Spinal epidural lipomatosis due to the corticosteroids; a case reportAbdollah Hadi1, Omid Masomi21. Associated professor, Department of Orthopaedics, Isfahan university of medical science, Isfahan, Iran.2. Department of Orthopaedics, Isfahan university of medical science, Isfahan, Iran.Abstract:Spinal epidural lipomatosis (SEL), an abnormal localized or tumor-like accumulation of fat in the epidural space, is an infrequent complication of chronic steroid usage and an uncommon cause of spinal cord compression. A patient with a history of rheumatologic condition on chronic corticosteroids presented with a clinical picture of thecal sac compression and was diagnosed with SEL.Background:Spinal epidural lipomatosis (SEL) is a condition in which adipose tissue accumulates excessively inside the spinal canal, causing the neural elemnt to become compressed. The incidence of symptomatic SEL is extremely rare and often associated with the use of exogenous steroids. SEL has also been associated with obesity and Cushing syndrome/disease (hypercortisolism), although they are less common. On rare occasions, epidural lipomatosis causes nerve root compression or spinal cord compression, leading to symptoms. There is a high rate of misdiagnosis of SEL because it can mimic the symptoms of spinal stenosis or degenerative joint disease. (1). The symptoms of spinal cord compression are primarily determined by the level of compression in the spinal cord. Men are more likely to experience SEL than women, with a ratio of 3:1, and the average age at presentation is 43. (2). The diagnosis of SEL can be best established with magnetic resonance imaging (MRI). The diagnostic criterion for SEL is an epidural adipose tissue thickness exceeding 7 mm (3, 4). We represent a case of spinal epidural lipomatosis due to the treatment with corticosteroids.Case:A 48-year-old man was admitted to Al-Zahra University Hospital in Isfahan, Iran with complaints of progressive weakness and numbness of the right lower limb. The weakness progressed gradually from one year before admission in an ascending fashion to involve the lower limbs. His symptoms had worsened rapidly over a period of two weeks preceding his admission to our hospital, to the extent that he had difficulty moving his right lower limb. His past medical history was a rheumatologic condition, with the history of five mg of prednisolone daily in the last eight years. Physical examination on admission revealed a well-nourished male patient who weighed 95 kg and measured 180 cm tall (body mass index, 29.3). Neurological examination of his cognitive function and cranial nerves were within normal ranges. Motor examination of the lower limbs revealed a significant weakness. Sensory examination showed hypoesthesia and impaired proprioception in right lower limb, with decreased sensation. The motor and sensory examination of the upper limbs was normal. On investigation, routine laboratory blood tests including complete blood count, liver function, and renal function analysis were within normal ranges. An MRI study of the lumbar and sacral spine was done and the radiologist reported fatty degeneration of paraspinal muscles and spinal lipomatosis in L4-L5 and L5-S1. They also reported extradural lipomatosis with compression effect on thecal sac in the same area (Figure 1&2).The patient underwent posterior laminectomy from L4 to S1 vertebral levels. A dorsally located and relatively vascular firm epidural fatty tissue was encountered, which was not infiltrating the bone or the dura; it was dissected hardly and incompletely removed due to its stickiness. Histological examination of the operative specimen demonstrated vascularized mature fibro-fatty tissue consistent with the diagnosis of lipomatosis. The patient had an uneventful postoperative period. The patient was able to walk with assistance two days after surgery and within a week, he was experiencing gradual improvement in his paraparesis and his motor function. He was discharged on the 7th postoperative day. He continued to show progressive neurological improvement with extensive outpatient physiotherapy program and finally was able to walk independently after 10 days. At 3-month follow-up, his examination revealed a complete neurological function.

