Oculocutaneous albinism type 1B (OCA1B) may present with subtle dermatologic manifestations and be initially suspected through ophthalmologic abnormalities. We report a 16-year-old female with normal psychomotor development who presented with progressive decreased visual acuity beginning in childhood. Ophthalmologic evaluation demonstrated reduced best-corrected visual acuity (BCVA) and fundoscopic findings, including pale optic discs and increased visibility of choroidal vessels. Suspicion of albinism increased after optical coherence tomography (OCT) revealed the absence of foveal depression. The patient was referred to clinical genetics, where next-generation sequencing (NGS) confirmed TYR variants consistent with OCA1B, followed by genetic counseling regarding autosomal recessive inheritance. Dermatologic evaluation later revealed Fitzpatrick phototype II skin and gray-green irides consistent with a mild hypopigmented phenotype of OCA1B. Mild acneiform lesions were also observed and considered incidental findings. This case highlights the importance of dermatologic assessment within a multidisciplinary diagnostic pathway, contributing to the recognition of subtle cutaneous phenotypes and the implementation of long-term photoprotection and surveillance strategies in patients with mild albinism.
Introduction Postoperative temporary facial nerve dysfunction (TFND) is a common complication after parotidectomy, and the tumor location is believed to influence its risk. This study aimed to evaluate the relationship between tumor location and postoperative TFND, as well as to assess the effects of lobe involvement and surgical approach. Methods This prospective observational study was conducted at Bangladesh Medical University, Dhaka, between June 2022 and December 2023, and 35 patients with parotid neoplasms who underwent surgery were enrolled in this study. Preoperative magnetic resonance imaging was used to determine the tumor location (anterior/posterior, superior/inferior, superficial/deep), and lobe involvement was confirmed intraoperatively. Facial nerve function was assessed via the House-Brackmann grading system on postoperative day 2 and at one and three months. Univariate and multivariate logistic regression were performed to analyze the TFND risk factors. Results The participants had a mean age of 48.80 ± 11.92 years, with a female predominance. Pleomorphic adenoma was the most common tumor type (60%). TFND occurred in 54.3% of patients on postoperative day 2, 51.4% at one month, and 45.7% at three months, most commonly involving the marginal mandibular branch. On multivariate analysis, anterior tumor location (OR: 25.05; 95% CI: 1.29-484.05; p = 0.033), bilobar involvement (OR: 21.84; 95% CI: 1.13-421.84; p = 0.041), and total conservative parotidectomy (OR: 20.89; 95% CI: 1.05-413.72; p = 0.046) were significantly associated with increased risk of TFND on postoperative day 2. At one month, anterior tumor location remained a significant predictor (OR: 31.75; 95% CI: 2.02-497.19; p = 0.014). At three months, anterior tumor location (OR: 13.59; 95% CI: 1.72-107.22; p = 0.013) and bilobar involvement (OR: 10.14; 95% CI: 1.39-73.92; p = 0.022) remained independently associated with persistent TFND. No significant association was observed between TFND and age, sex, tumor size, or histopathology. Conclusion Anterior tumor location, bilobar involvement, and extensive surgery significantly increase TFND risk and persistence. These findings suggest that careful preoperative imaging-based localization and meticulous surgical planning may help reduce the risk of TFND in parotid surgery.
Listeriosis is an infectious disease caused by Listeria monocytogenes. A retrospective analysis was conducted on four pregnant women and three newborns diagnosed and treated for listeriosis at Fuzhou University Affiliated Provincial Hospital between May 10, 2015, and June 1, 2023, using descriptive methods. Maternal Case 1 was a 33-year-old woman who underwent cesarean section at full term due to fetal distress, Case 2 was a 32-year-old woman who underwent cesarean section at preterm due to fetal distress, Case 3 was a 32-year-old woman who presented with spontaneous preterm labor, and Case 4 was a 30-year-old woman who underwent induction due to fetal malformation. Among the four pregnant women, initial symptoms included fever (n = 2), abdominal pain or vaginal bleeding (n = 3), and abnormal fetal heart monitoring (n = 2). Laboratory findings showed varying levels of procalcitonin (0.11-0.26 μg/L) and C-reactive protein (15-121 mg/L). Blood cultures of the newborns born in Cases 1 to 3 confirmed Listeria monocytogenes infection. Initial empirical treatment with cephalosporins was adjusted to penicillin, linezolid, or vancomycin based on drug susceptibility testing. Pregnancy-related listeriosis was associated with high feto-neonatal mortality. Clinicians should emphasize the importance of a healthy diet and raise awareness of this condition among pregnant women.
