Introduction: In the realm of orbital reconstruction following traumatic fractures involving the zygomatic complex (ZMC), the adoption of patient-specific implants (PSI) crafted through computer-assisted technology prompts inquiry into its comparative efficacy against conventional methods. This study investigates whether PSI enhances outcomes—such as orbital volume, enophthalmos, diplopia, implant malposition, and ZMC symmetry—in adult patients, compared to conventional approaches.

Background: Complex post-oncological reconstruction remains a cornerstone in restoring form and function following extensive oncological resections. Among the reconstructive options, free perforator flaps, including the deep inferior epigastric perforator (DIEP), anterolateral thigh (ALT), and superficial circumflex iliac perforator (SCIP) flaps, have emerged as versatile tools offering superior outcomes.

Background: The maintenance of calcium homeostasis and bone mineralization are two important functions of vitamin D in bone health. Vitamin D deficiency is known to cause cardiovascular, musculoskeletal, and other body systems diseases.

Introduction: Cervical incompetence is defined as the inability of the cervix to retain an intrauterine pregnancy in the absence of signs and symptoms of clinical contractions or labor during the second trimester of gestation.

OBJECTIVES: This quasi-experimental study aimed to investigate the effects of the "Application ODS" mobile app on educating one-day surgery (ODS) patients about anesthesia practices, specifically its impact on their knowledge and clinical outcomes.

OBJECTIVES: This quasi-experimental study aimed to investigate the effects of the "Application ODS" mobile app on educating one-day surgery (ODS) patients about anesthesia practices, specifically its impact on their knowledge and clinical outcomes.

Appendiceal cancer with peritoneal carcinomatosis (PC) represents a complex oncologic condition with distinct biological behavior and therapeutic challenges. Unlike other gastrointestinal malignancies, appendiceal neoplasms often exhibit extensive peritoneal dissemination, particularly in mucinous subtypes such as low-grade appendiceal mucinous neoplasms (LAMN) and pseudomyxoma peritonei (PMP). Historically, peritoneal dissemination was associated with poor prognosis, but the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has dramatically altered the disease trajectory. En bloc resection has emerged as a critical surgical strategy to achieve complete cytoreduction (CC-0/1) in cases with extensive peritoneal involvement, preventing tumor fragmentation and reducing recurrence risk.

Introduction: Small vessel vasculitis associated with neutrophil cytoplasm antibody (ANCA) presents with mild to severe clinical presentations, including renal failure and eye involvement. It is a rare disease with an incidence of 13-20 cases per million people globally, with an annual prevalence of 46-184 cases per million. In children, the incidence is 10-20 cases per million inhabitants per year, predominantly female.

INTRODUCTION: Polycystic ovarian disorder is the most common endocrine disorder seen in women of reproductive age. Since emotions are largely influenced by hormonal activity, this imbalance in hormone levels can significantly impact mental health. Young women with PCOD can have body image and self-esteem issues due to difficulty in losing weight and excess facial hair growth. Not only that but irregular menstrual cycles and fertility changes can cause them to have chronic high stress levels and anxiety.

Introduction: Transcranial Doppler (TCD) is a rapid, noninvasive, reproducible, and dynamic examination of the intracranial circulation. A unique advantage of TCD is the ability to detect microembolic signals (MES) during monitoring.

This study analyzed pro-environmental behavior among fishermen families in Muara Siberut, Mentawai Islands, Indonesia, focusing on waste disposal practices, vector disease control, footwear habits, ventilation behaviors, and cleaning the yard. A survey was used, utilizing formal questionnaires and qualitative interviews to analyze environmental behaviors and their determinants. Findings reveal significant environmental challenges, with 31.6% of households disposing of waste in rivers or beaches, 93.9% reporting vector disease presence, and 50% resorting to waste burning. Although 63.3% consistently wear footwear, sanitation practices remain inconsistent. The study highlights the urgent need for improved waste management infrastructure, targeted educational interventions, and policy support to promote sustainability. In conclusion, addressing environmental issues in fishing communities requires a multi-faceted approach, integrating socio-cultural factors, infrastructure development, and public health strategies to foster long-term behavioral change and environmental sustainability.

