbladder bed. Failure to recognise their presence could lead to life-threatening complications to the patient in the form of an abdominal collection, biliary peritonitis and sepsis. We describe a patient with two abnormal ducts found in the gallbladder fossa which were managed surgically. 13 Mar, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-220.php Tracheomalacia is the abnormal collapse and flaccidity of the supporting tracheal cartilage, leading to a reduction in the caliber of the anterior-posterior airway. Tracheomalacia is common after cardiac compression or tracheoesophageal fistula. In the severe type, tracheomalacia may lead to significant morbidity, especially if encountered at a younger age or in a critical area, such as the distal part of the trachea. We report two cases that did not improve after initial cardiac surgery with persistent airway narrowing of more than 80%, requiring prolonged ventilatory support. Both cases were difficult to manage but eventually showed a significant improvement after posterior aortopexy, which helped to wean them off the ventilator and produced marked clinical and radiological improvement. Both cases had residual malacia that was clinically presented as persistent audible wheezing and recurrent chest exacerbation. The diagnostic and therapeutic options for both cases are discussed. 27 Feb, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-219.php Objective: Of the study is to investigate the efficacy of Cognitive Restructuring Technique on Adjustment of Social Isolates in a sample of Nigeria Secondary School Adolescents. Methods: Pre-test post-test randomized control trial experimental design was adopted by the researchers for the study (60). Secondary school adolescents who were drawn through proportionate stratified randomly sampling technique constituted the sample for the study. The secondary school adolescents were randomly assigned to experimental (32) and (28) groups. Social Isolates Assessment scale for Adolescents (SIASA) and Adjustment Scale of Social Isolates (ASSI) were used for data collection. SIASA and ASSI were properly validated by experts in the test development and the internal consistency reliability indices of the items estimated as 0.82 and 0.86 respectively using Cronbach Alpha method. Before the commencement of the testing and treatment package, the researchers assured the participants of confidentiality of interactions and personal information as they work together in self-disclosure. Thereafter, pre-treatment assessment (pre-test) was conducted using the SIASA and ASSI in order to collect baseline data (Time 1). After that, the experimental group was exposed to 90 minutes of the Cognitive Restructuring Technique (CRT) program twice a week for a period of 6-weeks. The treatment took place between September and November 2019. Post-test (Time 2) assessment was conducted 1 week after the last treatment session. Besides, a follow-up assessment was conducted after two months of the treatment (Time 3). Data collected were analyzed using repeated measures analysis of variance. Results: The findings of the study revealed that the efficacy of cognitive restructuring technique on the adjustment of social isolates adolescents was significant at post-test and follow-up measures. One of the contributions of the findings is that if secondary school adolescents are not properly counseled, their social isolate behavior will continue to increase. Conclusion: The contribution among others is that Federal Government or relevant education authorities should provide enough guidance counselors in the various institutions of learning who will assist in the counseling of adolescents in the dangers of social isolate behaviour using CRT. 12 Feb, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-218.php Objectives: To study long term outcomes of HICDI. Design, settings and participants: Retrospective cohort study of adult patients diagnosed with HICDI during their admission to a tertiary teaching hospital between January 1st 2012 and December 31st 2016. Main outcomes: Primary aim was to study two-year mortality outcome and it’s predictors in HICDI patients. Secondary outcomes were to identify characteristics of HICDI and predictors of time to resolution of infection. Results: A total of 819 adult HICDI episodes were identified. 544 episodes occurring in 466 patients were included in final analysis. Single CDI episodes occurred in 409 patients, 45 patients had 2 episodes and 12 patients had greater than 2 episodes. Two-year all-cause mortality was 33% (152/409) in single CDI episodes and 61.4% (35/57) for those with more than one CDI episode. Of the 466 patients, the in-hospital all-cause mortality directly attributed to CDI was 14 patients (3%). Risk factors predicting long-term mortality were, chemotherapy (AHR(adjusted hazard ratio)2.7; 95% CI 1.90-3.81;p=0.01), low albumin(AHR 2.44; 95% CI 1.83-3.47; p=0.01), ICU admission(AHR 2.09, 95% CI 1.44-3.03; p=0.01) high WBC count (AHR 1.78,CI 1.28-2.30; p=0.01), multiple CDIs (AHR 1.24,95% CI 1.09-1.39; p=0.01) and age (AHR:1.04;95%CI:1.03–1.05;p=0.01). Most common type of HICDI was Hospital –Acquired CDI (HA-CDI) (55.8 %; n=260). Antibiotic usage before developing CDI significantly delayed the time to resolution of infection (AIRR: 1.35; 95% CI 1.06-1.71; p=0.01). In 1/3rd (n=180) of HICDI episodes, patients were discharged before resolution of diarrhoea. Majority of HICDI episodes (n=371) were treated with metronidazole. Conclusion: HICDI was associated with significant long term mortality and morbidity. Mortality increased with more than one CDI infection. Antibiotic usage before developing CDI significantly delayed the time to resolution of infection. 27 Jan, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-217.php Background: Our aim is to present the importance of mobile Handheld Lung Ultrasound (HLUS) in COVID-19 patients at the bedside, which is a pre-screening tool with high diagnostic value that can provide triage of symptomatic patients at home (pre-hospital), emergency services, Intensive Care Units (ICU). In this context, the current role and importance of HLUS at the bedside in COVID-19 pneumonia has been summarized. Method: We searched pubmed with key words; COVID-19 pneumonia, Lung Ultrasound (LUS), handheld ultrasound and reached 2428 articles with full texts. All abstracts were searched and 470 systematic review and meta-analysis determined. Only 10 articles were directly related to COVID-19 pneumonia and HLUS. These articles were interpreted to determine the role of HLUS at the bedside in COVID-19 pneumonia. Results: Although not specific for COVID-19, Ultrasonography (US) findings of peripheral interstitial viral pneumonias due to COVID-19 lung involvement are very characteristic. The use of HLUS in COVID-19 atypical pneumonia is of critical importance due to its high diagnostic value in diagnosis and follow-up. It was shown that the sensitivity and specificity of bedside LUS in the diagnosis of atypical pneumonia were high enough to include in radiologic algorithm. Conclusions: Handheld pocket-sized US devices are cheap, easy to handle and equivalent to standard scanners for non-invasive assessment of severity and dynamic observation of lung lesions in COVID-19 patients with pneumonia. So it has become of great importance to make a useful and simple radiological algorithmic approach that includes bedside HLUS in the diagnosis and follow-up of COVID-19 pneumonia patients. 