International Journal of Medical Science and Clinical Research Studies

Surgical Management of Ventricular Aneurysms in Pediatric Patients with Viral Myocarditis: A Comprehensive Review

Donaldo Emiliano Silva López — 2025-02-21

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.

Methods: A comprehensive review of existing literature was conducted, emphasizing pediatric cases of VA secondary to viral myocarditis. The analysis includes case reports, retrospective studies, and clinical guidelines outlining indications for surgical intervention and the technical considerations therein.

Results: Surgical resection of ventricular aneurysms in this population remains a challenging yet often life-saving procedure. Key findings highlight the importance of preoperative imaging modalities, intraoperative strategies to preserve ventricular function, and the role of postoperative care in optimizing outcomes.

Conclusions: While surgical management of VAs in pediatric viral myocarditis is rare, it provides a definitive treatment option with favorable outcomes in well-selected cases. Multidisciplinary collaboration and advancements in surgical techniques are critical in addressing this complex pathology.

The Role of Intravascular Ultrasound (IVUS) In Guiding Interventions for Patients with Aberrant Coronary Arteries: A Comprehensive Review

Donaldo Emiliano Silva López — 2025-02-21

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.

Cervico-Isthmic Cerclage Intra-Abdominal Approach for the Management of Cervical Incompetence: Case Report

Leonel Andrés Barrera-Heredia — 2025-02-05

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.

Case Report: We present a case of cervical incompetence with two previous preterm births and the use of Espinoza Flores cerclage. In this pregnancy, an abdominal cerclage was placed, resulting in a viable pregnancy until 36.5 weeks of gestation. The pregnancy concluded with a cesarean section due to premature rupture of membranes, resulting in the birth of a newborn with adequate weight and Apgar score.

Discussion: The management of cervical incompetence can be performed through transvaginal cerclage; however, there are alternatives such as an intra-abdominal approach, which has shown excellent results.

Conclusion: Intra-abdominal cerclage may be an option for the management of cervical incompetence in patients with previous preterm births and inadequate results with transvaginal management.

Pauci-Immune Vasculitis cANCA Positive with Renal-Lung Syndrome in Pediatrics: A Case Report

Manuel Alberto Escalante Chalé — 2025-02-05

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.

Clinical case: A 5-year-old female patient presented with fever, cough, and hemoptysis. Laboratory tests revealed severe anemia, and acute renal injury. During admission, she suffered from nephritic syndrome with hypertension, hematuria, and non-nephrotic proteinuria. A renal biopsy revealed diffuse extracapilar proliferative glomerulonephritis, both active and chronic, pauci-immune type. Steroid and immunomodulator administration were effective, achieving clinical improvement and hematological recovery. Outpatient management was continued with prednisone and cyclophosphamide for 3 months, followed up every 6-12 months by pediatrics.

Discussion: A case is presented of a female patient with lung-kidney syndrome secondary to cANCA-positive vasculitis. This vasculitis, associated with anti-neutrophil cytoplasmic antibodies, is a rare disease characterized by necrotizing inflammation of small blood vessels. The lung-kidney syndrome manifests with alveolar hemorrhage and glomerulonephritis, with vasculitis being one of its most common causes. Its etiology is unknown and appears to result from a complex interaction between genetic, environmental, and immune dysregulation.

In the literature, a predominance of the female sex has been observed in ANCA-associated vasculitis in children, although the patient in this case began to show symptoms at an earlier age than usual. Pulmonary symptoms include dyspnea, chronic cough, and hemoptysis, while renal involvement is manifested by abnormal urinalysis and glomerulonephritis confirmed by biopsy. Diagnosis relies on the determination of ANCA antibodies and histopathological studies, which in this case showed scar lesions in the glomeruli. For treatment, the EULAR recommendations were followed, using cyclophosphamide and glucocorticoids, resulting in a favorable evolution of the patient.

Conclusion: Systemic vasculitis, a rare childhood disease, requires high suspicion rate and timely treatment, especially in children with lung-kidney syndrome, to improve survival rates.

Effect of Giving Papaya Leaf Extract (Carica Papaya L.) on Changes in Fasting Blood Glucose in Male Wistar Rats (Rattus Norvegicus) Induced by Streptozotocin

Gabriella Alisha Sudarisman — 2025-02-05

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.

Effects of Mobile Application Education for the Practice of Anesthesia in Patients Undergoing Day Surgery

Wantana Boonkong — 2025-02-05

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.