Dengue hemorrhagic fever (DHF) is a severe form of dengue fever. Plasma leakage is the main pathophysiological hallmark that distinguishes DHF from mild dengue infection, and can result in hypovolemic shock and fatal outcome. No specific drugs and vaccines are available to treat dengue disease, and supportive therapy based on fluid replacement therapy and symptomatic medication (e.g., antipyretic/analgesics) should be promptly instituted. Platelet-activating factor (PAF) is associated with an increase in vascular permeability and has been found to be elevated in patients with DHF, supporting the use of strong PAF antagonists, such as rupatadine, in the management of severe dengue. We here report the case of a 17-year-old female patient presenting with fever, abdominal pain, headache, nausea, transvaginal bleeding, and thrombocytopenia (platelet count 45,000 cells/mm3), who was diagnosed with DHF by positive dengue IgM and IgG antibodies on the fifth day of illness. The patient was hospitalized, and oral rupatadine 40 mg/day was added to fluid-based supportive therapy. After two days of inpatient treatment, symptoms rapidly improved, and the platelet count increased to 110,000 cells/mm3. Nasal testing for SARS-CoV-2 infection performed on two occasions was negative. In summary, rupatadine as an add-on therapy to conventional therapy could reduce the risk of complications in DHF. This off-label use of rupatadine needs to be explored in larger studies.
Diabetic eye disease, the leading microvascular complication of diabetes mellitus (DM), is one of the leading causes of blindness worldwide, whose disease burden and demographics are only expected to grow in the coming decade. Advances in molecular biology techniques have enabled the identification and study of several proteins and transcription factors believed to play key roles in the underlying disease pathogenesis. A majority of these factors work together, contributing to both angiogenic (formation of new blood vessels) and inflammatory processes underlying diabetic retinopathy (DR).As a result, emerging therapies are increasingly targeting specific molecular mechanisms. In parallel, nonpharmacological interventions are being proposed to inform the development of appropriate clinical diagnostic and treatment guidelines. These approaches aim to address the early stages of disease and slow or prevent progression to chronic, later stages that may result in vision loss. This review synthesizes foundational and recent evidence using a qualitative narrative approach, focusing on hypoxia-driven molecular pathways rather than quantitative meta-analysis. Although numerous studies have consistently identified key molecular factors that contribute to the pathogenesis of diabetic eye disease, additional details regarding the specific roles of some factors listed herein, as well as the discovery and involvement of other factors in the pathway, remain to be fully explored and understood.
Anorectal melanoma is a rare and aggressive malignancy arising from melanocytes within the mucosal epithelium of the anorectal region. Because presenting symptoms such as rectal bleeding frequently mimic benign anorectal conditions, diagnosis is often delayed until advanced stages of the disease. Mucosal melanoma is characterized by aggressive local invasion and early metastatic spread. We present the case of a 54-year-old female with metastatic rectal melanoma whose disease course was complicated by extensive pelvic tumor burden, malignant venous compression leading to deep venous thrombosis, obstructive uropathy, and tumor-associated hemorrhage. Cross-sectional imaging demonstrated a massive posterior pelvic mass occupying the rectouterine space with displacement of surrounding structures, additional rectal tumor extension, metastatic lesions in the liver, and locally invasive disease adjacent to the patient's colostomy. Diagnosis was confirmed through sequential biopsy, molecular analysis, and definitive surgical pathology, demonstrating a poorly differentiated malignant neoplasm with melanocytic differentiation and immunohistochemical positivity for S100, SOX10, Melan-A, and HMB45. Despite thrombectomy with iliac vein stenting, percutaneous nephrostomy tube placement, arterial embolization, and multidisciplinary oncologic management, the patient experienced progressive metastatic disease and ultimately transitioned to hospice care. This case highlights the aggressive nature of anorectal melanoma and illustrates how advanced pelvic malignancy may produce complex multisystem complications requiring multidisciplinary management.