Background: Diabetes mellitus is a disease characterized by an increase in blood glucose levels due to decreased insulin production or decreased insulin action. Diabetes cases are described as a serious problem globally in the 21st century and cases are increasing worldwide. One type of plant that can be used as a medicine is papaya leaf (Carica papaya L.) which is known to contain several active compounds such as flavonoids, saponins, tannins, and alkaloids. Objective: To determine the effect of papaya leaf extract (Carica papaya L.) on changes in fasting blood glucose levels of male Wistar rats with hyperglycemia conditions. Methodology: This research is an experimental research Randomized Controlled Trial (RCT) with Pretest-Postest Group Design study design. This study used 35 male white rats which were divided into 5 groups. Group I (without treatment), group II (STZ-NA), group III (STZ-NA and Glimepiride), group IV (papaya leaf extract at a dose of 150mg/Kg), group V (papaya leaf extract at a dose of 200mg/Kg). The data obtained after the study will be tested for normality which is then continued with non-parametric tests using the Kruskal-Wallis and Mann-Whitney U tests, and an effect size test is carried out to determine how much effect is produced from the papaya leaf extract given. Research Results: The administration of papaya leaf extract at a dose of 200mg/200grBody Weight in male Wistar rats in group 5 proved to reduce fasting blood glucose levels more significantly than the administration of glimepiride at a dose of 0.04 mg and papaya leaf extract at a dose of 150mg/Kg. Conclusion: Administration of papaya leaf extract (Carica papaya L.) can reduce fasting blood glucose levels in diabetic model rats effectively at a dose of 200mg/Kg.

Cerebrovascular events in young adults constitute a significant and often underestimated cause of long-term disability and mortality. While ischemic stroke (IS) remains the predominant subtype in this population, hemorrhagic stroke (HS) also represents a considerable burden. The etiological spectrum in younger individuals differs markedly from that in the elderly, encompassing non-traditional risk factors such as arterial dissection, prothrombotic states, cardiac embolism due to structural anomalies (e.g., patent foramen ovale), vasculitis, and substance abuse. Genetic predisposition and autoimmune conditions further complicate the diagnostic and therapeutic landscape.

Formulating the Jelly Flawless preparation using extracts of meniran (Phyllanthus niruri) and Moringa (Moringa oleifera) which are rich in antioxidants. Antioxidants have an important role in the body by protecting cells from damage caused by free radicals. The Jelly Flawless formulation with ethanolic extracts of meniran (Phyllanthus niruri) and kelor (Moringa oleifera), combined with gelatin and pectin, affects the hardness test, showing no significant hardness in the fourth formulation. It contains positive secondary metabolites such as tannins, alkaloids, saponins, flavonoids, quinones, and steroids. The antioxidant test results for the extracts of meniran (Phyllanthus niruri) and kelor (Moringa oleifera) were 5.55 µg/mL, higher than the positive control of vitamin C of 2.78 µg/mL, indicating that the ethanolic extracts of Phyllanthus niruri and Moringa oleifera contain strong antioxidants. Therefore, the Jelly Flawless formulation of ethanolic extracts of meniran (Phyllanthus niruri) and kelor (Moringa oleifera) can be produced and consumed because it contains strong antioxidants that have an important role in the body.

Pregnant women with chronic energy deficiency are in a state of malnutrition, particularly in terms of energy and protein, that lasts for years. One of the causes is inadequate food intake, resulting in nutritional needs, especially energy, not being met daily. The effort to address the nutritional issue is through providing energy-dense and high-protein as an alternative additional feeding according to the nutritional needs of pregnant women, utilizing local foods such as skipjack tuna and moringa leaves. This study analyzes the nutritional quality, organoleptic quality, descriptive tests, and best treatment levels of Otak-Otak with a formulation of skipjack tuna (Katsuwonus pelamis) and moringa leaves as an alternative additional feeding for pregnant women with Chronic Energy Deficiency (CED). The type of experimental research with a Completely Randomized Design consists of 3 levels of treatment. The variables being studied are organoleptic quality (hedonic test) and nutritional value (Calculated Value). Next, the best treatment level is determined. The analysis of organoleptic data used the Kruskal-Wallis method with a confidence level of 95%. Skipjack tuna otak-otak with moringa leaves has a good level of preference (like-very much). The treatment levels only significantly affected the energy content and nutrient levels per serving (135 g), which met a as an alternative additional feeding for pregnant women with Chronic Energy Deficiency (CED). The best formulation of skipjack tuna fish in treatment 3 (T3) provides a nutritional contribution to the as an alternative additional feeding standards for pregnant women according to the regulation of the Ministry of Health in 2023 with energy at 101%, protein at 129%, fat at 117%, and carbohydrates at 80%.