METHODS: The sample consisted of 62 ODS patients at Lampang Hospital, randomly divided into experimental (n=31) and control (n=31) groups. The "Application ODS," a general information questionnaire, a knowledge assessment form, and a clinical outcome record form were utilized. Data analysis employed descriptive statistics, paired t-test, independent t-test, and chi-square test.

RESULTS: Pre-test and post-test scores the experimental group's mean knowledge score increased significantly more (11.03±0.65 to 17.83±0.73) than the control group's (10.77±0.55 to 12.55±0.77) (p<0.001). The experimental group achieved a high knowledge level and had no adverse events, with significantly lower hospital stay rates than the control group (p=0.015, p=0.019). Surgery cancellation or postponement did not differ significantly between groups.

CONCLUSIONS: The "Application ODS" effectively increased ODS patients' knowledge and improved some clinical outcomes. Widespread adoption should be promoted to enhance healthcare quality and safety for this patient group. Further app development based on user needs and larger, long-term studies are recommended to inform appropriate policies.

Study on the Physical Conditions of Horses for Better Management of Welfare in Conditions of Climate Change in the Diourbel Region, Senegal

Ousmane KANE — 2025-02-06

En Bloc Resection in Peritoneal Carcinomatosis with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Appendiceal Cancer: Surgical Strategies, Oncologic Outcomes, and Epidemiological Insights

Luis Jorge Caldera Sanchez — 2025-02-06

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.

Epidemiologically, appendiceal neoplasms are rare, with an incidence of approximately 0.12 cases per 100,000 individuals per year, accounting for less than 1% of all gastrointestinal malignancies. Despite their low incidence, the diagnosis of appendiceal cancer has been increasing due to advancements in imaging modalities and more frequent incidental discoveries during appendectomies. The prognosis of appendiceal cancer varies widely depending on histologic subtype, peritoneal carcinomatosis index (PCI), and the feasibility of complete cytoreduction. This article explores the epidemiology, surgical principles, and oncologic outcomes of en bloc resection in conjunction with HIPEC, emphasizing patient selection criteria, operative techniques, and perioperative management. Additionally, we analyze the impact of histopathological subtypes on treatment response, recurrence patterns, and survival outcomes, providing a comprehensive overview of this aggressive but potentially curative approach to managing peritoneal carcinomatosis from appendiceal malignancies.

Knowledge, Perceptions, Awareness, and Incidence of Cognitive Health Issues among Undergraduates at Risk for Polycystic Ovarian Disease (PCOD)

Dr. Shweta Sehgal — 2025-02-06

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.

MATERIAL & METHOD: An online structured questionnaire was created to collect data from 123 medical UG students of batch 2023 of various medical colleges.

RESULTS: Most participants began menstruating between ages 12 and 14, with a majority tracking their menstrual cycles and being informed about PCOD. While 90% of participants experience dysmenorrhea, only a small proportion take medication regularly for it. The majority sleep 6-8 hours daily, though some report irregular or insufficient sleep, indicating a need for better sleep hygiene. Stress levels are moderate for most, with a significant number experiencing anxiety, particularly related to academic pressures. Dietary habits show a reliance on fast food, with 52% consuming it 2-4 times weekly, which may contribute to weight management difficulties for some participants.

CONCLUSION: These findings suggest the importance of targeted interventions, including stress management, improved sleep hygiene, and healthier eating habits, to enhance the overall well-being and quality of life for young women, particularly concerning reproductive health and academic pressures.

Ischemic and Hemorrhagic Stroke in Young Adults: Etiological Considerations, Risk Factors, and Management Strategies

Meyboll Edily Rodriguez Medina — 2025-02-07

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.

This review provides an in-depth analysis of the pathophysiological mechanisms underlying stroke in young adults, highlighting the distinct clinical presentations, diagnostic modalities, and therapeutic options. The role of advanced neuroimaging, thrombophilia screening, and cardiac workup is emphasized in optimizing diagnostic accuracy. Additionally, we discuss the implications of early intervention strategies, including thrombolysis and endovascular therapy, alongside secondary prevention approaches tailored to this demographic. A comprehensive understanding of the unique aspects of stroke in young adults is imperative for improving clinical outcomes and reducing long-term disability in this patient population.

“Otak-Otak” Formulation of Skipjack Tuna (Katsuwonus Pelamis) and Moringa Leaves (Moringa Oleifera) as an Alternative Additional Feeding for Pregnant Women with Chronic Energy Deficiency

Vierencia Dwilian — 2025-02-07

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%.

