IntroductionPeriodontal and peri-implant surgery has experienced sustained progress in recent decades, integrating new technologies and biomaterials that aim to optimize healing, reduce post-operative discomfort, and improve clinical and aesthetic results. Among these developments, cyanoacrylate-based tissue adhesives have gained interest as an alternative or complement to conventional sutures, especially in procedures where soft tissue manipulation requires precision, speed, and minimal morbidity. These biomaterials have demonstrated hemostatic and bacteriostatic properties and adequate biocompatibility, positioning them as a potentially useful tool in the oral surgical context.Periodontal and peri-implant surgery attempts to correct defects in the soft and hard tissues surrounding teeth and implants to restore health, function, and aesthetics. These procedures usually require flap elevation, manipulation, and closure, which demands tissue stabilization techniques that ensure hemostasis, reduce morbidity, and promote optimal healing 1–4. Traditionally, this has been achieved through sutures, although these have limitations such as plaque accumulation, inflammation, the need for removal in a second surgical procedure, and longer operating times 1,2. In response, tissue adhesives such as cyanoacrylates have been proposed as either an alternative or a complement to conventional sutures 3,4, representing a promising alternative to conventional sutures, however, the limited evidence currently available underscores the need for further studies to validate their efficacy and long-term outcomes.

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Acute Intestinal Obstruction Due to Dual-Component Metastasis of Combined Small Cell Lung Cancer: A Case Report with Literature ReviewWei Jiang 1 Xiaohui Zhou 2, Xizhang Zhu31Department of Pathology, Dianjiang General Hospital, Chongqing 408300, China2Department of Pathology, Traditional Chinese medicine hospital, Dianjiang. Chongqing 408300, China3 Department of Pathology, Dianjiang General Hospital, Chongqing 408300, ChinaCorresponding authors:Xiaohui ZhouDepartment of Pathology, Traditional Chinese medicine hospital, Dianjiang. Chongqing E-mail: 18372552328@126.comOther author’s email:Wei Jiang jw18875443902@126.comXizang Zhu 13896573689@163comKeywords: Combined Small Cell Lung Cancer (C-SCLC); Acute IntestinalObstruction; Tumor Metastasis; Heterogeneous Metastasis; Immunohistochemistry (IHC); Case report

IntroductionCardiofaciocutaneous (CFC) syndrome is a rare RASopathy resulting from pathogenic variants in genes that regulate the RAS/MAPK pathway, which is essential for cellular growth and differentiation. Most cases are associated with BRAF variants, but variants in MAP2K1 ,KRAS , and MAP2K2 have also been identified (1). As this intracellular cascade plays a central role in controlling cell growth, differentiation, and survival, its dysregulation leads to various developmental abnormalities. CFC type 4 (OMIM 615280), caused byMAP2K2 variants, represents one of the rarest molecular subtypes, with limited phenotype-specific data. Characteristic features of CFC include macrocephaly, high forehead, curly or sparse hair, hyperkeratotic skin, segmental hemangiomas, and cardiac defects such as pulmonary stenosis or septal anomalies (2, 3). Neurological involvement, especially hypotonia, seizures, and global developmental delay, is frequent (1). Feeding difficulties in infancy are often severe and may be the earliest clinical manifestation (4). Here, we report an infant with a heterozygous MAP2K2 variant (c.619G>A, p.Glu207Lys), presenting from birth with severe oromotor dysfunction, macrosomia, distinctive craniofacial and cutaneous features, and paroxysmal neurologic episodes, thereby expanding the early phenotypic spectrum of CFC type 4.

INTRODUCTIONThe toothbrush is the most commonly used tool for maintaining oral hygiene across all age groups.1 While injuries involving toothbrushes are rare, they can occasionally lead to severe, life-threatening impalement injuries in children, particularly those under the age of six.1,2 While these injuries are typically treatable without permanent consequences, prolonged foreign body presence can result in various complications. Common complications include fibrosis, abscess formation, and sinus tracts. Rare but potentially serious complications may arise, such as deep neck abscess, mediastinal emphysema, pneumatocele, or internal carotid artery thrombosis.2,3,4 Managing these cases poses significant challenges for dentists, primarily due to complex facial anatomy, parental anxiety and the child’s uncooperative behavior.1 This case report describes the management of a four-year-old girl who sustained an accidental toothbrush impalement in the left buccal mucosa following a traumatic fall.