Denture stomatitis is a common oral health problem in denture users. It can occur due to fungal infections caused by C. albicans. An effervescent tablet is a chemical denture cleanser that can reduce plaque and microorganism accumulation, including C. albicans. The addition of natural ingredients such as cocoa pod husk extract, which contains chemical compounds like flavonoids, saponins, and tannins, has shown antifungal activity against microorganisms such as C. albicans. This research aims to determine the effect of cocoa pod husk (Theobroma cacao L.) effervescent tablets in inhibiting the growth of C. albicans after a 15-minute soaking period. The treatment groups were effervescent tablets containing cocoa pod husk extract at concentrations of 20% and 25%, polident and aquadest. The samples were thermoplastic nylon discs with a diameter of 10 mm and a thickness of 2 mm. The discs were immersed in the treatment solutions for 15 minutes and vibrated for 30 seconds using vortex, spreading 0,1ml Saboraud Dextrose Broth (SDB) on Saboraud Dextrose Agar (SDA) and incubated for 48 hours at 37°C. The number of C. albicans colonies grown on the SDA medium was counted using a colony counter. The results showed that the cocoa pod husk effervescent tablets with 25% concentration were more effective than the 20% concentration, with average colony counts of 231.8 and 372.6, respectively. The highest average C. albicans colony count was observed in the negative control group (694.8), while the lowest was in the positive control group (0). Based on the results effervescent tablets containing cocoa pod husk extract as a denture cleanser are effective in inhibiting the growth of C. albicans.

Rhinoplasty is a complex and versatile surgical procedure aimed at reshaping the nose for aesthetic and functional purposes. It employs diverse techniques, primarily categorized into open and closed approaches. Open rhinoplasty, characterized by a transcolumellar incision, allows superior visualization and precise modifications, making it suitable for complex cases and revisions but carries risks such as extended nasal tip edema and scarring. Closed rhinoplasty, devoid of external incisions, offers reduced recovery times and minimal visible scarring, albeit with limited access and visibility. Minimally invasive approaches, leveraging endoscopic visualization and piezoelectric instruments, are gaining traction for their ability to minimize tissue trauma and enhance recovery. Specific grafting techniques, such as lateral crural strut grafts and tongue-in-groove modifications, optimize structural support and nasal tip aesthetics while addressing demographic and ethnic variations. Despite advancements, rhinoplasty is associated with complications, including graft resorption, scarring, nasal obstruction, and residual deformities, underscoring the need for meticulous planning and patient-specific strategies. This review highlights the significance of tailored approaches in rhinoplasty to achieve optimal functional and aesthetic outcomes while minimizing complications.

A case of spontaneous left abdominal wall hematoma is presented in a 50-year-old male patient with a history of recently diagnosed hypertension under treatment, morbid obesity for the past 10 years without nutritional management, and occasional smoking and alcohol consumption. The patient presented with oppressive epigastric pain following food intake, accompanied by coughing and diaphoresis, with an initial intensity of 8/10 progressing to 10/10, radiating to the thoracic region. Upon admission, he exhibited a hypertensive emergency and signs of angina, requiring stabilization with nitroglycerin and management in the shock unit. During evaluation, a hematoma in the left abdominal wall was identified, along with a fracture of the left eighth costal arch and a costal exostosis on the left tenth costal arch, as well as pleural effusion and ipsilateral atelectasis, confirmed by computed tomography (CT). There was no history of trauma, transfusions, or prior surgery. The patient received conservative treatment, including triple antihypertensive therapy (calcium channel blocker, angiotensin II receptor blocker, and prazosin), anti-inflammatory agents, analgesics, and bed rest, without the need for surgical intervention. Acute-on-chronic kidney disease (KDIGO 1) was diagnosed, and the patient was evaluated by cardiothoracic surgery for follow-up.

