In this study, we present a case of Grade IV diabetic foot ulcer (DFU) and its management with Vrana ropana chikitsa along with Ayurvedic precision medicines. A 72-year-old male patient having grade IV DFU was given the Vrana ropana chikitsa with precision medicines. The bacterial profile and antibiotic resistance, and wound characteristics were monitored before and after the treatment. After the treatment, significant progressions were found in the patient. There was a decrease in the growth of Staphylococcus aureus in the wound after the treatment. Doxycycline and erythromycin-resistant isolates were switched to antibiotic sensitive strains with Vrana ropana chikitsa. Progression of Grade IV ulcer to healing wound was found in the patient. A case of Grade IV DFU with drug-resistant S. aureus was managed with the alternative treatment of Vrana ropana chikitsa and showed improved wound healing.

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Cyproheptadine hydrochloride(CH)- and dexamethasone-induced obsessive-compulsive symptomatology with suicide is extremely rare. We describe the case of a 20-year-old lean male who developed obsessive-compulsive symptoms and suicidality within a week of the use of CH and dexamethasone. There was complete resolution of symptoms after stopping the offending agent. Ashort trial of selective serotonin reuptake inhibitor was given for the rapid improvement of symptoms.

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Idiopathic granulomatous lobular mastitis (IGLM) is an uncommon and rare chronic inflammatory breast disease. The exact etiology is not known. Although various etiologies have been implicated, autoimmunity is favored and widely accepted. In countries with a high prevalence of tuberculosis, the diagnosis of IGLM is often challenging. Clinical presentation is quite variable. Ultrasonography and mammography findings lack specificity. Fine-needle aspiration (FNA) cytology features of idiopathic granulomatous mastitis (IGM) have been described in few reports, but they are still debatable. We report the case of a 36-year-old female with a hard lump in the left breast. Aspiration cytology smears showed many well-formed epithelioid granulomas and few scattered epithelioid cells. The background showed numerous polymorphonuclear leukocytes with few reactive lymphoid cells and foreign-body giant cells. There was no necrosis. Acid-fast bacilli (AFB) and fungal stains did not show AFB and fungal hyphae. A diagnosis of IGM was suspected on aspiration cytology. Histopathology examination confirmed the diagnosis. To conclude, though tuberculosis is highly prevalent in India, if breast FNA smears show epithelioid granulomas with numerous polymorphonuclear leukocytes with no necrosis or AFB, IGLM must be suspected.

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We report the case of a 60-year-old woman with left knee pain for 6 years, and left knee osteoarthritis was diagnosed by physical examination and radiography. She had a prior history of the right knee osteoarthritis and underwent total knee arthroplasty (TKA). After we performed TKA on her left knee, drop foot and sensory impairment were observed in the ward postsurgery, complicated with common peroneal nerve injury.

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Background: Nocturnal enuresis or bedwetting is the most common type of urinary incontinence in children. The wide prevalence of nocturnal enuresis speaks to the need for an improved understanding of this condition by others to improve the management plan. The management can be motivationally or pharmacologically. Our study aimed to evaluate the management outcomes of primary mono-symptomatic nocturnal enuresis among Sudanese children. Methods: A retrospective hospital-based survey was carried to assess 52 children aged 5–18 years (21:31 male: female ratio) and suffering from primary mono-symptomatic nocturnal enuresis. They divided into two groups; Group 1 (28 patients) were on desmopressin melt tablet 120 mcg once daily before bedtime, while Group 2 (24 patients) were on simple behavioral therapy. Data were collected by a well-designed checklist and analyzed using SPSS. Results: The wetting frequency decreased at the end of treatment by a total response rate of 96.4% with desmopressin and 75% with simple behavioral therapy. The complete response and partial response rate of desmopressin at the end of treatment were 89.3% and 7.1%, respectively. For simple behavioral therapy, the complete response and partial response rates at the end of treatment were 66.7% and 8.3%, respectively. The number of wet night per week at the end of 2 weeks of treatment among the two groups was statistically significant, with P = 0.025. Moreover, the relapse rate was higher with simple behavioral therapy (66.7%) than with desmopressin (57.1%). Conclusion: There is a highly significant decrease in wet nights in response to both desmopressin and simple behavioral therapy, both interventions were effective, desmopressin showed higher efficacy and associated with less relapse rate.

