Salivary High-Sensitivity C-Reactive Protein and Its Clinical Relevance in Modern Medicine: A Comprehensive Review.

High-sensitivity C-reactive protein (hsCRP) has emerged as a critical biomarker in inflammation, offering insights into various chronic diseases. However, traditional blood-based assays for hsCRP measurement pose limitations regarding invasiveness and cost. In recent years, saliva has garnered attention as an alternative diagnostic medium, presenting a noninvasive and easily accessible option for biomarker analysis. Salivary hsCRP has thus emerged as a promising avenue for research and clinical application, offering potential advantages over blood-based assays. This comprehensive review aims to elucidate the biological basis of salivary hsCRP, its clinical applications, and methodologies for measurement. By exploring its diagnostic potential, prognostic value, and implications for treatment monitoring, this review highlights the potential impact of salivary hsCRP in modern medicine. Moreover, it emphasizes the need for continued exploration, validation, and integration of salivary hsCRP into routine clinical practice to realize its full potential for enhancing patient care and advancing personalized medicine approaches.

Hydatidosis: A Rare Case of Multi-organ Involvement.

Echinococcus granulosus is the tapeworm that causes hydatidosis. The liver is the most frequently impacted region, although it can also affect the spleen, lung, and peritoneum. Dogs are the definite hosts, whereas humans are the unintentional accidental hosts. The peritoneum is an unusual site for hydatid cysts. We report the case of a 42-year-old male who had abdominal distension. A CT scan revealed hydatid cysts in the liver, spleen, and peritoneum. The patient was managed conservatively with albendazole and advised for surgical intervention and removal of daughter cysts. This case highlights the uncommon presentation of hydatid disease involving multiple intra-abdominal organs concurrently. The successful management of such cases necessitates a multidisciplinary approach, encompassing accurate diagnosis, timely intervention, and comprehensive treatment strategies. Furthermore, this case emphasizes the importance of clinical suspicion in endemic regions to optimize patient outcomes and enhance quality of life.

From Treatment to Tragedy: Severe Methotrexate Toxicity With Mucocutaneous Ulcers, Myelosuppression, and Nephropathy.

Methotrexate (MTX) is a well-established drug for the use of various neoplastic disorders. Recently, it has been widely used as a disease-modifying antirheumatic drug (DMARD) in low doses, mainly for rheumatoid arthritis (RA) and psoriasis. The drug is known to cause renal damage as well as be excreted via the kidneys, thus causing a higher incidence of adverse effects in patients with impaired renal function. The side effects of MTX toxicity range from mucocutaneous ulcers to nephrotoxicity and bone marrow depression, all of which are seen in this case. Here, we report an elderly male in his late 60s who was prescribed MTX 15 mg once a week along with folic acid 5 mg for RA by a general practitioner. Despite being prescribed once weekly, he continued to take MTX daily without following up with a physician for a span of five months. Following this, he presented to the medicine outpatient department with odynophagia due to oral ulcers for 10 days. He was diagnosed with MTX toxicity, causing nephropathy, myelosuppression, and mucocutaneous ulcerations. He was treated with injectable leucovorin 100 mg thrice a day until the toxicity subsided, leading to his eventual recovery.

Reactive Thrombocytosis: A Bizarre Consequence of Splenectomy.

Platelets are blood components produced in the bone marrow and are essential in forming blood clots. Thrombocytosis refers to a condition that causes the excess production of platelets in the body. When it develops as a reaction to an infection, trauma, or surgery, it is known as secondary or reactive thrombocytosis. Although thrombocytosis is typically a self-limiting disorder, it can frequently result in hemorrhagic or thrombotic events. Extreme thrombocytosis may trigger thrombotic events. Therefore, clinicians must be aware of the complications of thrombocytosis. In this case report, a 35-year-old female, known to have portal hypertension and Budd-Chiari syndrome, presented with complaints of weakness and tingling in her hands persisting for eight days. She disclosed that she had undergone an elective splenectomy as part of her management for portal hypertension and Budd-Chiari syndrome eight days prior.

A Comprehensive Review on Serum Ferritin as a Prognostic Marker in Intensive Care Units: Insights Into Ischemic Heart Disease.