19 Jan, 2021 https://www.clinsurggroup.us/articles/GJMCCR-8-216.php Severe Malaria is a medical emergency mainly because of its rapid progression to complications and death if not promptly and adequately treated. In 2018 WHO put the incidence of P. falciparum Malaria in the African region to be around 99.7%. We present a case where a boy who presented with high grade fever, prostration, and jaundice. On investigation he was found to have parasitemia of 35%, met multiple criteria for Severe Malaria namely: Hyper-parasitemia, Thrombocytopenia, Anemia and Metabolic acidosis. The child was treated with I.V. Artesunate and I.V. Antibiotics, developed AKI (Acute kidney injury) during the hospital stay necessitating multiple dialysis sessions before making a complete recovery. This is a rare case in several aspects as discussed below. 29 Dec, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-215.php The today’s efforts of system engineers to assure adequate and reliable performance of Medical Devices (MD) and instrumentation, not to mention the performance of the medical personnel, are, as a rule, unquantifiable. It is argued by this author that the successful outcome of a medical mission or a more or less typical clinical extraordinary situation cannot be expected, if it is not quantified, and that because of the various inevitable intervening uncertainties, this quantification should be done on the probabilistic basis. 29 Dec, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-214.php Health as a public good is a collective good, a right for all, a right that social, economic and political actors in each country must defend and preserve. It is an inalienable right of the people, non-negotiable and whose enjoyment is not supported by any rivalry [1]. 03 Dec, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-213.php Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare neurologic clinical syndrome that is often misdiagnosed. The pathophysiology of RCVS is unknown, but oftentimes presents as a thunderclap headache that is commonly overlooked once cerebral hemorrhage is ruled out of the differential. Typically patients follow a benign course and make a full recovery, however, in a small subset of patients RCVS can result in permanent neurologic damage. We present a patient with an uncommon clinical course of RCVS and identify pitfalls in the diagnostic workup. 09 Nov, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-211.php Despite the known association between autoimmune and psychiatric conditions, pertinent evaluations are often overlooked in clinical practice. The author of this report describes the successful identification and treatment of a patient whose myriad neuropsychiatric symptoms were ultimately attributable to antiphospholipid syndrome. The importance of comprehensive and persistent workups is emphasized, particularly in the context of individuals with pre-existing inflammatory diseases and/or cerebrovascular anomalies. 07 Nov, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-210.php Malhan S1*, Torgay A2, Kavuncubası S1, Alzhanov S3, Kikimbayeva R4, Malchenko V5, Zhunussov Y6 and Haberal A7 07 Nov, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-209.php Bee stings are common in the tropics and cause minor problems but may occasionally cause severe anaphylactoid reactions. Summary of clinical case: We present a case of M.O.O., an 8-year-old boy who was stung three times on the face and developed severe manifestations including acute kidney injury, cavernous sinus thrombosis and multiple convulsions but recovered without sequelae. Discussion: There is an association between the severity of reaction and the number of bee stings but this case was unique in the sense that we had only 3 stings reported and we developed life threatening clinical manifestations. 06 Nov, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-208.php Eosinophilic enterocolitis is an exceptionally rare disease with few cases described in the literature. It is the least frequent manifestation of the broad spectrum of gastrointestinal eosinophilic diseases. We describe a case of a female patient presenting with a form of the disease manifested by Koenig’s syndrome and diarrhea. This posed a diagnostic challenge for us due to its non-specific symptoms, associated with the absence of standardized histological criteria, hence the need for a high level of suspicion. There is also no consensus regarding the treatment. It should be individualized according to the age of the patient and the severity of symptoms. 03 Nov, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-207.php Metacognition is among the current controversial neuropsychological topics that influence perspective of cognition in ill and healthy individuals. Many cognitive failures that Traumatic Brain Injury (TBI) patients endure are not tackled in standardized protocols of cognitive rehabilitation efforts. One of the debilitating features of TBI is the lack of self-awareness of the disease and its corresponding cognitive failures. Cognitive failures can be a result of both cognitive decline due to insult and lack of awareness of error detection that is secondary to the injury. Metacognitive training can help in diminishing rehabilitation resistance obstacle. Not many studies have been done on meta-cognitive rehabilitation efforts in the case of TBI patients. In this review, electronic database is searched in strict inclusion exclusion criteria and 393 studies were identified from two database and grey literature. Eight studies were included in a descriptive analysis after selecting clinical trials which aimed to elevate cognitive components outcome in TBI patients through applying metacognitive training. This systematic review might determine the power of evidence on the effect of metacognitive skills and strategy training on cognitive function in TBI patients regardless if cognitive outcome is measured through a holistic instrument or if the training has aimed to elevate one component or more of cognition. Studies recruited ranged from addressing executive function, social skills, to general cognitive competences. All of the studies proved the significance of metacognitive interventions in altering cognitive rehabilitation outcome as it had been interpreted by the conductors of the trials themselves but more attention should be given to the generalization of learned skills to daily life. Further details regarding the usage and implementation of metacognitive training are discussed and finally metacognition is judged to be an essential component that must be better addressed in cognitive and non-cognitive rehabilitation in TBI patients. 27 Oct, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-206.php Gastric volvulus is seldom seen in clinical practice. The clinical triad, of upper abdominal pain, intractable retching and inability to pass nasogastric (NG) tube, if found, can help in diagnosis. It can lead to gangrene and perforation of the stomach if remained undiagnosed or treated late. Both acute and chronic presentation is seen. The chronic form is more common than acute clinical presentation but the latter is associated with more complications. Laxity of gastric ligaments, made up of peritoneal folds is responsible for this condition. The knowledge of the condition, timely diagnosis and early surgical management is essential for a favourable outcome as done in the case being presented. 21 Oct, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-205.php Ascending aortic thrombus is a rare condition that is fatal due to its complications [1]. In this case report, we aim to present a case of renal infarction due to ascending aortic thrombus. A 71-year-old male patient was admitted to the emergency department with chest pain and right-side pain. Physical examination revealed tenderness in the right flank. Thoracic Computed Tomography (CT) angiography was performed, and ascending aortic thrombus and focal parenchymal infarction area in the right kidney were observed in abdominal sections included in the examination. 