The global rollout of COVID-19 vaccines has been a significant step in controlling the SARS-CoV-2 pandemic. While the vaccines have proven to be generally safe, adverse reactions, including both local and systemic effects, have been observed. Cutaneous manifestations, though rare, have been reported in some instances. We report the case of a 67-year-old male who developed pruritic erythematous-to-violaceous papules and plaques three days after receiving the second dose of a COVID-19 vaccine. The lesions were found on the right inner thigh, forearms, trunk, and neck. Histopathological examination revealed findings consistent with a lichenoid drug eruption (LDE), a condition typically linked to medications or, in rarer cases, vaccines.

64-year-old man with a history of non-reperfused acute myocardial infarction 11 yearspreviously, type 2 diabetes and systemic arterial hypertension. His condition began whileperforming moderate physical activity with oppressive chest pain in the left shoulder,intensity 6/10, with radiation to the precordial region accompanied by diaphoresis, dizziness,fainting and nausea that led to vomiting of gastroalimentary content on one occasion, so hewent to the second level hospital where an electrocardiogram was performed with evidenceof acute myocardial infarction with ST segment elevation in the inferior wall, managementwas started with acetylsalicylic acid 300 mg, clopidogrel 300 mg, atorvastatin 80 mg,enoxaparin 30 mg IV , with subsequent thrombolysis based on Tenecteplase 30 mg, meetingclinical and electrocardiographic criteria for successful lysis, requesting transfer to a thirdlevel unit for pharmacoinvasive strategy. Coronary angiography was performed, documentingchronic total occlusion of the circumflex artery with TIMI flow 0, left coronary artery (LCA)with proximal obstructive lesion of 60% without affecting flow, and right coronary artery(RCA) could not be cannulated (Fig. 1A), so the procedure was terminated. Based on theaforementioned findings, coronary angiography was requested (Fig. 1B,C) which showed:coronary arteries with atherosclerotic disease corresponding to CAD-RADS 5, right coronaryartery with anomalous and high origin, 38 mm from the valvular plane in the anterior and leftwall of the ascending aorta with a short interarterial path of 16 mm, at the junction of theproximal and middle segments mixed plaques in tandem with high-risk signs that causeocclusion and subocclusion. Another distal mixed plaque with high-risk signs and 70%stenosis and thinning (3 mm) of the inferolateral wall of the basal and middle third withsubendocardial calcification probably related to an old infarction in the circumflex territory.Therefore, coronary angioplasty was contraindicated due to the risk of vascular injury,optimal medical treatment was started and the patient underwent cardiac revascularization surgery

Introduction: Herlyn-Werner-Wunderlich Syndrome (HWWS) is an embryological malformation that damages the urinary and genital systems. It may have clinical repercussions as progressive dysmenorrhea and compromise the patients obstetric future, with occurrence of severe endometriosis and infertility.

Cronkhite-Canada Syndrome (CCS) is a rare, non-hereditary gastrointestinal polyposis syndrome characterized by a complex constellation of clinical features, including diffuse gastrointestinal polyposis, ectodermal abnormalities, and profound malabsorption. Although its exact etiology remains elusive, an autoimmune pathogenesis has been increasingly suspected, with reports of immune-mediated damage contributing to epithelial dysfunction. Patients with CCS typically present with chronic diarrhea, weight loss, protein-losing enteropathy, and alopecia, in addition to nail dystrophy and cutaneous hyperpigmentation. Histopathological examination of intestinal polyps reveals hamartomatous and inflammatory characteristics, with a predilection for the stomach and colon.

Kaposi sarcoma (KS) is an angioproliferative disorder that is characterized by the appearance of purplish, reddish blue, or dark brown macules, plaques, and nodules on the skin, it can range in size from very small to several centimeters. In the etiopathogenesis, Human Herpesvirus 8 infection and immunosuppression has a fundamental role. The clinical evolution is usually chronic and indolent. We present a case in a patient with Human Immunodeficiency Virus (HIV) infection and complicated Kaposi sarcoma that caused his death.