Serum ferritin has garnered considerable attention as a prognostic marker in intensive care units (ICUs), offering valuable insights into patient outcomes and clinical management strategies. This comprehensive review examines the role of serum ferritin in predicting outcomes among critically ill patients, with a particular focus on its implications for ischemic heart disease (IHD). Elevated serum ferritin levels have consistently been associated with adverse outcomes in ICU settings, including increased mortality, prolonged hospital stays, and higher morbidity rates. Furthermore, the relationship between serum ferritin levels and IHD underscores its potential as a biomarker for cardiovascular risk assessment in critically ill populations. The review synthesizes existing literature to highlight the predictive value of serum ferritin in assessing illness severity and guiding clinical decision-making in the ICUs. It also explores potential mechanisms linking serum ferritin to adverse outcomes and discusses implications for clinical practice. Integrating serum ferritin measurements into routine assessments could enhance prognostication and risk stratification in ICU patients, while further research is needed to elucidate optimal management strategies and therapeutic targets. Collaborative efforts between clinicians and researchers are essential to advance our understanding of serum ferritin's prognostic value in the ICUs and translate this knowledge into improved patient care and outcomes.

Non-albicans Candida Infection as a Rare Cause of Emphysematous Pyelonephritis in an Uncontrolled Diabetic Patient: A Case Report.

The uncommon but dangerous condition known as emphysematous pyelonephritis (EPN) usually affects people with diabetes. This potentially fatal illness is characterized by gas-forming necrosis of the kidneys and surrounding tissues, typically brought on by urinary tract bacteria. Fungal EPN, less prevalent than bacterial EPN, has been reported in a few isolated cases. Cultures of the urine or blood often detect the infection. With an 18% fatality rate, EPN is still a serious illness despite advancements in therapy. High suspicion for EPN is critical in diabetic patients experiencing pyelonephritis. Interestingly, women with uncontrolled diabetes seem to be more susceptible. While Escherichia coli is the usual culprit, rare cases involve Candida species. This case report describes a pathogen that is rarely encountered and causes EPN. A diabetic woman in her sixties without prior hospitalizations presented with a sudden fever and excruciating abdominal pain. The patient also complained of abdominal distension with reduced urine output and breathlessness at rest. Investigations revealed left-sided EPN that was "WAN Type 1." We treated the patient according to culture sensitivity with systemic antifungals, percutaneous nephrostomy (PCN), and ureteral stenting (double J stent or DJ stent). Following successful treatment, the patient recovered and was discharged. This case highlights the importance of considering uncommon causes, even in seemingly typical presentations of EPN. Our case is unique as the patient had an infection with non-albicans Candida with a complication of anuric acute kidney injury and uncontrolled diabetes mellitus.

Case Report on Mycobacterium tuberculosis Presenting As Lemierre's Syndrome: A Reemerging Catastrophe.

Lemierre's syndrome is characterized by internal jugular vein thrombophlebitis and bacteremia, primarily from anaerobic organisms. The condition usually arises after a recent oropharyngeal infection. Young, healthy people with prolonged pharyngitis that progresses into septicemia, pneumonia, or lateral neck stiffness should be suspected of having Lemierre's syndrome. Identifying internal jugular vein thrombophlebitis and developing anaerobic bacterial growth on blood culture are frequently used to confirm the diagnosis. Treatment consists of long-term antibiotic treatment, sometimes in conjunction with anticoagulant medication. In this case report, we describe the unique case of a 29-year-old male with Mycobacterium tuberculosis with pulmonary tuberculosis, tubercular meningitis, tuberculosis-related acute ischemic stroke with septic thrombophlebitis. The patient presented with sudden onset altered sensorium for 4 hours. Magnetic resonance imaging of the brain was done, which suggested obstructive hydrocephalus with periventricular ooze. The patient was started on antibacillary treatment, antibiotics, anticoagulants, and systemic steroids. The patient was vitally stable when he was discharged. Therefore, it is crucial to consider the likelihood of such atypical tuberculosis presentations while providing a prompt and relevant diagnosis and recommending the right course of therapy.

A Rare Case of Dyke-Davidoff-Masson Syndrome in an Adolescent Female.

The Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon neurological disorder whose prevalence is not yet known. There have only been 21 adult manifestations of this rare brain disorder, out of around 100 cases previously documented. Diagnosis is challenging because of the complexity of radiological findings and clinical symptoms, which include ventricle dilation, hypertrophy of the cranial bones, increased pneumatization of the sinuses, and cerebral hemisphere atrophy. It can be inherited or acquired from infections, brain hemorrhage, and hypoxia during pregnancy. Usually, neuroimaging is used to diagnose it. This case study reports the case of a 17-year-old girl who had complex partial seizures at the age of 17 and right-side paralysis since she was three years old.

Clinical Biomarkers of Acute Vaso-Occlusive Sickle Cell Crisis.

It is known that an inherited blood condition called sickle cell disease (SCD) is a result of one gene. A number of blood and urine biomarkers have been determined in association with lab and clinical history for SCD patients. SCD has numerous interacting pathways associated with it, which have been identified by biomarkers. These mechanisms consist of some examples, such as endothelial vasodilation response, hypercoagulability, hemolysis, inflammation, oxidative stress, vascular dysfunction, and reperfusion injury among others. To effectively manage SCD, a comprehensive panel of validated blood and urine biomarkers must be established. Despite its monogenic inheritance, the complex nature of the SCD phenotype has impeded progress in its treatment. However, significant strides have been made in clinical biotechnology, paving the way for potential breakthroughs. In SCD, a panel of verified blood and urine biomarkers must be established, however. Despite monogenic inheritance, the great complexity of the SCD phenotype has hindered progress in its management. With few exceptions, clinical biomarkers of illness severity have been found through epidemiological investigations; nevertheless, systematic integration of these biomarkers into clinical treatment algorithms has not occurred. Furthermore, sickle cell crisis, the primary acute consequence of SCD, has been difficult to diagnose with the biomarkers now in use. Inadequate care and a lack of appropriate outcome measures for clinical research are the consequences of these diagnostic constraints. A new chapter in SCD customized treatment has begun with recent advancements in molecular and imaging diagnostics. Strategies in precision medicine are especially relevant now that molecular therapies are within reach. The significance of biochemical indicators linked to clinical manifestation and sub-phenotype identification in SCD is reviewed in this research.

Concurrent Challenges in Idiopathic Hypereosinophilic Syndrome Complicating Beta-Thalassemia Major: A Case Report.

This case report highlights the uncommon idiopathic hypereosinophilic syndrome (HES) complicating beta-thalassemia major, presenting a diagnostic and management challenge. Beta-thalassemia major, characterized by impaired beta-globin synthesis, necessitates regular blood transfusions and iron chelation therapy. HES, a rare disorder marked by persistent eosinophilia, adds complexity to the clinical course. We present the case of a 27-year-old male with beta-thalassemia major who developed fever, weakness, and weight loss and was subsequently diagnosed with HES. Treatment involved antibiotics, blood transfusions, and corticosteroids, leading to clinical improvement. This case underscores the need to further understand the relationship between thalassemia and eosinophilia and the importance of comprehensive evaluation in patients with overlapping hematological disorders.

Metronidazole-Induced Acute Cerebellitis in a Young Patient: Unusual Onset, Delayed Remission, and Characteristic Imaging Features.

Metronidazole-induced acute cerebellitis is an exceptionally rare condition resulting from severe adverse reactions to metronidazole, a medication generally employed in the management of infections caused by anaerobic microbes. Although neuropathy has been linked to metronidazole use, reports of acute cerebellitis are infrequent. The neurological effects associated with metronidazole can include weakness, dysarthria, postural instability, seizures, giddiness, vertigo, ataxia, confusion, encephalopathy, headaches, and tremors. The onset of cerebellitis can vary, occurring as early as one day or after several weeks of metronidazole treatment. This article presents a case of a young girl who presented to us with weakness in both upper and lower limbs, dysarthria, and postural instability after exposure to 12 grams of metronidazole (suicidal, 30 tablets of 400 mg). With the above-mentioned complaints, the patient was advised of magnetic resonance imaging of the brain, which showed the features of cerebellitis.

Unveiling Dermatomyositis: A Tragic Tale of Mortality in a 23-Year-Old.