15 Sep, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-204.php Fc Receptor for Immunoglobulin G (IgG) is the major class among the five classes of Fc receptors including Fc Receptor for IgA, IgE, IgM and IgD. Three types (type I, II and III) of the Fc Receptors for Immunoglobulin G (FcRγs) on a variety of hematopoietic cells with different structures and different functions were defined by World Health Organisation (WHO). FcRγs are a group of integral membrane glycoproteins molecules mainly on the surface of effector cells playing very important roles in host defence and regulation in both of the adaptive and innate immune system through signal transduction and other several biological processes after triggered by the immune reactions. Rare diseases are a group of diseases/disorders occurring in a small percentage of the population commonly with the chronic phase and most of them are genetic based. Data suggested that some types of Rare diseases/disorders such as auto-immune and immune-deficiency are associated diseases associated with dysfunction of Fcγs, even some types of cancer. Recently, intensive studies on Fcγs from the level of genetics increased the understanding in pathophysiological mechanism of some diseases. Such advances obtained provide the opportunities for the therapeutical approaches for Rare diseases in some types involved in dysregulations of Fcγs. The aim of this review is to discuss the characterisation of Fcγs from genotype to phenotype and the Fcγs associated Rare diseases including cancers from laboratory bench to clinical bedside. 14 Aug, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-203.php In our six-year study, Dr. Ulatowska and her coworkers collected the testimonial language of eighty WWII veterans who volunteered to participate in semi-structured interviews about their wartime experiences. The veterans of WWII have a unique shared group of identities and values that are characteristic of this period in American culture which is well documented in the literature [1]. 09 Jul, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-202.php This article describes a case of Caroli’s disease in a 53-year-old female patient who complained non-specific abdominal pain without cholestasis or cholangitis. Ultrasound and hepatic magnetic resonance imaging showed segmental saccular dilations connected to intrahepatic bile ducts without hepatic fibrosis. This clinical case shows the possibility of having oligosymptomatic forms in the diffuse forms of Caroli disease, therefore the interest to consider this diagnosis in case of non-specific abdominal signs and to request a hepatic ultrasound. 06 Jul, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-201.php Introduction: Breast Neuroendocrine Tumours (B-NETs) are rare entities; the incidence in Italy is about 1%. The great variability of manifestations and localizations made it very interested in studying. Only few cases are available in literature; actually this pathology is more difficult to treat because specific guidelines don’t exist for the treatment of primary metastatic NETs. Case presentation: The case concerns a 48-year-old woman with a diagnosis of Breast Neuroendocrine Tumours (B-NET). She was treated with multidisciplinary approach; the patient started neoadjuvant chemotherapy and then she underwent right radical mastectomy. No further chemotherapy treatment was performed. In the last ten years, no signs of local recurrence or metastases were observed. Conclusion: The presented case is very characteristic for its multidisciplinary approach. 03 Jul, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-200.php Starting from the general concept of Apraxia, the present work focuses on the clinical, neurobiological, and functional aspects of the morbid condition, suggesting a multidimensional treatment between rehabilitation exercises for lost skills and psychotherapy. 25 Jun, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-199.php An aesthetic and functional smile enhancement has great contribution to a person’s self confidence in addition to their longevity and functional success. It gives us an idea of treatment modality as a corrective approach when trying to uplift the patient’s confidence and giving her a reason to smile again. 22 Jun, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-198.php Spasmodic dysphonia is a neurogenic voice disorder which is characterized by severe and spasmodic problems of vocal fold approximation. Symptoms of the disorder consist of several sensations like strain and strangle which varies from mild to severe. Over the years, there have been several attempts in the line of treatment approaches which helps in voice modification by surgical, pharmacological treatment and voice therapy. In the recent years there are many success stories of patients who have benefitted from pharmacological treatments involving partial and temporary paralysis of muscle fibers within the larynx followed by botulinum injection. This article gives a picture of in depth evaluation of a 68 years old male who was diagnosed as having adductor spasmodic dysphonia. Detailed information regarding characteristics of voice, perceptual evaluation, acoustic analysis of voice, and medical and surgical management opted by the patient is discussed. Efficacy of voice therapy associated with medical management is explained in this case report. The case report emphasizes on the effectiveness of medical as well as therapeutic treatment required for spasmodic dysphonia as well as multifaceted approach to symptom management. 20 Jun, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-197.php Auditory Neuropathy Spectrum Disorder (ANSD) is a hearing disorder where outer hair cell function inside the cochlea is typical, but inner hair cell and/or the auditory nerve function is disrupted. It is a heterogeneous disorder which can have any congenital or acquired causes. Additionally, the etiology of auditory neuropathy is immense, which may comprise prematurity, hyperbilirubinaemia, anoxia, hypoxia, congenital brain anomalies, ototoxic drug exposure, and genetic actors. It is projected that roughly 40% of cases have an underlying genetic origin, which can be inherited in both syndromic and non-syndromic conditions. The below case report serves as an extra evidence for the underlying genetic trait in ANSD. The study presents two cases where, both father and daughter were diagnosed as ANSD. 11 Jun, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-195.php The fleshy telangiectatic bud or pyogenic granuloma is a tumor-like lesion that develops from chronic inflammatory situations of the conjunctiva or the eyelid. The chalazion represents one of the most frequent of these situations. We report the case of a child who presented, after a chalazion, a pyogenic granuloma, treated by surgical removal. 26 May, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-194.php Primary spontaneous pneumothorax is due to Spontaneous rupture of a subpleural bulla [1], 25 May, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-193.php We report an unusual case of a 78 year old lady presenting with sepsis secondary to necrotising soft tissue infection of her right forearm which she had initially sustained when falling on her driveway and hitting her right arm. 25 May, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-192.php Kidneys produce bicarbonate ions that neutralize acids in the blood. 22 May, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-191.php Articles and studies have reported this for years. But how do we make this happen and what does it mean? 18 May, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-190.php We report a case of bleomycin induced drug allergy in a healthy 34 year- old gentleman. 16 May, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-189.php Objective: This paper studied the diagnostic value of FibroScan (FS) for the degree of liver fibrosis in patients with ALT<2×ULN chronic hepatitis B(CHB). 