Neuromuscular blockade (NMB) monitoring is essential in modern anesthetic practice, particularly for optimizing the administration of blocking agents and their reversal agents. We present the case of a 54-year-old female patient with a history of chronic carbamazepine use and monoplegia, who underwent a laparoscopic cholecystectomy. Despite the administration of standard and additional doses of rocuronium, significant resistance to NMB was observed, along with difficulty maintaining the surgical field, as confirmed by quantitative monitoring. The patient showed rapid recovery from the blockade without the need for reversal agents, highlighting the crucial role of continuous monitoring in intraoperative decision-making. This case underscores the importance of considering factors such as anticonvulsant use and neurological disorders in NMB response and emphasizes the impact of quantitative monitoring in resource-limited settings to enhance perioperative safety and outcomes.

This is an integrative review of the literature which analyses the studies of treatments of keloid scars, touching on the pathophysiology and aetiology of the scars. The paper explores all the different aetiology which could lead to keloid scars such as genetics, inflammatory cells and growth factors including Tenasin C, TGF-ß1 and ß2; all the risk factors which cause the scars; an in-depth detail of all the pathways and protein alteration of the scars such as extracellular matrix proteins and ECM-associated proteins; the epigenetics of keloid scarring including DNA methylation and histone modifications. In addition to this, the paper ended with a detailed analysis of the different treatments for keloid scarring including surgery, radiotherapy, interferons, botulinum toxins and bleomycin. These findings showed that while there are many hypotheses regarding the pathophysiology and aetiology of the keloid scars by understanding the protein alteration and pathways, many scientists have created adequate treatments for it. With the current advancement, the treatments all have their own limitations but this study aims to summarise each limitation to provide pathways to best treat the keloid scars.

Aberrant coronary arteries present unique challenges in diagnostic and interventional cardiology due to their atypical anatomy, high variability, and potential association with adverse cardiac events. Intravascular ultrasound (IVUS), as an intraluminal imaging modality, has emerged as a critical tool in guiding interventions in this subset of patients. IVUS provides high-resolution cross-sectional images of vessel morphology, allowing precise assessment of luminal dimensions, plaque burden, and stent positioning, especially in anatomically complex regions where conventional angiography falls short. This review explores the utility of IVUS in the evaluation and management of aberrant coronary arteries, highlighting its role in minimizing complications, optimizing procedural outcomes, and advancing our understanding of these rare but clinically significant anomalies. We also discuss the integration of IVUS with adjunctive imaging modalities, technical considerations, and future perspectives in the field.

Background: Viral myocarditis represents a significant cause of pediatric cardiac morbidity and is occasionally complicated by the formation of ventricular aneurysms (VAs). These rare lesions can lead to life-threatening complications, including arrhythmias, embolic events, and cardiac rupture, necessitating timely and effective management. Objective: This article aims to review the surgical approaches employed in managing ventricular aneurysms in children with viral myocarditis, focusing on clinical presentations, diagnostic tools, surgical techniques, and outcomes.

The bacterium Mycobacterium leprae is responsible for the development of lepromatous leprosy (LL), which is a severe form of leprosy. Skin lesions that are widespread, nerve damage in the periphery, and systemic involvement as a result of a poor immune response to the pathogen are the characteristics that define this condition. The purpose of this manuscript is to provide a comprehensive review of lepromatous leprosy, with a particular emphasis on its pathogenesis, clinical manifestations, diagnostic approaches, and treatment strategies. In this discussion, the immunological aspects of learning disability (LL) are highlighted, including the role of regulatory T cells and cytokine profiles. Additionally, the difficulties associated with managing this disease in areas where it is endemic are investigated. Through the process of synthesising the existing body of literature, the purpose of this review is to improve patient outcomes and to contribute to a better understanding of LL.