Dermatomyositis represents a rare inflammatory myopathy that induces inflammation in the muscles or related tissues, including the blood vessels supplying these muscles. The precise pathogenesis of this condition remains unknown. Diagnosis typically relies on clinical indicators such as skin rashes, progressive muscle weakness, elevated serum muscle enzymes, abnormal electromyogram results, and muscle biopsy. In this case study, we report a fatal case of dermatomyositis in a 23-year-old female patient who succumbed to complications of dermatomyositis, causing mortality without any evidence of malignancy.

Enteric Fever Presenting With Complete Heart Block (CHB): A Rare Case of Reversible Arrhythmia.

Salmonella enterica serovar Typhi is the causative agent of enteric fever, commonly called "typhoid". This fever can be mistaken for a variety of other febrile disorders. It is an endemic sickness, especially in developing nations. Enteric fever typically manifests with fever, abdominal pain, and constitutional symptoms, making it a diagnostic challenge due to its broad clinical spectrum. Enteric fever also affects various other systems, causing complications, amongst which the cardiovascular system is no exception. Complications in the cardiovascular system may range from myocarditis to cardiomyopathy and various arrhythmias. This case report describes a case of a 28-year-old male who presented to us with fever and giddiness. Examination revealed profound bradycardia and electrocardiography (ECG) revealed features of a complete heart block (CHB). Investigations for fever confirmed enteric fever. This case report highlights one of the rarest complications of enteric fever.

Navigating the Enigma: A Comprehensive Review of Idiopathic Intracranial Hypertension.

An unidentified source of increased intracranial pressure is a hallmark of idiopathic intracranial hypertension (IIH), also referred to as pseudotumor cerebri. It mainly affects young, obese women, yet it can happen to anyone, regardless of age, gender, or weight. IIH presents with symptoms such as headaches, visual disturbances, and pulsatile tinnitus and can lead to severe complications, including vision loss, if left untreated. Diagnosis involves clinical evaluation, neuroimaging, and lumbar puncture, while management options include medical interventions and surgical procedures. This review provides a comprehensive overview of IIH, including its etiology, clinical presentation, epidemiology, complications, management approaches, and challenges. Increased awareness among healthcare professionals, standardized diagnostic criteria, and further research efforts are essential for improving outcomes and quality of life for individuals with IIH.

Mucinous Carcinoma of the Breast: A Case Report.

This case report presents the diagnostic journey of a 65-year-old female presenting with symptoms suggestive of breast pathology, ultimately diagnosed with mucinous carcinoma, following comprehensive clinical evaluation and histopathological confirmation. Initial assessments indicated a fibroadenoma; however, subsequent histopathological examination revealed mucinous carcinoma, highlighting the importance of histopathological confirmation in establishing definitive diagnoses. The case underscores the challenges in distinguishing between benign and malignant breast lesions based on clinical presentation and imaging findings alone. The multidisciplinary approach facilitated discussions regarding treatment options tailored to the patient's clinical and pathological characteristics. This case emphasizes the significance of a comprehensive diagnostic approach, integrating clinical evaluation, imaging studies, and histopathological analysis, in ensuring accurate diagnosis and guiding optimal management strategies for patients with breast cancer.

Unveiling Rare Complications: Pancreatic Pseudocysts and Monomicrobial Non-neutrocytic Bacterascites in Decompensated Cirrhosis.

One frequent side effect of chronic pancreatitis is pancreatic pseudocyst. Abdominal pain and vomiting are common complaints that the patient presents with. However, atypical manifestations of pancreatic pseudocyst still confound medical professionals worldwide, making identification challenging and ultimately increasing the risk of fatal consequences. We describe the case of a 41-year-old man who had decompensated liver cirrhosis linked to alcohol intake. The patient presented with dysphagia and yellowish skin discolouration, which, upon further investigation, turned out to be peripancreatic pseudocysts extending into the mediastinum. Diagnostic challenges arose due to the rare occurrence of a pancreatic pseudocyst located in the mediastinum. Patient was treated with a culture-sensitive antibiotic and on follow up he was doing well.

Elizabethkingia meningoseptica Causing Infection in a Chronic Kidney Disease Patient With Hepatitis B Positive Status: Unraveling the Hidden Culprit.