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Purpose: The purpose of this study was to evaluate the radiographic and clinical outcomes of hook plate fixation with and without coracoclavicular (CC) ligament augmentation with suture anchors for acute acromioclavicular (AC) joint dislocation. Methods: The study included 67 patients (48 males and 19 females; average age: 45.5 years) with acute AC joint dislocation (Rockwood types III and V) treated with hook plate fixation. The patients were divided into two groups: those treated with hook plate fixation with or without CC ligament augmentation with suture anchors. We used the CC distance and ratio as radiographic outcomes. We evaluated the American Shoulder and Elbow Surgeons (ASES) score and the Constant Shoulder Score as functional outcomes. The following were considered major complications: symptomatic acromial osteolysis, peri-implant fracture, acromial cut-out, and hook plate disengagement. Results: Among the Rockwood type III patients, there was no significant difference between the two subgroups in terms of the functional outcome after adjusting for sex and age. However, among the type V patients, treatment with CC ligament augmentation with suture anchors revealed a superior outcome in terms of the ASES score (P = 0.01). There was no difference in the risk of developing major complications between the two subgroups among type III and type V patients. The risk of residual subluxation of the AC joint was significantly lower in the CC augmentation subgroup among the type III patients (P = 0.04), and a similar result was obtained among the type V patients with borderline significance (P = 0.06). Conclusions: Hook plate fixation with CC suture anchor augmentation provided radiographic benefits in both type III and type V patients and yielded better functional outcomes in type V patients after implant removal but had no significant influence on the complication rate. Additional CC suture anchor augmentation may prevent residual subluxation and yield better functional outcomes.

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Background: Adrenal crisis is a life-threatening medical emergency associated with high mortality unless it is recognized early and treated. Aims: The aim of this study was to evaluate the clinical characteristics, etiology, and outcomes of patients with adrenal crisis. Methods: This was a hospital-based, prospective study of 35 adult patients, age >18 years diagnosed with the adrenal crisis. Patients were studied for clinical, etiological, laboratory parameters, comorbidities, and outcome. Results: The mean age of patients with the adrenal crisis was 47.2 ± 16.8 years, and there was female (68.6%) preponderance. The most common mode of presentation was hypotension (100%), shock (94.3%), altered sensorium (28.6%), hyponatremia (45.7%), hypoglycemia (17.1%), and sepsis (37.1%). Hypoglycemia and hyperlactatemia were predominantly found in patients without known adrenal insufficiency before the presentation. Secondary adrenal failure (57.1%) followed by sepsis-related adrenal failure (34.3%) and primary adrenal failure (8.1%) was the most common cause of admission. Secondary adrenal failure comprised of withdrawal of exogenous glucocorticoid therapy (25%), Sheehan syndrome (30%), pituitary surgery (15%), and pituitary tumor (15%). Overall mortality was 17.1%, with the highest mortality for sepsis-related adrenal failure (33.3%). Elderly (age >60 years), altered sensorium, serum sodium <120 mEq/L, hypoglycemia, multiorgan dysfunction syndrome (MODS), and lactic acidosis significantly increase the mortality in adrenal crisis. Conclusions: Patients with adrenal crisis carry significant morbidity and mortality with particular emphasis on sepsis-related adrenal failure. The factors predicting mortality in adrenal crisis are elderly, altered sensorium at presentation, severe hyponatremia, hypoglycemia, MODS, and lactic acidosis.

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Background: Wilms' tumor (nephroblastoma) is the most common solid primary renal malignancy in children but extremely rare in adult population. We report the clinical presentation and therapeutic results of our adult Wilms' tumor patients and review the previous literatures about diagnosis and treatments. Methods: A retrospective review was carried out to investigate the patients with adult Wilms' tumor at the Tri-Service General Hospital during a 35-year period (1980–2014). Seven patients ≥16 years old (one female and six males; median age at the time of diagnosis of 24 years; range: 21–48 years) were staged according to the National Wilms' Tumor Study staging system as follows: three patients had Stage II disease, two patients had Stage III disease, and two patients had Stage IV disease. All statistical values were represented as mean ± standard deviation. All tests were two-sided, with P < 0.05 considered statistically significant. All statistical analyses were carried out using SPSS software (IBM, Armonk, NY, USA). Results: The most common clinical presentation is flank pain (57%) followed by palpable mass (43%). Only one patient presented with gross hematuria. Four patients underwent renal arteriography, which all disclosed irregular, tortuous vessel pattern with faint tumor stain. All patients underwent radical nephrectomy (one – hand-assisted laparoscopic nephrectomy and six – open transperitoneal nephrectomy). Two patients developed lung metastases after radical surgery. Six patients received multimodal therapy, including surgery, chemotherapy, and radiation therapy. The mean disease-free survival is 81 months. The 3- and 5-year survival rates are 83% and 71% separately. Conclusions: Selective renal arteriography could provide a valuable diagnostic hint in adult Wilms' tumor. Using multimodality therapy, improved prognosis could be achieved.

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Since the outbreak of COVID-19, emerging data and reports have shown that all types of violence against women and girls, particularly domestic violence (DV), has intensified. As the pandemic continue to strain health services, other essential services, such as DV shelters and helplines, have reached capacity. This article highlights the difficulties in establishing the anti-sexual violence work during such disasters and also impel on making advance preparations for the same.

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