Background: Neonatal sepsis is the single most common cause of neonatal death in hospital as well as community in developing country. Methods: A cross sectional study design was used to identify the nurses knowledge and practice regarding prevention of neonatal sepsis. Total 120 samples were selected to use purposive sampling technique and data were collect by using self-administered semi-structured questionnaire. Result: In this study, Knowledge Mean scores of knowledge was16.03 and mean practice was 40.36. 80.15% of the participants had adequate knowledge level and 80.72% had a good practice level. Conclusion: This study underscores that nurses possess a commendable level of knowledge and practice regarding the prevention of neonatal sepsis, with high compliance in key areas such as hand hygiene, aseptic techniques, and umbilical cord care.

The aim of this research was to find out if the water (Ro) in the majority of Iraqi houses contains E. coli bacteria because of the prevalence of diarrhea and other illnesses among the populace. The goal was accomplished by. The study samples were collected from R. O water filling stations in Karbala, including 40 samples from Karbala Center, 20 samples from Tuwairij District, 20 samples from Al-Hussainiya District, and 20 samples from Ain Al-Tamr District for the purpose of investigating the E. coli bacteria contaminating these waters, where microscopic and cultural examinations and biochemical tests were used. The results of these tests showed that 3 samples of R.O water out of 100 samples, with an isolation rate of 4.5%, gave positive results through their growth on selective and differential media and their fermentation of lactose sugar. On the other hand, the research results showed that the highest percentage of bacteria isolation was from R.O water filling stations in Ain Al-Tamr district with a percentage of 2.5) 2.2%) and the lowest percentage was from R.O water filling stations in Al-Hussainiya district with an isolation percentage of 1.7) 1.5%), while R.O water filling stations in the center of the governorate of Karbala and Twerij district did not record the least contamination with coliform bacteria (0.5 %). Through the research, the results showed that R. O water in some areas is contaminated with E. coli bacteria, which may be the source of human waste, which indicates the inefficiency of these stations.

Background: Qigong is used by cancer patients, but its effect has not been adequately evaluated. Lung cancer is a widespread and lethal malignant disease. Objective: The current study aimed to explore the effect of Qigong on quality of life, in lung cancer patients. Methods: A total of 156 lung cancer patients were randomly assigned, at a 1:1 ratio, to receive a 6-week Qigong training (intervention group) or usual care (waitlist control group). The outcome was a composite score of the quality of life assessed through the European Organization for Research and Treatment of Cancer, Core Quality of Life questionnaire, and Lung Cancer module was evaluated at baseline, the end of treatment, and at 12 weeks. Results: Between groups, statistically significant improvements from baseline to 12th week were observed in global health status (p = 0.021), functional quality-of-life score (p = 0.001), and the symptom subscale of the quality-of-life scale (p = 0.002). Conclusion: Qigong was effective and safe on the alongside core quality of life indicators.

Rheumatoid arthritis (RA) and bullous pemphigoid (BP) are autoimmune diseases influenced by genetic and environmental factors, with the concept of "shared autoimmune diathesis" suggesting that individuals with one autoimmune condition may be predisposed to developing another. This report describes a 62-year-old female with a 30-year history of untreated RA who presented with a progressive skin eruption initially misdiagnosed as herpes zoster. Over a four-month period, the patient developed pruritic bullous lesions predominantly in flexural areas. Histopathology and direct immunofluorescence confirmed BP by revealing subepidermal blisters with prominent eosinophilic infiltrate and linear IgG deposits along the dermoepidermal junction. Initial management with high-dose prednisone and azathioprine resulted in partial improvement; however, due to persistent lesions, rituximab was introduced, leading to significant clinical improvement. This case highlights the diagnostic challenges and therapeutic complexities encountered when RA and BP coexist, underscoring the potential shared pathophysiological mechanisms underlying autoimmune diathesis. The successful use of rituximab in this patient aligns with current literature advocating for biologic therapy in refractory BP cases, particularly in the context of other autoimmune disorders. These findings emphasize the importance of a multidisciplinary approach—integrating dermatology, rheumatology, and immunology—to ensure timely diagnosis and optimal management, ultimately improving patient outcomes in complex autoimmune presentations.