 Metaplastic breast carcinoma (MBC) is a rare and aggressive subtype of breast cancer, accounting for less than 1% of all cases. MBC is characterized by a metaplastic transformation of glandular epithelium into squamous and/or mesenchymal elements. Most tumors are triple-negative, lacking expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), which limits targeted therapeutic options. MBC also exhibits marked histopathological heterogeneity and high chemoresistance.  We conducted a retrospective study of 15 patients with histopathologically confirmed MBC treated at a tertiary care center in India. All cases demonstrated a triple-negative immunophenotype (ER < 1%, PR < 1%, HER2-negative), with documented metaplastic differentiation. Detailed data on demographics, clinicopathological features, treatment, and outcomes were collected and analyzed.  The median age at diagnosis was 52 years. All patients presented with advanced disease: stage II in 60% (n = 9) and stage III in 40% (n = 6). Metaplastic differentiation included spindle cell features in 40% (n = 6), squamous features in 33.3% (n = 5), and mixed patterns in 26.7% (n = 4). Tumors were more commonly located in the right breast (73.3%, n = 11). Surgical management included mastectomy in 60% (n = 9) and breast-conserving surgery in 26.7% (n = 4). Neoadjuvant chemotherapy (NAC) was administered to six patients (40%), achieving a pathological complete response (pCR) in two of these (33.3%). Adjuvant chemotherapy was given to seven patients (46.7%), and 11 patients (73.3%) received radiotherapy. At the last follow-up, six (40%) were alive and disease-free, two (13.3%) were alive with disease, three (20%) had died, two (13.3%) were lost to follow-up, and two (13.3%) had incomplete assessment.  MBC in this cohort presented with aggressive histopathological features and predominantly advanced-stage disease. These findings highlight the need for improved breast cancer awareness, early detection, and individualized treatment strategies, particularly in resource-limited settings.
The heart functions as a coordinated four-chambered pump, with four valves ensuring unidirectional blood flow. The tricuspid valve, located between the right atrium and right ventricle, consists of anterior, posterior, and septal leaflets that coapt during systole to prevent retrograde flow. Valvular disorders may result in stenosis or regurgitation, thereby increasing cardiac workload and predisposing to chamber dilation and heart failure. Congenital abnormalities, including partial or complete leaflet absence, are rare but can significantly disrupt normal hemodynamics. Reports of absent tricuspid valve leaflets are exceedingly uncommon and have primarily involved the anterior or posterior leaflet. During the thoracic dissection of a 41-year-old female body donor with a reported history of cardiovascular disease, cardiomegaly was identified. Gross examination revealed marked right atrial and ventricular enlargement. Internal inspection demonstrated a complete absence of the septal leaflet of the tricuspid valve, with intact anterior and posterior leaflets. Additional findings included dilation of the superior and inferior venae cavae, hypertrophied right atrial pectinate muscles, smooth and flattened right ventricular trabeculae carneae, and heterogeneous right ventricular myocardial thickness. The left heart structures were largely unremarkable aside from calcification of the mitral valve. Isolated absence of the septal tricuspid leaflet in adulthood has not been previously described. Loss of septal leaflet coaptation likely resulted in chronic tricuspid regurgitation, progressive right-sided volume overload, compensatory chamber dilation, and eventual cardiomegaly. Recognition of such rare structural variants is important for accurate imaging interpretation and surgical planning, particularly given potential distortion of critical landmarks such as the Triangle of Koch.
