Background: High-energy fractures of the distal tibia associated with soft tissue defects represent a significant therapeutic challenge due to the high risk of infection and non-union.  We demonstrate an effective treatment of such a fracture using S53P4 bioglass. Case Report: We present the case of a 53-year-old male patient who sustained a comminuted distal metaphyseal fracture of his tibia and fibula, complicated by extensive burns in vicinity and a bone defect. Following initial stabilization and soft tissue management, the bone defect was treated with plate osteosynthesis and filled with S53P4 bioactive glass. At the 9-month follow-up, the fracture had healed with a good functional outcome and no signs of infection. Conclusion: S53P4 bioactive glass is an effective alternative to autologous bone grafts in high-risk environments due to its osteoinductive and antimicrobial properties. Continue Reading

Background: Hypercalcemia is a common electrolyte abnormality with varied etiologies and clinical manifestations. Although primary hyperparathyroidism and malignancy account for the majority of cases, less common causes may present diagnostic challenges. Case Presentations: We report three unusual cases of hypercalcemia secondary to disseminated tuberculosis, sarcoidosis and acute lymphoblastic leukemia. The first case involved a 44-year-old woman presenting with fever and altered sensorium. Laboratory investigations revealed severe anemia, acute kidney injury, pancreatitis and PTH independent hypercalcemia. Cerebrospinal fluid analysis was normal but chest imaging and lymph node biopsy confirmed disseminated tuberculosis. After initiation of antitubercular therapy, she developed drug-induced hepatitis followed by progressive multiorgan dysfunction, culminating in death. The second case involved a 48-year-old woman presenting with generalized body aches and a past history of cervical cancer. Malignancy-related hypercalcemia was initially suspected. However, further evaluation established a diagnosis of sarcoidosis. Management with intravenous hydration and corticosteroids led to normalization of serum... Continue Reading

Background: The purpose of this article is to highlight the importance of in a case of peripheral arterial disease (PAD) with suspected microembolization, through the presentation of a complex clinical case involving a patient with a mechanical heart valve, anemia, and heart failure. The aim is also that of emphasizing the importance of the multidisciplinary approach to treating comorbid conditions, such as type 2 diabetes, in patients with PAD. Case Presentation: A 48-year-old diabetic and hypertensive man presented with rest pain and left forefoot gangrene. He was diagnosed with advanced PAD (Fontaine stage IV) with multiple comorbidities. Endovascular revascularization and optimized multidisciplinary management were performed, resulting in clinical improvement, increased walking distance, and regression to Fontaine stage IIA. Conclusion: This case emphasizes that advanced PAD requires prompt multidisciplinary management and strict control of comorbidities, highlighting also that poor adherence to anticoagulation therapy and risk factor management may contribute to complications... Continue Reading

Background: Large urinary bladder (UB) calculus is now rare in urological clinical practice. UB stone presents with obstructed urinary flow, increased urinary frequency, and lower abdominal and perineal or penile pain. Male patients are affected more. Hot environmental condition, poor water intake, benign prostatic enlargement, urethral stricture, and prolonged urethral catheterization are some of the contributory factors for bladder stone formation. Herein, we have tried to highlight importance and need of open cystolithotomy in five cases of large UB calculus presented to outpatient department (OPD) with their clinical presentation, history, and investigations with probable causes and review of literature.Case series: Five consecutive patients were evaluated, diagnosed, and operated for giant UB calculus by open cystolithotomy. Patients were discharged with suprapubic catheter (SPC) and per-urethral catheter (PUC) in situ. SPC and PUC were sequentially removed after 3 weeks of surgery. All five patients had intact UB stone removal except one where... Continue Reading

Background: Lemierre syndrome is a rare but potentially life-threatening condition classically characterized by recent oropharyngeal infection, septic thrombophlebitis of the internal jugular vein, and septic embolization. However, severe deep neck infections may occasionally present with clinical features that mimic Lemierre syndrome, even when internal jugular vein thrombosis, septic embolization, and positive cultures are absent.Case Presentation: A 21-year-old previously healthy man presented to the emergency department with altered mental status following a two-week history of sore throat. Fever, chills, dyspnea, and confusion had developed within the previous 24 hours. On admission, he was febrile, tachypneic, confused, and poorly cooperative. Laboratory investigations revealed neutrophilic leukocytosis and elevated inflammatory markers. Contrast-enhanced neck computed tomography demonstrated a right-sided peritonsillar/parapharyngeal abscess measuring 18 × 28 × 54 mm with obliteration of the parapharyngeal fat planes. However, no evidence of internal jugular vein thrombosis or septic pulmonary embolism was identified. The patient was admitted to the... Continue Reading

Background: Ferric carboxymaltose can cause fibroblast growth factor 23-mediated renal phosphate wasting; neurological presentations may delay recognition. Case Presentation: A 76-year-old woman presented after a 2-minute focal seizure one month after receiving a single 1 g intravenous ferric carboxymaltose infusion for iron-deficiency anemia. Computed tomography of the head and electroencephalography showed no acute intracranial or epileptiform cause. Extended testing demonstrated severe hypophosphatemia (0.23 mmol/L) and hypomagnesemia (0.52 mmol/L), with recurrent phosphate decline despite replacement. Fibroblast growth factor 23 was inappropriately normal (35 pg/mL) for the preceding severe hypophosphatemia, supporting ferric carboxymaltose-associated phosphate wasting. Concurrent pantoprazole use likely contributed to hypomagnesemia. After phosphate and magnesium replacement and pantoprazole discontinuation, electrolytes stabilized by day 12 and no further seizure occurred. Conclusion: Ferric carboxymaltose-induced hypophosphatemia should be considered in patients presenting with unexplained seizures after intravenous iron exposure. Continue Reading

Background: Flail arm syndrome (FAS) is an uncommon variant of amyotrophic lateral sclerosis (ALS) characterized by progressive, predominantly lower motor neuron weakness confined mainly to the upper limbs. Because structural cervical disease is common in older adults, its diagnosis may be delayed or misattributed to compressive or peripheral nerve disorders. Case Presentation: A 69-year-old man developed progressive asymmetric upper limb weakness over two years, evolving into bilateral brachial diplegia with preserved lower limb function. Neurological examination showed marked upper limb atrophy, fasciculations, and extensor plantar responses, without sensory deficits. MRI showed no significant cervical compression, while electromyography revealed multisite denervation, supporting the diagnosis of flail arm syndrome as a phenotype of ALS. Multiple alternative diagnoses, including cervical myelopathy, multifocal motor neuropathy, and myopathy, were systematically excluded. Conclusion: This case highlights the importance of recognizing flail arm syndrome within the ALS spectrum. Electrophysiological evidence of multisite motor neuron involvement is crucial... Continue Reading