Revolutionizing Reconstruction: The Role of Custom Implants in Orbital and Zygomatic Complex Fractures

Steven Steven — 2025-02-07

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.

Methods: We conducted a systematic review following PRISMA guidelines, focusing on peer-reviewed articles published after 2014 that reported comparisons between implants based on computer-assisted technology and conventional methods for orbital bone and zygomatic complex fractures in adults. Databases and trial registries were systematically searched to identify relevant studies. The Newcastle-Ottawa Scale (NOS) was employed to assess the quality of studies included in this systematic review.

Results: Following a comprehensive literature search, 1,463 articles were initially identified and screened for relevance and duplication, resulting in a final selection of 3 articles. Orbital and zygomatic complex reconstruction using patient-specific implants (PSI) was performed in 61 patients, while 70 patients underwent conventional methods. The most common post-surgical complications included enophthalmos (n=23), diplopia (n=20), and implant malposition (n=13). PSI facilitated the restoration of orbital volume levels between injured and uninjured orbital bones and achieved ZMC symmetry. All studies included in this review were categorized as level 3 evidence.

Conclusion: This examination of published literature on PSI for orbital and ZMC fracture reconstruction underscores that, while PSI can effectively, precisely, and safely address orbital fractures, patient outcomes are largely comparable to those achieved with conventional methods, and PSI do not present a clear advantage over conventional implants.

The Effect of Tablets Effervescent Cocoa Pod Husk Extract (Theobroma Cacao L.) as a Denture Cleanser Against the Growth of Candida Albicans on Thermoplastic Nylon Plate

Arum Ramadhanti — 2025-02-08

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.

An Updated Overview for Rhinoplasty Techniques.

Héctor Gutiérrez Reyes — 2025-02-10

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.

COVID-19 Vaccine-Induced Lichenoid Drug Eruption

Fouzia Hali — 2025-02-10

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.

Lichenoid drug eruptions are often seen in association with certain medications, and less commonly with Hepatitis B vaccination. However, this case presents an uncommon presentation of LDE following COVID-19 vaccination, with an atypical distribution of lesions, involvement of uncommon sites, and no history of prior drug or vaccine hypersensitivity.

This case underscores the importance of recognizing rare or atypical skin manifestations, such as lichenoid drug eruptions, as potential vaccine-related adverse effects. Identifying these conditions allows clinicians to ensure accurate diagnosis and appropriate management.

The Impact of Vitamin D Supplementation on Patients with Essential Hypertension and Vitamin D Deficiency

Anita Dahliana — 2025-02-13

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.

Objective: To examine how vitamin D affects hypertension in those who are deficient in it.

Methods: The PubMed and Google Scholar databases are used in this investigation to conduct a literature review utilizing a narrative methodology that looks at and analyzes research findings in regional or global literature.

Results: Blood pressure levels after taking vitamin D are dramatically reduced.

Conclusion: Patients who are vitamin D deficient can benefit from vitamin D to treat their essential hypertension.

Optimization of Gelatin and Pectin Combination as a Gelling Agent in the Formulation of Flawless Jelly Preparations with Ethanol Extracts of Meniran (Phyllanthus Niruri) and Kelor (Moringa Oleifera)

Tiara Nastiti Sari — 2025-02-13

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.

Detection of Microembolism Signs using Transcranial Doppler in Infective Endocarditis

Karla Fabiola Aguirre Avila — 2025-02-14

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.

Case presentation: We present the case of a 24-year-old man with no significant history or previously identified risk factors.

With a probable diagnosis of infectious endocarditis based on clinical findings. The echocardiogram revealed a bicuspid aortic valve, with a doubtful diagnosis of cardiac vegetation. A diagnosis of endocarditis was made thanks to the support of microembolic signal detection by transcranial Doppler.

Conclusion: The relevance and importance of transcranial Doppler support in infective endocarditis is evaluated. This is a tool that could be considered to be part of the DUKE criteria.

The Role of Free Perforator Flaps in Complex Post-Oncological Reconstruction: Insights into DIEP, ALT, and SCIP Flap Techniques

Abigail Berenice Gómez Valenzuela — 2025-02-14

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.

Objective: This article evaluates the indications, surgical techniques, and outcomes associated with the use of DIEP, ALT, and SCIP flaps in managing complex defects in oncological reconstruction.