Disseminated intravascular coagulation (DIC) is a critical complication of systemic illness, and its diagnosis can be especially challenging in patients with cirrhosis, where baseline liver-related coagulopathy may mask the development of superimposed consumptive coagulopathy. In the setting of sepsis and liver dysfunction, DIC may progress to purpura fulminans (PF), a rare, life-threatening condition characterized by dermal necrosis and microvascular thrombosis. We present the case of a 54-year-old man with alcoholic cirrhosis and untreated hepatitis C who developed DIC and PF following methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and toxic shock syndrome (TSS). Despite treatment with antibiotics, transfusions, intravenous immunoglobulin (IVIG), and hemodialysis, he developed multiorgan failure. This case highlights that in patients with sepsis and cirrhosis, acutely worsening coagulation parameters, falling fibrinogen, and evolving purpuric or necrotic skin lesions should not be attributed to liver disease alone but should instead prompt urgent evaluation for DIC and PF. The early recognition of this distinction is essential to guide timely multidisciplinary intervention in this rare but devastating complication.
Iron deficiency is the most common cause of anemia worldwide, yet desiderosmia remains rarely described as one of its manifestations. The term "desiderosmia" was first proposed in a case series by Hansen et al. to describe compulsive olfactory cravings for specific scents observed in three symptomatic patients with iron deficiency, derived from the Latin word "desiderare" for desire and the Greek word "osme" for smell. Desiderosmia appears to be closely related to pica, a common manifestation of iron deficiency, though the key difference is that patients report olfactory cravings without the desire to consume the scent-producing substance. As far as the authors of this report are aware, the number of published cases of desiderosmia is extremely scarce, and the term itself has yet to become recognized in medical literature, owing to its novelty. We report the case of a 32-year-old woman with menorrhagia and iron deficiency anemia (IDA) refractory to oral ferrous sulfate despite adherence. Despite her hemoglobin improving from 9.1 to 9.9 g/dL (reference range: 12-15.5 g/dL), her ferritin remained critically low at 1 ng/mL (reference range: 30-400 ng/mL). At that time, she developed an intense urge to smell pine-scented cleaning products, alongside migraines and restless leg syndrome, hypothesized to be neuropsychological symptoms linked to altered CNS iron homeostasis. We speculate that desiderosmia may share a similar neurological mechanism, correlating more closely with the severity of iron store depletion rather than with anemia severity. Recognition of this symptom prompted identification of IDA not improving with oral iron and escalation of therapy to IV ferrous carboxymaltose. Following treatment with intravenous iron repletion, her ferritin increased to 52 ng/mL, and she no longer experienced desiderosmia or any other iron deficiency symptoms. This case highlights the need for validating studies of desiderosmia's potential as a diagnostic marker in cases of severe iron deficiency and the symptom's pathophysiology.
Thanatophoric dysplasia (TD) is the most common lethal skeletal dysplasia, caused by de novo fibroblast growth factor receptor 3 (FGFR3) mutations. Prenatal ultrasound may detect key features such as severe micromelia, narrow thorax, macrocephaly, and temporal lobe dysplasia, although molecular confirmation is essential. Type I TD (TD1), the most frequent subtype, shows "telephone-receiver" femur bowing, frontal bossing, and midface hypoplasia. Type II TD presents with a cloverleaf skull and straight femurs. TD is generally fatal due to pulmonary hypoplasia, narrow thorax, and brainstem compression, with survival beyond the early neonatal period being uncommon. We report a newborn with prenatal suspicion of skeletal dysplasia, confirmed postnatally as TD1 via FGFR3 p.Ter807Trp mutation, highlighting the importance of prenatal counseling, early genetic confirmation, and palliative care involvement.