01 May, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-188.php The surgical and anesthetic management of patients with giant umbilical hernia associated with Hurler’s disease is a challenge due to the many problems. We present a recent case of giant umbilical hernia with skin necrosis accompanying Hurler’s syndrome. 01 May, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-187.php This study is to analyze the statistics and causality inferences of simulation of tumor due to exposition on immune system, CD8+ and NK cells and their relationship to happiness and Down syndrome. 29 Apr, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-186.php 2019 marks the 50th anniversary of the discovery of fosfomycin, an antibiotic widely used in urological and systemic diseases. 27 Apr, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-185.php Neurofibromatosis type 1 (NF-1) is a common autosomal dominant inherited disorder. Aside from typical symptoms like pigmentary manifestation, patients with NF-1 can also have unspecified T2 hyperintensities (T2Hs) on the brain and may develop benign or malignant tumours in central nervous system or other parts of the body. In this article, we reported a 54-year-old female diagnosed as NF-1 combined with T2Hs and pinealoma that was proved to be a high-grade glioma in later follow-up. We noticed some clinical manifestations such as pigmented teeth and dentition defects that had not been described before. There were some reflections from the poor prognosis of this patient. Even though the course of the disease is relatively indolent most of the time, long-term surveillance is in need and treatment may be required in those with symptoms or unstable imaging findings. 27 Apr, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-184.php Introduction: Spinal Dural Arteriovenous Fistulae (SDAVF) is a vascular malformation of the spinal cord. Digital Subtraction Angiography (DSA) is the gold standard for the diagnosis. Sometimes there are false negatives. Case Report: The authors describe a 62-year-old male with SDAVF. He presented with a slow ascent of sensory and motor impairments. DSA showed normal at first, but showed the presence of SDAVF in the second time. 25 Apr, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-183.php Background: In Ghana, the Ministry of Health (MOH-GH) have recommended that every suspected malaria case is tested and treatment given should be based on test results. However, several patients are still given antimalarial drugs without confirmation of malaria. The objective of this study was to determine the proportion of under-five children who received diagnosis of malaria from clinicians even when the test was negative for malaria. Methods: A cross-sectional study was used which involved two randomly selected government-owned hospitals in the Northern zone of Volta region in Ghana. For each hospital, 439 under-five children participated in the study. Adherence to the malaria test results was based on the mRDT and expert microscopy test results in the selected hospitals. 25 Apr, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-182.php There are different types of congenital anomalies who have its origin in the embryological development of the esophagus and trachea at the fifth and seventh weeks. Examples of these are Laryngotracheoesophageal clefts, esophageal atresia with or without fistula and Congenital Esophageal Stenosis (CES) [1-3]. The following case expose a 28-days-old baby boy with a extrange type of tracheoesophageal fistula with an esophageal estenosis. 20 Apr, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-181.php Physicians have at least two roles as medical professionals: direct patient management, which involves diagnosis and treatment, and delivering new discoveries acquired from daily clinical activities to patients both in the present and future world. Importantly, these two activities are closely related, and the process of case report writing will integrate them [1]. Here we introduce several activities which will be helpful for case writing. 16 Apr, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-180.php Maternal red blood cell alloimmunization is an important cause of morbidity and mortality in the antepartum and neonatal periods. Typically, the serological diagnosis of Hemolytic Disease of the Fetus and Newborn (HDFN) includes a positive direct antiglobulin test on the infant’s red blood cells and the presence of an IgG red cell alloantibody in both maternal and cord sera. 11 Apr, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-179.php Chlorine inhalation related Acute Respiratory Distress Syndrome (ARDS) is rare in clinical practice. Although full recovery from chlorine inhalation injuries remains the most likely outcome, it is true that permanent disability of lung function or even a fatal outcome are possible in severe cases. Reviewing the literature, there are some reports wherein severely injured cases have a mortal outcome. We report a case of high-dose chlorine inhalation injury which induced ARDS and severe acidosis with refractory shock status 4 hours after the initial insult. A vein to artery Extra-Corporeal Membrane Oxygenation (ECMO) system was applied for the ARDS and systemic steroid therapy was also administered. The patient had a good recovery of the pulmonary oxygenation after 70 hours of ECMO support and intubation and ventilation support for five days. He was then transferred to the ward after a one-week stay in the intensive care unit. Oral steroids were gradually tapered over 4 weeks. The follow-up pulmonary function test, performed 6 weeks after the injury, revealed fair recovery without remarkable sequelae while the high resolution pulmonary computed tomography showed bilateral pulmonary fibrosis. To the best of our knowledge, this is the first case report wherein an ECMO system has succeeded in salvaging a patient who suffered from chlorine inhalation injury complicated with ARDS and refractory shock. It is noteworthy that the ECMO system may be deemed beneficial for this group of patients so long as there is no clinical contraindication for the use of such a therapeutic strategy. 19 Mar, 2020 https://www.clinsurggroup.us/articles/GJMCCR-7-178.php The author presents the case of a 63-year-old man who was diagnosed with type 2 diabetes 15years ago (2004) and with ulcers in both feet with 12years of clinical course (which have required hospital admissions). The patient was diagnosed with moderate Charcot neuroarthropathy in 2009 using foot X-rays, receiving no specific treatment for this condition. The ulcers had been treated with multiple healing products, with poor results, for ten years. 17 Dec, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-177.php Tako-Tsubo cardiomyopathy is an increasingly recognized as clinical syndrome characterized by transient apical left ventricular dysfunction. 05 Nov, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-176.php Sister Mary Joseph Nodule (SMJN) is a cutaneous nodule resulting from metastasis of malignant tumors affecting the umbilicus; it had been reported in 0.7e10.4% of patients. 16 Aug, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-175.php Cases of survival after a penetrating fi rearm injury to the head are very uncommon. In cases where the bullet does not exit the head, it can be lodged anywhere in the cavities of the skull leading to fatal consequences. This case report examines a rare case of a penetrating fi rearm injury to the face where the victim survived and the bullet was discovered to be lodged at the nasal roof. 03 Aug, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-174.php The purpose of this presentation is to report the antenatal diagnosis and perinatal management of an amniotic band syndrome which occurred in the fetus of a pregnant 30-year-old Thai woman who presented at the gestational age of 21 weeks. 