1.IntroductionJuvenile Systemic Lupus Erythematosus (JSLE) is a rare, chronic autoimmune condition that occurs in children below the age of 18 years. It is distinguished by a broad spectrum of clinical manifestations that may affect multiple organ systems and may be manifested at varying degrees of severity [1]. JSLE, in comparison with adult-onset SLE, shows higher rates of disease activity, organ damage, and occurrence of specific manifestations [2]. JSLE may be difficult to diagnose because it has a heterogeneous presentation and there are no specific diagnostic criteria, which may rely on those of adult-onset SLE [3]. Early and proper diagnosis is essential in the management of the disease and to preclude serious complications since JSLE is more aggressive than its adult counterpart [4]. Multisystemic involvement is characteristic of JSLE, and almost all of the body systems are susceptible. The most reported symptoms are constitutional (e.g., fever, fatigue, weight loss), mucocutaneous (e.g., malar rash, mouth sores, hair balding), musculoskeletal (e.g., arthritis, arthralgia), and even hematological (e.g., anemia, leukopenia, thrombocytopenia). Among more severe manifestations, neuropsychiatric lupus (NPSLE) poses a serious concern, and a considerable number of paediatric individuals with SLE develop it. NPSLE is very diverse, with an equal variety of neurological and psychiatric symptoms, such as seizures, headaches, cognitive dysfunction, mood disorders, and psychosis, which may have a dramatic effect on the patient’s quality of life and functional status [1,5]. The following case presentation provides detail on the clinical course of a 15-year-old male with multiple and complicated features of JSLE, which included the involvement of the nervous system.

Key Clinical MessageOculogyric crisis is a rare but important cause of acute ocular deviation that may mimic neurologic emergencies. A detailed medication history is essential, as recognizing drug-induced dystonia such as that caused by aripiprazole can prevent misdiagnosis and unnecessary interventions.A 21-year-old male with depression had been taking aripiprazole 24 mg daily for several months. While at work, a colleague noticed an upward deviation of his eyes. He visited an ophthalmologist, but no abnormalities were found. Later that day, he developed difficulty maintaining forward gaze and presented to the emergency department. He was alert and oriented, with stable vital signs. Neurological examination was normal except for sustained upward ocular deviation (Figure). Laboratory tests and neuroimaging revealed no abnormalities. Accordingly, a diagnosis of aripiprazole-induced oculogyric crisis (OGC), representing an acute dystonic reaction, was made. As the symptoms were mild and improving, no pharmacologic treatment was given. The evening dose of aripiprazole was withheld, and the dosage was later reduced to 12 mg, leading to full recovery within three days.This case underscores the importance of recognizing drug-induced dystonic reactions that may mimic acute neurologic emergencies. OGC is a rare form of focal dystonia characterized by sustained, bilateral upward eye deviation, resulting from involuntary contraction of the extraocular muscles (1). Episodes typically last from minutes to several hours and may be associated with anxiety or neck stiffness.The pathophysiology of neuroleptic-induced acute dystonia is thought to involve relative dopaminergic blockade or functional D2 receptor antagonism, leading to an imbalance between dopaminergic and cholinergic activity within the basal ganglia (1) . Aripiprazole, an atypical antipsychotic of the second-generation, acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist at 5-HT2A receptors with a low intrinsic risk of extrapyramidal side effects (2). Nevertheless, dystonic reactions may still occur, particularly in individuals with certain predisposing factors such as young age, male sex, concurrent use of psychoactive substances like cocaine, and a history of acute dystonia (2, 3). The prevalence of oculogyric crisis associated with antipsychotic medication has been reported to range between 0.9% and 3.4% (1).OGC can be misinterpreted as seizure, encephalitis, or psychogenic disorder, often leading to unnecessary neuroimaging or anticonvulsant administration. Unlike most previously reported cases, this patient developed oculogyric crisis during chronic aripiprazole therapy without recent dose escalation or overdose (3).Although anticholinergic agents such as biperiden are generally considered first-line therapy for drug-induced acute dystonia, the symptoms in this case resolved spontaneously without pharmacologic intervention. The spontaneous improvement may have resulted from restoration of dopaminergic–cholinergic balance as the steady-state serum concentration of aripiprazole was reestablished (1, 2). Similar spontaneous remissions have occasionally been reported in mild cases of oculogyric crisis once the offending agent was metabolized (2).In patients presenting with acute-onset abnormal eye movements or dystonic posturing, obtaining a thorough medication history is essential for diagnosis. When neurological examination and laboratory investigations reveal no abnormalities, clinicians should consider drug-induced dystonia, particularly in individuals who have ingested dopamine receptor-modulating agents such as aripiprazole. Early recognition of this condition can prevent misdiagnosis, avoid unnecessary interventions, and ensure prompt, effective management.