Esthetic dentistry increasingly emphasizes patient-centered treatment planning and effective communication between clinicians and patients. Conventional consultation methods often rely on verbal explanations and static images, which may not adequately convey the expected esthetic outcomes. Digital Smile Design (DSD) has emerged as a modern digital tool that allows clinicians to simulate potential smile outcomes. This digital approach may improve patient understanding, enhance confidence in treatment planning, and increase patient satisfaction with the consultation process. This study aimed to evaluate the impact of DSD on patient satisfaction and treatment acceptance during esthetic dental consultation. This prospective clinical study was conducted in the Department of Restorative Dentistry and included 80 patients who sought esthetic dental treatment. Following a conventional consultation involving a clinical examination and verbal explanation of the treatment plan, patient perceptions were recorded. A digital smile simulation was then generated using the Smile Designer Pro software (Tasty Tech Ltd., London, United Kingdom) and presented to the patients. Patient understanding of the treatment plan and confidence in the proposed treatment were assessed before and after the digital smile simulation using a 5-point Likert scale. Overall satisfaction with the consultation process was evaluated using a 10-point Visual Analog Scale (VAS). Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20 (Released 2015; IBM Corp., Armonk, New York). Descriptive statistics were calculated, and pre- and post-consultation scores were compared using a paired t-test with a significance level set at p < 0.05. A significant improvement in patient understanding and confidence was observed following the DSD consultation. Scores related to the clarity of procedures, understanding of treatment duration, costs, and limitations increased significantly after digital visualization (p < 0.001). Patient confidence in the anticipated final smile, confidence in the dentist, certainty of proceeding with treatment, and ability to visualize the expected outcome also improved significantly (p < 0.001). Overall, satisfaction with the consultation process was high, with the majority of participants reporting improved communication and greater involvement in treatment planning. In addition, 85% of the patients accepted the proposed treatment following digital smile simulation. DSD significantly enhanced patient understanding, confidence, satisfaction, and treatment acceptance during esthetic dental consultation. Its integration into clinical practice may improve communication and promote predictable patient-centered treatment planning in esthetic dentistry.
Induction of general anesthesia in the sitting position may be associated with hemodynamic instability resulting from decreased venous return, as well as challenges in airway management due to limited access to the airway. However, in patients who cannot tolerate the supine position because of post-traumatic pain or other conditions, induction in the sitting position may be unavoidable. In this report, we describe a case in which sedation was initiated in the sitting position, spontaneous respiration was preserved during the transition to the supine position, and tracheal intubation was subsequently performed, resulting in safe anesthetic management. The patient was a woman in her 40s with obesity who was scheduled to undergo robot-assisted surgery for a uterine malignancy associated with atypical endometrial hyperplasia. She had a history of a lumbar vertebral compression fracture secondary to a road traffic accident and was unable to tolerate the supine position while awake. After arrival in the operating room, remimazolam infusion was initiated at 6 mg·kg⁻¹·hour⁻¹ under supplemental oxygen. The patient was then moved to the supine position while maintaining spontaneous respiration. Following the administration of rocuronium and remifentanil, tracheal intubation was performed using a video laryngoscope. No complications, including decreased peripheral oxygen saturation, were observed during induction. The patient's postoperative course was uneventful without hypoxemia after extubation, and she was discharged on postoperative day 4. In patients with obesity who cannot tolerate the supine position due to severe pain, an induction strategy using remimazolam that preserves spontaneous respiration in the semi-sitting position while transitioning to the supine position may be a useful option. When performing induction in the sitting position, developing an anesthetic plan centered on agents with available antagonists may further enhance patient safety.
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that predominantly affects immunocompromised individuals. Reports in immunocompetent children are rare. We report the case of a previously healthy 5½‑year‑old Saudi girl who presented with fever, dry cough, and progressive respiratory distress. Her condition rapidly deteriorated, requiring pediatric intensive care admission and mechanical ventilation due to severe acute respiratory distress syndrome. Her course was complicated by pneumothorax, pneumomediastinum, and extensive surgical emphysema. Extensive microbiological investigations were negative except for bronchoalveolar lavage demonstrating Pneumocystis jirovecii using Gomori methenamine silver staining. The patient was treated with intravenous trimethoprim-sulfamethoxazole and supportive intensive care management with gradual clinical recovery. Immunological evaluation, including lymphocyte subsets, immunoglobulin levels, complement levels, vaccine antibody responses, and whole‑exome sequencing, revealed no evidence of primary or secondary immunodeficiency. Long‑term follow‑up for more than 10 years showed no recurrent severe infections. This case highlights that PJP may rarely occur in immunocompetent children and can present with life‑threatening respiratory failure. Awareness of this possibility is important in severe unexplained pneumonia.