02 Aug, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-173.php Introduction: The aim of this clinical study was to evaluate the effect of different antibacterial combinations on the outcome of revascularization process in permanent anterior immature teeth. 26 Jun, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-172.php A 21 year old man was complaining of pain in a toe withswelling, which was interfering with his walking. The lesion was itchy and nodular. He thought he had been bitten and the insect had left a bump and black mark on the skin. 26 Jun, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-171.php 50 year old woman presented at surgery on return from a holiday in Tanzania. She was complaining of multiple, small red, very itchy, lesions scattered round her waist line, on the inside of thighs and upper arms. She had been scratching these areas and there was now reddened skin, with lacerations on her thighs, seeping of the wounds and small patches of sepsis. 20 Jun, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-170.php A 34 year old female with metastasizing neuroendocrine lung carcinoma with no underlying etiologies. Patient was diagnosed with stage 4 lung neuroendocrine cancer with treatment options limited due to intellectual disability and overall poor prognosis. The patient had a rapid decline over a 5 week period with decreased intake, decreased appetite, and overall azotemia and resulted in patient’s death. 15 Jun, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-169.php Canabis abuse is a rare but well-known und increasing cause of myocardial infarction in young people, predominantly in the male sex. Although the exact pathophysiological mechanism is not completely understood, several hypotheses have been proposed: coronary artery spasm due to alpha-adrenergic receptor stimulation; premature atherosclerosis with „classical “plaque formation and rupture resulting in thrombus formation with complete vessel closure. The latter model is supported by the fact that concomitant cigarette smoking is usual in cannabis drug abusers and represents a classical cardiovascular risk factor [1]. 13 Jun, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-168.php Mushrooms are a rich source of chemical compounds. Such a mushroom is also polypore Laetiporus sulphureus, in which a large number of bioactive substances with cytotoxic, antimicrobial, anticancer, anti-inflammatory, hypoglycemic, and antioxidant activity have been found. This short review summarizes the results of the most important chemical and biological studies of the fruiting bodies and the mycelial cultures of L. sulphureus. Since the ingredients of this edible mushroom have beneficial effects on human health, it could become a functional food. 28 May, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-167.php Rheumatic fever continues to be a frequent cause of cardiac valve disease in developing countries. The combination of rheumatic heart disease and pregnancy represents a challenge in the management of these patients. Prevention strategies are often insufficient; this is why we continue to observe complicated cases that demand more complex treatments. We are reporting the case of a 20-year-old woman, with a history of aortic valve replacement and mitral valve repair due to rheumatic heart disease. Two years later after her valve replacement, she attended consultation with signs and symptoms of heart failure in functional class III during a pregnancy of 20 weeks. The echocardiography showed: dysfunctional biological aortic prosthesis with severe stenosis and moderate regurgitation (central and para-valve leak), as well as severe mitral valve insufficiency, eccentric, directed towards the atrial free wall. She was admitted, and received optimal medical treatment for 4 weeks with little response and subsequent worsening. A multidisciplinary committee was formed including cardiologists, cardiac surgeons, obstetricians, neonatologists, and specialists in bioethics. It was decided to proceed with valve replacement surgery during the 21st week of her gestation. Successful double valve replacement (mitral and aortic) was performed, without complications for the patient or the fetus. She was discharged in good health. In her 38th week of gestation, a successful cesarean delivery was performed without any complications. 11 May, 2019 https://www.clinsurggroup.us/articles/GJMCCR-6-166.php While rarely seen in the present-day, Phocomelia syndrome is a sporadic congenital malformation disrupting the normal growth and progressing of the musculoskeletal system. 20 Dec, 2018 https://www.clinsurggroup.us/articles/GJMCCR-5-165.php Cronkhite-Canada syndrome is a rare disorder which is sporadic in nature, its pathology and cause is not fully understood, usually characterized by the presence of polyps in the stomach and large intestine and less frequently in the oesophagus with associated, the aim of this report is to discuss the pathogenesis of this syndrome and possible treatment options, in this case there was a non-conventional approach applied to this with a good prognosis, the disease itself is usually present among the Japanese population with a male to female ratio 2:1 but was of irrelevance as our patient was Indian, this report will also shed some light on the use of herbal medicine and its application in the treatment of this disease along with conventional medicine. 16 Nov, 2018 https://www.clinsurggroup.us/articles/GJMCCR-5-164.php Oral anticoagulants frequently endorsed to treat a thromboembolic occasion or for its prevention. This remedial class, which is a narrow therapeutic index, defended watchful observing, particularly in the principal long stretches of his medicine, and by and large, near patients in whom the draining danger is high (particularly elderly). 14 Sep, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000063-gjmccr.php Background: A patient’s motivation for consulting a physician is paramount to the first steps of achieving an early diagnosis of hereditary angioedema (HAE). Understanding what triggers this motivation can help in the design of strategies to increase the number of visits to a specialist physician following early symptoms of HAE. The aim of the present study was to identify the reasons that led patients to seek the opinion of an HAE expert physician. 30 Jun, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000062-gjmccr.php In our series of unsung or forgotten medical heroes, we first published a manuscript on Alvin Blunt, Jr, M.D. who was the first African American MASH physician in the Korean War. Dr. Kenneth L. Wilson’s manuscript changed United States military history. Our second manuscript in our series, Medical Miracle in Indianola, Mississippi: The Untold Story of Dr. Clinton Battle and the Indianola Conjoined Siamese Twins, introduces the world to a 29-year-old physician who vaginally delivered the first set of conjoined twins to be successfully separated and both survived the operation. This great feat was done at Rev. John and Missouri Matthews’ home without anesthetics or ultrasound. Dr. Battle died dejected because he never received any credit for this magnificent accomplishment in medical history. In this manuscript, we present the compelling story of Dr. Colonel Vance Marchbanks, who monitored astronaut John Glen during his historic space flight. Dr. Marchbanks was a pioneer Flight Surgeon who developed an oxygen delivery system that enabled flight crews to fly at higher altitudes. 20 Jun, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000061-gjmccr.php Amenorrhoea is a very common complaint in obstetrics and gynecology outdoor patient department, but primary amenorrhea is not a common complaint. 