Elizabethkingia meningoseptica is a rare gram-negative bacterium recognized for its propensity to induce hospital-acquired infections, particularly in individuals with compromised immune systems and those equipped with indwelling medical devices. Its notorious resistance to a broad spectrum of antibiotics poses a considerable challenge in treatment protocols, contributing to its emergence as a significant cause of heightened mortality rates among critically ill patients. Herein, we present a case of E. meningoseptica infection in a patient afflicted with end-stage renal disease (ESRD) undergoing maintenance hemodialysis, concurrently grappling with ESRD, and a positive status for hepatitis B. This case report aims to shed light on the intricate complexities involved in diagnosing and managing such infections within this intricate clinical context.

Black Digits Matter: A Multispecialty Enigma.

Introduction Digital ischemia is alike any other visceral ischemic event leading to severe tissue damage ultimately causing necrosis of the involved extremity. It's like a preview of the upcoming systemic disorder and can present itself in any specialty and hence everyone, be it a physician or a surgeon must be primed toward how to proceed with a case of digital ischemia. In this case series, we present six such cases that presented with digital ischemic events either as a sole presentation or were followed by other systemic manifestations that led to their evaluation and ultimately the etiology behind it. Material and method Patients visiting Rheumatology OPD with complaints suggestive of digital ischemia were included in this study. All patients underwent thorough history taking and clinical examination to establish the cause of digital ischemia. Patients with probable infective, trauma, cardiac, and drug-induced causes and malignancies were excluded. As per probable autoimmune causes, patients underwent evaluation via antinuclear antibodies by immunofluorescence (ANA by IF), antiphospholipid antibodies like lupus anticoagulant (LAC), anticardiolipin antibodies (AcL) and anti Beta2GP1 antibodies, extractable nuclear antigens (ENA) and in cases of suspected vasculitis doppler ultrasound and angiography.  Results Six patients were identified as cases primarily presenting with digital ischemia or with a prior history of digital ischemia. Two patients were of the pediatric age group, one 16-year-old male presenting with acute arthritis and a history of digital ischemia one year back, and the other was a 12-year-old female with blackening of the second toe in her left foot with a history of similar complaints in the left great toe for which she underwent amputation of that toe. Other four cases were of the adult age group, with two cases of scleroderma, one with systemic lupus erythematosus, and one with Takayasu arteritis. All of these patients primarily presented to departments other than rheumatology. Conclusion Digital ischemia is a pan-specialty problem with the etiologies spreading across a vast spectrum of rheumatological disorders, many of which may present to different specialties initially, later discovered to be part of the systemic manifestation of autoimmune diseases. Hence, it becomes imperative to have a rheumatological perspective in these cases of digital ischemia which all specialities should be aware of, and timely referral may prevent permanent loss of the digits and in some cases the entire limb.

Surviving a Rare Case: Successful Endovascular Treatment for Multiple Dural Venous Sinus Thrombosis With Dural Arteriovenous Fistula.

Vascular anomalies known as dural arteriovenous fistulas (DAVFs) occur when arteries that emerge from carotid or vertebral artery branches empty straight into the dural venous sinuses. A 16-year-old male patient at the center of this case study initially arrived at the hospital with symptoms of generalized tonic-clonic seizures and headaches accompanied by vomiting, followed by right-sided hemiparesis and subsequently left-sided hemiparesis. An MRI brain with MR angiography was performed, revealing an abnormal fistulous connection between the sigmoid and transverse sinus and the branches of the bilateral external carotid and right internal carotid artery. Embolization was performed using a mixture of glue and lipoid to address the issue.

A Case Report of Dermatofibrosarcoma Protuberans and Refractory Hypomagnesemia: Unveiling a Paraneoplastic Syndrome.

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft tissue sarcoma of the skin. DFSP typically presents as an asymptomatic, firm plaque in its earliest stage, gradually enlarging over months to years. This case report delineates a singular instance involving a 66-year-old female patient previously diagnosed with and treated for DFSP. The individual presented with a recurrent history of hospital admissions, manifesting symptoms of loose stools, generalised weakness, and diminished appetite. Investigations revealed persistent hypomagnesemia. The patient was treated with magnesium correction. Eventually, all complaints were resolved, and the patient was discharged satisfactorily. This case report aims to elucidate an exceptional correlation between DFSP and hypomagnesemia, characterised as its paraneoplastic syndrome (PNS). This study intends to comprehensively outline the clinical manifestations, diagnostic approaches, and therapeutic interventions pertaining to this distinct association.