Methods: A comprehensive review of the literature was conducted, focusing on patient selection, anatomical considerations, operative nuances, and postoperative results for each flap type.

Results: DIEP, ALT, and SCIP flaps provide significant benefits, including reduced donor-site morbidity, reliable vascularity, and aesthetic outcomes. Each flap exhibits unique advantages depending on the reconstructive needs and patient characteristics, with tailored approaches enhancing both functional and cosmetic results.

Conclusion: Free perforator flaps represent the gold standard for addressing complex reconstructive challenges in post-oncological surgery. An individualized, multidisciplinary approach is critical to optimize outcomes and patient satisfaction.

Spontaneous Hematoma of the Left Abdominal Wall Secondary to Costal Exostosis: A Case Report

Dr. Manuel Rodríguez Navarro — 2025-02-17

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.

Analysis of Pro-Environmental Behavior in Fishermen Families at Muara Siberut, Mentawai Islands, Indonesia

Aria Gusti — 2025-02-17

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.

Acute Myocardial Infarction in the Inferior Wall in a Patient with Anomalous Origin of the Right Coronary Artery

Karla Julissa Juárez Núñez — 2025-02-18

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

Cronkhite-Canada Syndrome: A Comprehensive Review of Its Pathophysiology, Clinical Manifestations, and Current Therapeutic Approaches

Mariano de la Vega Muñoz — 2025-02-18

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.

The diagnosis of CCS relies on a combination of endoscopic findings, histopathological analysis, and the exclusion of other polyposis syndromes. Given the high morbidity and potential for malignant transformation, early recognition and intervention are crucial. Treatment strategies are primarily supportive, aiming to manage nutritional deficiencies and control inflammation. Glucocorticoids, immunosuppressive agents, and proton pump inhibitors have been utilized with varying success, while emerging therapies targeting immune dysregulation offer potential novel avenues for management. Despite therapeutic advancements, the prognosis remains guarded, with a substantial risk of relapse and complications such as gastrointestinal bleeding and malignancy.

This review aims to provide a detailed analysis of the pathophysiology, clinical spectrum, diagnostic modalities, and therapeutic strategies for CCS, emphasizing recent insights into its immunopathogenesis and emerging treatment options.

Successful Gestation of a Herlyn-Werner-Wunderlich Syndrome Carrier And Patient, After a Hysteroscopic Septoplasty

ANA CLARA RODRIGES PONTES — 2025-02-18

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 patient’s obstetric future, with occurrence of severe endometriosis and infertility.

Case Report: A patient, 18 years old, admitted for an amniotic fluid loss complaint. She demonstrated a previous diagnosis of HWWS during anamnesis, which was previously discovered and surgically adjusted 4 years earlier, through a hysteroscopic vaginal septoplasty. The patient needed an obstetric admission due to a clinical diagnosis of Prelabor Rupture of Ovular Membranes (PROM), with abdominal delivery after 5 days due to the development of severe preeclampsia. The procedure had no intercurrence, alongside the birth of the conceptus in good clinical conditions.

Discussion: The patients who carry that rare syndrome have didelphys uterus, low genital obstruction and unilateral renal agenesis. When the genital obstruction is complete, the symptoms are often more glaring, producing palpable and painful abdominal mass because of the hematocolpos. Regardless of the anatomic space, the retained flow is susceptible to infections and may cause abdominal sepsis. Furthermore, the patient can acquire infertility for the higher risk of endometriosis or for the anatomic distortions. The cirurgical adjustment is associated with good pregnancy rates and should always be suggested to those patients.

Conclusion: Considering the serious repercussions to the life quality of those patients, the Herlyn-Werner-Wunderlich Syndrome (HWWS) should always be present in differential diagnosis of a specialist doctor’s routine. The premature diagnosis leads to a necessary adjustment and contributes to positive and favorable results in the reproductive life of such patients.

Fatal Outcome in a Patient with Kaposi's sarcoma: Case Report and Literature Review

Andrea Guadalupe Navarro Ortega — 2025-02-20

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.

Case Report: Resistance to Neuromuscular Blockade and the Benefits of Quantitative Monitoring

Nicolas Antonio Benitez Monroy — 2025-02-20

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.

Keloid Scars: A Comprehensive Review of Pathophysiology, Aetiology, and Therapies

Papichaya Katanyutanon — 2025-02-20

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-β1 and β2; 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.