22 Mar, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000060-gjmccr.php Familial hyperlipidemia is defi ned by abnormal levels of the following: low density lipoprotein cholesterol (LDL-C); high density lipoprotein cholesterol (HDL); triglycerides (TAG); or any combination of the three. 16 Mar, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000059-gjmccr.php Transverse myelitis is an autoimmune demyelination disease of the spinal cord that can present with a myriad of symptoms ranging from altered sensations, weakness, loss of bowel control and so forth. There are approximately 1400 new cases reported each year in the United States, but this is likely an underestimation, without a gender bias or familial predisposition and a bimodal age distribution of onset (between 10-19 and 30-39) [1]. 05 Feb, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000058-gjmccr.php Spontaneous rupture of the kidney consists of the atraumatic disruption of the renal parenchyma, followed by hemorrhage or leakage of urine into the perinephric space. 31 Jan, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000057-gjmccr.php Liposarcoma is the most common retroperitoneal sarcoma and represents more than 15% of all sarcomas. Well differentiated liposarcoma is usually located in the extremities. We report the case of a patient with a giant retroperitoneal liposarcoma revealed by an abdominal mass. 21 Nov, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000056-gjmccr.php The simultaneous commencement of operative interventions by two or more surgical teams in the multiply injured patient is gaining more acceptance. 15 Nov, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000055-gjmccr.php Objective: Evaluate the treatment result of corticoid injection for subacromial impingement syndrome Patients and method: 30 patients with shoulder pain for at least 3 months, diagnosed subacromial impingement syndrome, excluded rotator cuff tear and labral lesion. A single injection into subacromial space with Methylprednisolone acetate 40 mg. Evaluate the result with VAS and Constant score. 05 Sep, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000054-gjmccr.php Despite that even normally functioning bicuspid aortic valves can have abnormal transvalvular-fl ow patterns, resulting in regional increases in wall shear stress and aortic dilatation, most often are preserved during ascending aorta replacement. 04 Aug, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000053-gjmccr.php A case of cutaneous phaeohyphomycosis of the foot affecting interdigital spaces between toes in a 31 year old immunocompetent male with no history of diabetes is illustrated. Fugal elements were found in direct microscopic examination of skin scrapping. 24 Jun, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000052-gjmccr.php Splenic tuberculosis (splenic TB) is extremely rare. It is likely to be misdiagnosed as carcinoma of spleen, splenic abscess, lymphoma, or others. The misdiagnosis rate is high if there is no tuberculosis history in other organs. 23 Jun, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000051-gjmccr.php Ortner’s syndrome is rare syndrome characterised by hoarseness of voice due to recurrent laryngeal nerve involvement in cardiovascular disease. This report presents a case of left laryngeal paralysis caused by an aortic arch aneurysm and to highlight the importance of an otorhinolaryngology evaluation along with a thoracic radiologic study. 23 Jun, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000050-gjmccr.php Foreign bodies in the rectum often pose a challenging diagnostic and management dilemma that begins with the initial evaluation in the emergency department and continues through the post extraction period. 21 Jun, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000049-gjmccr.php Background: Non-communicable diseases including cardiovascular disease, hypertension, hyperlipidemia, and stroke are on the rise throughout the world. Further, there is a large proportion of individuals that have hyperlipidemia and hypertension that is not diagnosed, treated or controlled in low and middle income countries (LMICs). 20 Jun, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000048-gjmccr.php Branchial anomalies (BA) are developmental lesions that are believed to be either vestigial remnants resulting from incomplete obliteration of the branchial apparatus or the result of buried epithelial cell rests. They are classified as either first, second, third, or fourth according to their proposed pouch or cleft of origin and are relatively common findings. 20 Jun, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000047-gjmccr.php In recent years the incidence of both amputations as total joint replacement surgery of lower limbs has been increased. So it is not rare to fi nd both circumstances in the same patient. We discuss about the technical problem of this eventuality. 15 Jun, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000046-gjmccr.php Synovial sarcoma accounts for 5 to 10% of soft tissue sarcoma. It occurs mainly in young adults, where 90% of cases occur before 50 years. Over 80% of cases arise in deep soft tissue of extremities, especially around the joints [1]. 02 Jun, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000045-gjmccr.php We report the rare case of a left isolated superior rectus muscle (SRM) rupture due to a bizarre mechanism of injury, where a universal serial bus (USB) fl ash drive entered the orbit during a motor vehicle accident leading to rupture of the SRM 7mm from the limbus. 27 Apr, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000044-gjmccr.php Background: Socioeconomics only account for 18% of all healthcare disparities. Healthcare disparities in the intensive care unit (ICU) have been well documented and persist in spite of previous government and medical interventions. 25 Apr, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000043-gjmccr.php The article outlines the principal theses of the concept of psychotherapy of anxiety disorders, based on changing the client’s perception on his problem and revising the system of values. Model of “anxiety-centered” behavior is reviewed and ways of transformation of client’s self-evaluation and lifestyle that are to manage the anxiety are described. Changing the “reference system” as core element of recovery is reviewed. Material is illustrated with case studies and excerpts from therapeutic sessions. 24 Apr, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000042-gjmccr.php Asthma is a chronic lung disease. The prevalence of asthma in pregnancy is 1-4%. Asthma can have a negative impact on maternal and fetal health. But it depends if treated adequately or not, during pregnancy. 07 Apr, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000041-gjmccr.php Presently, the prevalence of congestive heart failure in the United States is 6.5 million people. We report two cases of severe congestive heart failure patients with a very poor prognosis, treated successfully with a combination of high dose vitamin D, digoxin, and BiDil (Matthews’ Two Inotrope Protocol). 03 Apr, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000040-gjmccr.php Background: Screening programs for detecting cancer early are critically important for a better prognosis and a long acting survival. In our country, second most common cause of death is cancers with the rate of 21.1 %. The aim of this study was to investigate cancer screening and awareness in healthy individuals in our region. 22 Mar, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000039-gjmccr.php Background: To investigate the clinical effect of Nd:YAG laser combined with total glucosides of paeony (TGP) for the treatment of erosive oral lichen planus (OLP). 