Left ventricular noncompaction (LVNC) is a rare primary cardiomyopathy characterized by a failure of myocardial morphogenesis, resulting in a prominent, characteristic "sponge-like" trabeculated endocardial layer. Clinical presentation is classical for heart failure, ventricular arrhythmias, and systemic thromboembolism, which defines its severity. Here, we describe a 34-year-old male with no prior medical history who presented with progressive dyspnea and volume overload. On initial evaluation, severe biventricular failure, stage 3b chronic kidney disease (type 2 cardiorenal syndrome), and significant hemodynamic impairment were noted. Subsequently, contrast-enhanced transthoracic echocardiography (TTE) was consistent with the diagnosis of LVNC and identified multiple mural thrombi, including a 2 cm mobile apical thrombus. Coronary angiography revealed normal coronary anatomy. Following these findings, the patient was stabilized with intravenous diuretics and initiated on guideline-directed medical therapy (GDMT). Due to the high risk of sudden cardiac death and persistent low ejection fraction, he was discharged with a wearable cardioverter defibrillator and referred for advanced heart failure and transplant evaluation. Shifting focus to the underlying pathophysiology, thrombus formation in LVNC is unique. It goes beyond global systolic dysfunction; the deep intertrabecular recesses create stasis that predisposes to fibrin deposition regardless of wall motion. This thrombogenicity necessitates a nuanced approach to anticoagulation. In summary, LVNC should be a primary consideration in young patients presenting with new-onset heart failure. This case underscores the necessity of imaging to identify obscured thrombi and highlights the evolving role of direct oral anticoagulants (DOACs) in managing the specific mechanical risks inherent to noncompacted myocardium.
Giant hepatic hemangiomas, particularly those involving central hepatic segments (IV, V, and VIII), present unique surgical challenges due to their proximity to major hepatic veins and first-order portal structures. While laparoscopic approaches have been described, detailed guidance for open enucleation across a range of lesion locations and complexities remains limited. This technical report describes a systematic open parenchyma-preserving enucleation technique and presents a retrospective consecutive case series of six patients who underwent the described procedure over an eight-year period at a tertiary hepatobiliary center (American University of Beirut Medical Center, AUBMC). Patient demographics, tumor characteristics, operative details, and postoperative outcomes were retrospectively extracted from medical records following a structured chart review. All patients were followed clinically postoperatively, with no evidence of recurrence or late complications during the available follow-up period. Six patients (5 female, 1 male), with ages ranging from 26 to 50 years, underwent open enucleation using a uniform Cavitron Ultrasonic Surgical Aspirator (CUSA)-guided pseudocapsular technique without inflow occlusion (Pringle maneuver). Tumor locations included purely central segments (n=2), mixed central and peripheral segments (n=3), and a complex suprahepatic lesion with inferior vena cava (IVC) involvement (n=1). Preoperative tumor sizes ranged from 7 to 12.9 cm. Documented estimated blood loss ranged from 150 to 500 mL; five of six cases required no transfusion. One case involving direct IVC adherence required primary suture repair and intraoperative transfusion (3 units; Clavien-Dindo grade III). One patient experienced urinary retention (Clavien-Dindo grade I). No conversions to formal hepatectomy, bile leaks, postoperative liver failure, or mortality occurred. Length of hospital stay ranged from 5 to 10 days. All pathology specimens confirmed cavernous hemangioma. The described CUSA-guided pseudocapsular enucleation technique without the Pringle maneuver is feasible and safe for giant hepatic hemangiomas across central, peripheral, and complex tumor locations. This technical report provides detailed operative guidance applicable across central and peripheral tumor locations, with particular attention to centrally located lesions where proximity to major hepatic veins and portal structures demands structured operative planning and heightened technical vigilance.