Microscopic polyangiitis (MPA) is a systemic autoimmune necrotizing vasculitis belonging to the group of antineutrophil cytoplasmatic antibody (ANCA)-associated vasculitis (AAV). Characterized by pauci-inmune crescentic glomerulonephritis without systemic involvement. AAV is an uncommon disease with an incidence of about 20 per million population per year in Europe and North America. The kidney is involved in more than 90% of MPA cases. Rapidly progressive glomerulonephritis is the most common clinical presentation or renal vasculitis, revealed by rapid deterioration of renal function, low-grade glomerular proteinuria, and constant microhematuria, with the presence of red blood cell casts in the urine sediment. Renal biopsy is the gold standard diagnostic test that confirms renal involvement of AAV. This report presents a case of a 23-year-old female with no pathologic history of any chronic disease, presented with acute kidney failure symptoms. Initial evaluation suggested rapidly progressive glomerulonephritis, but further diagnostic workup, including renal biopsy and auto-inmune serology confirmed MPA. The patient was treated with glucocorticoids and Mycophenolate mofetil. Significant improvement was observed, with complete resolution and normal kidney function at the 3-month follow-up.

Chondrosarcoma is the third most common primary bone tumor of the hand, after myeloma and osteosarcoma, affecting mainly the proximal phalanx of the fifth finger, with a long-term clinical presentation, manifested mainly by local pain and enlargement, affecting mostly people in the fifth and sixth decades of life, with no reports of which hand is most affected. It is diagnosed by combining imaging studies in combination with the histopathological study, with magnetic resonance being the preferred paraclinical study due to its multiple benefits. The main proposed management is amputation, however lately a primarily conservative management has been advocated, with the aim of preserving the function of the affected hand, justified by the low metastatic rate of chondrosarcomas in the hand. We present the clinical case of a 76-year-old female patient who presented after a fall from her own height with a pathological fracture of the proximal phalanx of the fourth finger of the left hand. Upon questioning, the patient denied having presented clinical symptoms prior to her incident; her surgical management was decided by means of wide resection and placement of a bone graft, since the patient did not accept general anesthesia, the placement of a cadaveric cortical graft was chosen.

Ribociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, is widely used in the treatment of metastatic breast cancer. However, its dermatologic adverse effects, particularly vitiligo-like lesions, have been recently reported. The pathomechanisms underlying these lesions remain unclear, but immune-mediated melanocyte destruction has been proposed. A literature review reveals an increasing number of similar cases, highlighting the need for further investigation into these adverse effectsncidence, mechanisms, and clinical implications. We present a case of vitiligo-like depigmentation in a patient undergoing ribociclib therapy.

Biliary ileus is a rare cause of intestinal obstruction, first described by Bartholin in 1654, is an impaction of gallstones into the intestinal tract through a cholecystoenteric fistula (CEF). A CEF, a relatively rare complication of gallstones, is defined as an autonomous communication between the inflamed gallbladder and the surrounding adherent gastrointestinal tract, usually secondary to Mirizzis syndrome. Computed tomography (CT), with a sensitivity greater than 90% and specificity close to 100%. The treatment of biliary ileus is surgical and is mainly aimed at resolving the intestinal obstruction, the optimal surgical approach is still under debate. There are mainly 3 current surgical options: isolated enterotomy with spontaneous closure of the fistula, one-stage surgery performing enterolithotomy with cholecystectomy and closure of the fistula, and lastly two-stage surgery consisting of enterolithotomy followed by cholecystectomy and closure of the fistula.

Introduction: Fabry disease (FD) is an X-linked lysosomal deposit disorder caused by a deficiency in the enzyme lysosomal a-galactosidase A (a GAL-A) and the accumulation of globotriaosylceramide (Gb3) in the nervous, cardiovascular, and renal systems. Initially thought to be predominantly male, it has evolved to include heterozygous women with a diverse range of clinical symptoms. FD can pose health risks to the mother and her offspring during pregnancy, childbirth, and the neonatal period. The disease begins during the fetal stage of development, with most affected children remaining asymptomatic for the first few years. Progression of FD is associated with decreased renal function and proteinuria, and adults usually die prematurely due to organ failure. FD affects 1 in every 117,000 newborns, with an estimated prevalence between 1:40,000 and 1:117,000.