09 Mar, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000038-gjmccr.php Background: It has been estimated that over 400,000 patients die each year from medical errors in the United States. The purpose of this study was to investigate the impact of vitamin D (a steroid hormone and immune modulator) and glutamine supplementation, evidence- based medicine, and close staff supervision on hospital mortality rate in trauma patients. 02 Mar, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000037-gjmccr.php Avulsion injuries of the fl exor digitorum profundus (FDP) tendon are common and widely reported [1-3]. Closed traumatic avulsion of the fl exor digitorum superfi cialis (FDS) tendon is, however, rare, with few reported series of isolated FDS ruptures [3-6]. 22 Feb, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000036-gjmccr.php Melioidosis is an infection caused by a gram negative bacterium .We report a case of FUO which upon investigation revealed muscle abscess and subsequent pus culture revealed melioidosis. This case is reported since melioidosis can often mimic other diseases and in rare instances present with psoas abscess. 15 Feb, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000035-gjmccr.php Background: Mucoceles are cavities fi lled with mucous and often occur in the oral mucosa. When they develop in children may cause diagnostic and management concerns. 10 Feb, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000034-gjmccr.php Conjoined twins are very rare. The overall survival rate has been estimated to be approximately 25% to 50%. We report a case of conjoined twins delivered in Indianola, Mississippi in 1955 who made medical history. The Matthews’ conjoined twins were the fi rst in history to be separated and both survive. 07 Feb, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000033-gjmccr.php A 37 year old woman (G1P1 spontaneous delivery) was admitted to our university hospital for menometrorrhagia. The case history showed the patient had menometrorrhagia for six months; moreover, during the abdominal examination we found a mass occupying the hypogastric and mesogastric area. 23 Jan, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-5282.000032-gjmccr.php One of the lesser-known adverse effects of antipsychotic medication is hypothermia, a signifi cant and protracted plunge in body temperature. Known risk factors are older age and exposure to a new for-the-person antipsychotic drug. 30 Dec, 2016 https://www.clinsurggroup.us/articles/GJMCCR-3-131.php There is a paucity of literature on this potentially devastating side effect of vacuum-assisted delivery. We present here a significant subdural haemorrhage associated with tentorial tear following vacuum-assisted delivery that resolved with only supportive medical measures without resulting in any neurological deficits nor delays on thorough examination and formal neuro-developmental assessment. 22 Dec, 2016 https://www.clinsurggroup.us/articles/GJMCCR-3-130.php Diabetic management requires a continuous assessment of performance, looking at successes and failures. Especially in community setting, the development of a Collaborative Diabetes Management [CDM], Low Sugar Volunteers [LSVs], core-community working group, vigorously participated in all community activities to manage diabetes disease and its relevance. 18 Nov, 2016 https://www.clinsurggroup.us/articles/GJMCCR-3-129.php Background: The coexistence of giant cell tumor (GCT) and metacarpal bone tuberculosis (TB) of the hand has never been described before in the English written literature. We report here a first observation. 01 Aug, 2016 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-3-128.php Lutembacher syndrome is a combination of ostium secundum atrial septal defect with acquired rheumatic mitral stenosis. This is a case of middle aged woman who had lutembacher syndrome with severe pulmonary hypertension with class IV symptoms. She had very severe mitral stenosis with valve area of 0.7 cm2 and ostium secundum atrial septal defect of 14 mm size. The management of lutembacher syndrome was only surgical till 1990s. Total percutaneous management has been described in late 1990s. Percutaneous management is relatively cheaper option and saves the patient from artificial valve and related complications. However, only a small number of cases of total percutaneous management of this condition are available in world literature. 30 Jun, 2016 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-3-127.php Introduction: Isolated right ventricular myocardial infarction is an uncommon entity in the spectrum of acute coronary syndrome. It is often overlooked during the assessment of patients suspected to have acute coronary syndrome. 29 Jun, 2016 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-3-126.php The presence of a large bulky pancreatic tumour in a young female should raise suspicions of the diagnosis of solid-pseduopapillary tumour of the pancreas. 13 Jun, 2016 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-3-125.php Pasteurella spp is the first organisms to consider in any patient who presents with a soft tissue infection following cat or dog bites. Pasteurella canis is most common isolate of dog bites, but there are no reports of pastereulla canis infection caused by sheep bite. A case of a 66 years old farmer woman with symptoms of infected left hand with wrist septic arthritis, after a lamb bite is described (the sheep was sick after a dog bite). Microbiological examination of the wrist articular liquid was performed. The specimen was both aerobic and anaerobic cultures were performed. After 24 hours, growth of smooth 08 Jun, 2016 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-3-124.php Cystic disease of the bile duct is a congenital abnormality of the biliary tree that most commonly affects the neonatal population, and is uncommon after childhood, it is rarely diagnosed in adults. We report the case of a 42-year-old woman affected by choledochal cyst type I, according to Todani’s classification, found unintentionally. The patient was submitted to the complete surgical excision of choledochal cyst, and discharged on the 11th postoperative day without complications. 12 Mar, 2016 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-3-123.php Paracetamol is one of the most used drugs in the world. We report here two cases of children poisoning (less than 3 years old) who were accidentally administered an adult form of rectal suppository containing a combination of paracetamol-codeine (1000 mg/60 mg). The first child received a dose of 154 mg /kg of paracetamol and 9 mg/kg of codeine two times daily for 2 days. Clinical signs were vomiting and epigastric abdominal pains. Biochemistry showed an increase of liver enzymes (4 to 40 fold), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (GGT). The second child received the suppositories discontinuously (two times daily) and showed less severe signs of intoxication. The administration of N-acetylcysteine at admission into hospital limited the toxic effects of paracetamol. The toxic effects of codeine, such as central nervous system (CNS) depression were not obvious in both cases. 11 Mar, 2016 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-3-122.php Background: Being differently abled is a complex phenomenon and also concept of disability has shifted from individual impairment to social phenomenon. 17 Dec, 2015 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-2-121.php Sevoflurane is considered a safe inhaled anesthetic of choice in patients with liver disease. Compared to other halogenated inhaled anesthetics, Sevoflurane is reported to lessen the severity of decreased hepatic blood flow and undergoes a different mechanism of hepatic metabolism. 