While developmental delay is often associated with 22q11.2 deletion syndrome and congenital heart diseases, developmental regression is rarely observed. We report the case of a one-year-old girl with 22q11.2 deletion syndrome whose motor development regressed after radical repair of an interrupted aortic arch and ventricular septal defect. Despite reasonable achievement of the initial motor milestones, she stopped crawling and was unable to pull herself to stand at one year and six months of age. No signs of suppressed cardiac function were observed, and residual coarctation was acceptable. Finger swelling coupled with limited knee extension was a clue to the suspicion of complicating juvenile idiopathic arthritis (JIA). Since our patient was refractory to the treatment with prednisolone and methotrexate, adalimumab was introduced, after which joint symptoms disappeared immediately without developing adalimumab-mediated cardiac dysfunction. Then, somatic growth as well as her motor development were regained without joint destruction. Although reported cases of JIA related to 22q11.2 deletion syndrome are primarily teen years, JIA became a source of developmental regression due to early onset in this case. Since early diagnosis and treatment are critical to prevent joint damage, physicians who participate in the medical care of patients with congenital heart diseases and 22q11.2 deletion syndrome should suspect JIA in case of motor developmental delay.
Nasal valve collapse (NVC) is a common cause of nasal obstruction that significantly impairs quality of life (QoL), which is traditionally treated via functional rhinoplasty. There is, however, no consensus on the best management for NVC. This paper describes the experience of a single district centre using the LATERA implant (Stryker, Kalamazoo, MI, USA) to treat NVC by evaluating its efficacy and safety. Complications and patient satisfaction were evaluated as secondary outcomes. A prospective study was conducted between 2022 and 2025. Eligible adults were recruited to undergo LATERA implant placement. The primary outcome of efficacy and safety of the LATERA implant was evaluated via the change in the Functional Rhinoplasty Outcome Inventory-17 (FROI-17) scores from baseline to six months post-procedure. A significant improvement in FROI-17 scores was observed in 90.9% (n=20) of patients, with a mean score decrease of 38.5 points (p<0.01). No major complications, such as infection or implant extrusion, were recorded. The LATERA implant is a safe and effective intervention for NVC, showing a high success rate in significantly improving procedure-specific QoL in our single-centre study. These findings support its role as a valuable minimally invasive option, although further detailed comparative studies are warranted.
Giardiasis is a protozoal infection that typically presents with diarrhea, abdominal pain, and malabsorption. Peripheral eosinophilia is unusual and may confound diagnosis by suggesting eosinophilic gastrointestinal disease (EGID). We present a 41-year-old woman with abdominal pain, diarrhea, malabsorption, and peripheral eosinophilia. Endoscopic biopsy performed shortly after anti-parasitic therapy demonstrated eosinophilic duodenitis, raising concern for eosinophilic gastroenteritis. However, repeat biopsy after recovery revealed resolution of eosinophilia, excluding EGID. This case highlights the importance of timing diagnostic endoscopy after giardiasis treatment to avoid misdiagnosis.
Melanoma is an aggressive malignancy with a high risk of distant metastasis, including hepatic involvement, which is associated with poor prognosis. We report a patient initially diagnosed with stage IA melanoma who developed an isolated liver metastasis seven years later. Molecular analysis identified a TP53 mutation and PD-L1 expression ≥ 1%. Treatment with nivolumab achieved a sustained radiological and biochemical response over four years. Owing to favorable systemic control and resectable disease, surgical liver resection was performed. Follow-up demonstrated no evidence of recurrence. At 48 months after initiation of immunotherapy and 12 months after surgery, the patient remains alive and disease-free. This case supports the integration of immunotherapy and surgery in selected patients with metastatic melanoma to the liver and highlights the importance of multidisciplinary management.