Mohammad Firoz Anjum,1 Suraj Sah,2Inesh Khanal,2 Sharmila Gainju,3Sriram KC41Pediatric Nephrologist, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal, 2Intern Doctor, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal,3Resident, Department of Pediatrics, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal,4Pediatrician, Armed Police Force Hospital, Balambu, Chandragiri, Kathmandu, NepalCorrespondence: Dr Inesh Khanal, Intern Doctor, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal, Email: std.ineshkhanal@pahs.edu.np , Phone: +977-9813865449.Author contribution:Dr. Firoz Anjum: Conceptualization; Investigation; Methodology; Project administration; Software; Supervision; Validation; Writing - original draft; Writing - review & editing.Dr. Suraj Sah: Conceptualization; Methodology; Writing - original draft; Writing - review & editingDr. Inesh Khanal: Conceptualization; Formal analysis; Software; Supervision; Writing - original draft; Writing - review & editingDr. Sharmila Gainju: Conceptualization; Methodology; Project administration Supervision; Writing - review & editingDr. Sri Ram KC: Conceptualization; Investigation; Supervision; Writing - original draft; Writing - review & editingAbstractLupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE) typically characterized by glomerular “full-house” immunofluorescence. However, non-lupus nephropathies may occasionally exhibit similar patterns, creating diagnostic uncertainty. Non-lupus full-house nephropathy (FHN) is a recently recognized entity in which a full-house immunofluorescence pattern occurs in the absence of serological or clinical evidence of SLE. We report a 4-year-old girl who presented with generalized edema, hematuria, hypertension, and nephrotic-range proteinuria. Laboratory evaluation revealed anemia, elevated serum creatinine, and low complement C3 levels but negative antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) tests. Renal biopsy demonstrated diffuse proliferative glomerulonephritis consistent with lupus nephritis Class IV, with full-house immunofluorescence positivity for IgG, IgA, IgM, C3, and C1q. In the absence of systemic or serologic lupus features, a diagnosis of non-lupus full-house nephropathy was made. The patient was treated with pulse methylprednisolone followed by oral prednisolone, monthly cyclophosphamide for six months, and maintenance therapy with azathioprine and low-dose steroids. Hydroxychloroquine and antihypertensive agents were added. She achieved clinical and biochemical remission on follow-up.Keywords: Non-lupus full-house nephropathy, Lupus nephritis, Seronegative lupus, Pediatric nephrology, Diagnostic dilemma

Unmasking the Silent Glomus Tumor of the Index Finger – A Case Report and Literature Review

Spontaneous Thoracic Spinal Epidural Hematoma: A Case Report and Literature Review