20 Nov, 2015 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-2-120.php Compression of the airway by vascular anomalies is a co-morbidity occurring frequently in children with congenital heart diseases. Here we presented a cohort of 7 patients with respiratory distress who showed airway compression due to vascular anomalies on evaluated with multidetector computed tompgraphy. 16 Oct, 2015 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-2-119.php Coarctation of the aorta is a relatively common defect that accounts for 5-8% of all congenital heart defects and is characterized by discrete medial thickening with superimposed neointimal tissue, leading to aortic lumen narrowing of different degrees. 12 Sep, 2015 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-2-118.php Background: Isolated fallopian tube torsion is very rare during pregnancy .The reporter's show that the right fallopian tube torsion is most common. Most of the cases have presented in the third trimester. The diagnosis of this torsion is very difficult. There are not pathognomonic symptoms; clinical, imaging, or laboratory findings. The diagnosis is proved during the operation. 14 Aug, 2015 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-2-117.php The skeletal muscles are rarely affected by tuberculosis because they are not a favorable site for the survival and multiplication of Mycobacterium tuberculosis. A case of tuberculous abscess in rectus abdominis muscle is described in a 20- year- old female in an apparently healthy individual without any past history of tuberculosis. 24 Jul, 2015 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-2-116.php Background: Gender inequalities continue in all walks of life for all women, urban rural. Objective: was to know gender differences in everyday life of women. Material methods: Thousand non-pregnant and thousand, pregnant women were interviewed. 18 Mar, 2015 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-2-115.php Numerous reports have surfaced over the past decade centering on the potential for complications when transfusing "new" versus "old" stored red blood cells (RBCs). The transfusion of whole blood and packed RBCs has been a standard medical treatment since Landsteiner in 1900 developed red cell ABO typing, leading to compatible transfusions from donor to recipient. 10 Nov, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-114.php A 47-year-old woman presented to her family physician with complaints of persistent fatigue of three months duration. She had menorrhagia, irregular menses and mild dysmenorrhea but denied dyspnea, weight loss, fevers, night sweats, melena stool, overt rectal bleeding, hematuria, hematemesis and abdominal pain. She did not smoke and drank socially. 24 Oct, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-113.php The aim of this work is to show the relationship between obesity and aggressivenes of Prostate Cancer. We conducted a retrospective study of 132 men affected by Prostate Cancer underwent radical prostatectomy. Gleason score was abstracted by biopsy specimens and by post-operatory specimens. We evaluated PSA level and Body Mass Index (BMI). 15 Oct, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-112.php Introduction: Fabry disease (FD) is a rare metabolic disorder that leads to severe morbidity and premature mortality as a result of cardiac, renal or cerebrovascular complications. Enzyme replacement therapy (ERT) has been shown to provide clinically important benefits, and treatment is likely to alter the natural history of FD. 20 Sep, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-111.php Vesical calculi are not commonly seen with utero vaginal prolapse. Calculi may be missed unless ultrasonography or X-ray is done. If not diagnosed problems can occur during surgery and post operatively. If vesical calculi are removed vaginally during anterior colporrhaphy, it may lead to fistula formation. Suprapubic cystotomy and removal of calculi done during vaginal surgery for genital prolapse seems better option. 13 Sep, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-110.php A case of müllerian agenesis, Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome, in a 16 year-old female with primary amenorrhea is reported. This patient exhibited normal female external physical characteristics with a shallow, blind vaginal pouch upon examination. 12 Sep, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-109.php Surgical reconstruction of large facial defects is not possible at times due to extensive loss of tissues that cannot be corrected by surgery alone. In these cases, prosthetic restoration of lost facial tissues can be done using maxillofacial prostheses. Introduction of new material which gives life-like appearance to such prosthetic restorations e.g. silicone and poly ether rubbers and use of implants to retain these prostheses have given a new dimension to rehabilitation of such patients. 28 Aug, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-108.php Chorea associated with non-ketotic hyperglycaemia is an uncommon dyskinetic syndrome in uncontrolled or undiagnosed diabetes. Various theories are postulated but the underlying mechanism remains poorly understood. We report a 70-year-old man suffering from sudden choreodystonic movements and undiagnosed hyperglycemia. It always marks the importance of screening for diabetes as a cause of acute onset of hyperkinetic disorders. 28 Aug, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-107.php During the recent past, the biomedical publishing field has witnessed a decline in the publishing of the case reports by many journals. This trend is not particularly helpful for the medical community at large. The main reason for the above trend is the low citation value of the case reports, which reduces the overall impact factor of the journals. 14 Aug, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-106.php Obstructed hemivagina with ipsilateral renal agenesis (OHVIRA Syndrome) is a rare congenital anomaly. It mostly presents with severe dysmenorrhea and a palpable mass due to unilateral hematocolpos. Sometime it presents in unusual way with prolonged vaginal bleeding and profuse vaginal discharge. 03 Jul, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-104.php Background and Purpose: Adolescent soccer players are often prone to low back pain and one source of low back pain incurred by adolescents is Schmorl's nodes, or end-plate disc herniations. Patients with low back pain due to Schmorl's nodes are often given home exercise programs to manage their symptoms and increase their core stability. The purpose of this case report is to describe the treatment and outcome for a young athlete with Schmorl's nodes causing low back pain and lower extremity weakness. 25 Jun, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-103.php Introduction: Aggressive angiomyxoma is a mesenchymal tumour which presents rarely; usually in women in reproductive age group, as a mass in the pelvic tissue. Only exceptionally, has it been seen to originate from the uterus and cervix. 23 Jun, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-102.php Introduction: Symptomatic adjacent segment disease after anterior cervical decompression and fusion has been well described, but there have been few reports of symptomatic adjacent segment disease after cervical laminoplasty. 23 May, 2014 https://www.clinsurggroup.us/Clinical-Case-Reports/GJMCCR-1-101.php Introduction: Lung cancer frequently causes metastases to the spine, especially to the thoracic vertebrae, which sometimes compress the spinal cord and induce irreversible palsy. Many patients suffering from metastatic spinal tumors need to undergo repetitive radiotherapy. In such situations, intensity-modulated radiotherapy including volumetric modulated arc therapy can reduce the dose delivered to the spinal cord at the junction.