A 60-year-old man was diagnosed with non–ST-segment elevation acute coronary syndrome (ACS) (Figure A). Coronary angiography (CAG) showed collateral flow from the left to right coronary artery (RCA) without occlusion (Figure B, C). Intravascular ultrasound (IVUS) revealed plaque-rich stenosis (Figure D), treated with drug-eluting stent (DES) placement.One month later, he was brought to our hospital due to ventricular fibrillation, requiring Veno-arterial extracorporeal membrane oxygenation (VA-ECMO). CAG showed mid-RCA stenosis refractory to 1 mg intracoronary isosorbide dinitrate (ISDN) (Figure E). OCT demonstrated fibrous cap disruption in the mid RCA, with otherwise normal adjacent segments. (Figure F-H). Although definitive plaque rupture was not evident, the lesion was considered potentially responsible for ACS, and PCI with DES implantation was performed. Continuous intravenous ISDN was administered post-PCI. After neurological recovery under targeted temperature management (TTM), VA-ECMO was weaned on day 3, with no significant ECG changes during TTM.Three hours later, ST elevation (Figure I, J) and pulseless electrical activity required VA-ECMO reinstitution. CAG showed distal RCA occlusion relieved after 15 mg ISDN (Figure K, L). OCT revealed microthrombus, multiple intimal injuries, and vessel shrinkage (Figure M–P). He died on day 4 from non-occlusive mesenteric ischemia despite intensive care.This patient experienced three ACS episodes in a short period, two at rest in the early morning. In the first event, the collateral flow suggests transient occlusion, possibly due to resolved thrombus or severe spasm. Intimal rupture has been documented in vasospastic angina; however, the extensive and multiple lesions identified in our case on final-event OCT may represent a more severe phenotype that has not been well characterized in previous literature.1 These findings underscore the potential of spasm to trigger cardiac arrest and the diagnostic utility of OCT.Figure Legends(A) Initial ECG. (B) Stenosis. (C) Collateral flow. (D) Plaque-rich stenosis. (E) Mid-stenosis. (F) Fibrous cap rupture. (G, H) Normal segments. (I, J) ECGs around recurrent arrest. (K) Occlusion. (L) Restored flow. (M, arrow) Thrombus. (N–P, arrow) Intimal injuries and vessel shrinkage.

A document by Abhisek Jha. Click on the document to view its contents.

Therapy-related acute myeloid leukemia following plasma cell leukemia: a case report and literature review

A document by Jose Marino. Click on the document to view its contents.

“RENAL ONCOCYTOMA WITH RETRORENAL APPENDICITIS: AN UNCOMMON JUXTAPOSITION OF NEOPLASTIC AND INFLAMMATORY PROCESSES IN THE CONTEXT OF HIV INFECTION”1Mohammed Salah E. Khalifa SALEM,1Nathan Poppleton, 2Jacob Varghese,3Mohammedsuror Alsammani, 4Alain Mwamba Mukendi1University of the Witwatersrand, Division of Urology, Department of Surgery, Klerksdorp Hospital, Klerksdorp, Northwest, South Africa.2University of the Witwatersrand, Department of Radiology, Klerksdorp Hospital, Klerksdorp, Northwest, South Africa.3University of the Witwatersrand, Department of General Surgery, Klerksdorp Hospital, Klerksdorp, Northwest, South Africa4University of the Witwatersrand, Division of Urology, Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa.*Corresponding AuthorAlain Mwamba MukendiCel: 0027711576350E-mail: alainmwamba2006@yahoo.fr

A Rare Case of Delayed Cerebral Air Embolism Occurring 7 Hours after Central Line Removal

A document by Muhammad Noraiz Abbas Khan. Click on the document to view its contents.

Full-Thickness Corneal Perforation Secondary to Monopolar Cautery Burn During Cosmetic Blepharoplasty in a Young Adult: Successful Management with Cyanoacrylate GlueRahim Saffari11, Mojtaba Abrishami a, Seyed Ali Ebrahimi22, Amin Maleki33a Eye Research Center , Mashhad University of Medical Sciences , IranCorresponding Author:Amin MalekiE-mail address: Malekia4011@gmail.comShort Title: Corneal Perforation from Monopolar CauteryKeywords: Corneal burn; Monopolar cautery; Blepharoplasty complication; Cyanoacrylate glue; Corneal perforation