Root fracture has been defined as a fracture involving dentin, cementum, pulp and periodontal ligament. A multidisciplinary approach is adopted to treat dental trauma in clinical practice. This case report described the use of 18-months VITAPEX paste dressings to induce the formation of hard tissue barriers in the multidisciplinary management of

Monkeypox (MPOX) is a zoonotic disease with roots tracing back to Western and Central Africa since its initial appearance in humans in 1970. However, the recent upsurge in MPXV outbreaks spanning over 100 nations has sparked substantial concern. In the present investigation, we examine the relative abundance (RA) and relative density (RD) of simple sequence repeats (SSRs) among the global collection of 404 MPOX genomes. Our analysis brings to light substantial shifts in the RA and RD of SSRs as they show transition across temporal spans, from ancient to contemporary lineages. The majority of SSR variations were found in Clades I, IIa, and IIb. Notably, each of the three clades exhibits distinct SSR motifs that are unique to their respective clades. Furthermore, our exploration identifies 26 conserved SSR regions exclusive to MPXV that could be used as molecular or diagnostic markers, and hold potential for vaccine development as well. Moreover, 10 variable SSR hotspot sites were discovered in nine genes with the highest variation in the MPXV genome. Notably, these nine genes have been found to be involved in surface protein synthesis and host regulation, which may have implications for monkeypox pathogenesis and evolution.

The incidence of secondary malignancies associated with busulfan exposure is considered low, but has been poorly characterized. Because this alkylating agent is increasingly utilized as conditioning prior to gene therapy in non-malignant hematologic and related disorders, more precise characterization of busulfan’s potential contribution to subsequent malignant risk is warranted. We conducted a literature-based assessment of busulfan and subsequent late effects, with emphasis on secondary malignancies, identifying publications via PubMed searches and selecting those reporting at least 3 years of follow-up. We identified 8 pediatric and 13 adult publications describing long-term follow-up in 570 pediatric and 2,076 adult hematopoietic cell transplant (HCT) recipients. Secondary malignancies were reported in 0.5% of pediatric HCT recipients, with no cases of myelodysplastic syndrome (MDS) or acute myelocytic leukemia (AML). Fatal secondary malignancies were reported in 0.8% of 1887 evaluable adult HCT recipients, and an overall incidence of secondary malignancies of 4.8% was reported in a subset of 389 evaluable adult patients. We also reviewed long-term results from 8 publications evaluating lentiviral- and human promotor-based HSC-targeted gene therapy in 215 patients with non-malignant conditions, in which busulfan/treosulfan monotherapy or busulfan/fludarabine was the only conditioning. Two malignancies were reported in patients with Sickle Cell Disease (SCD), one of which was potentially busulfan-related. No additional malignancies were reported in 173 patients with follow-up of 5-12 years. The incidence of busulfan-related secondary malignancies is low, and likely to be substantially less than 1% in pediatric transplant recipients, especially those receiving busulfan monotherapy for non-malignant conditions other than SCD.

Maternal provisioning and the developmental environment are fundamental determinants of offspring traits, particularly in oviparous species. However, the extent to which embryonic responses to these factors differ across populations to drive phenotypic variation is not well understood. Here, we examine the contributions of maternal provisioning and incubation temperature to variation in hatchling morphological and metabolic traits across four populations of the American alligator (Alligator mississippiensis), encompassing a large portion of the species’ latitudinal range. Our results show that whereas the influence of egg mass is generally consistent across populations, responses to incubation temperature show extensive population-level variation in several fitness-related traits, including mass, head length, head width and residual yolk mass. Additionally, the influence of incubation temperature on developmental rate is greater at northern populations, while the allocation of maternal resources towards fat body mass is greater at southern populations. Overall, our results suggest that responses to incubation temperature, relative to maternal provisioning, are a larger source of interpopulation phenotypic variation and may contribute to the local adaptation of populations.

Winter, the most challenging season for animals, is usually accompanied by extremely cold temperatures and limited food resources. Harsh winter conditions force birds to develop behavioral and physiological adaptations to reduce mortality. Birds might select for sexual segregation to reduce conflict between different social hierarchies at the population level. They can also adjust their body conditioning via fat reserve to balance the trade-off between starvation and predation at the individual level. Using mist-netting surveys and bird banding, we traced 61 orange-flanked bush-robin (Tarsiger cyanurus), an abundant and easily-observed long-distance migratory bird exhibiting delayed plumage maturation, to better understand the winter adaptation of these songbirds. We found that the number of 2yr+ adult males with bright-blue plumage was significantly lower than the number of males with olive-brown plumage. However, the sex-ratio was only slightly skewed to males with olive-brown plumage, suggesting that habitat-type influences sexual segregation. This robin tends to become heavier and store more fat over the course of winter, as they can fine-tune their fat reserve in response to changes in weather (including temperature, humidity, and snowfall) and food abundance. Interestingly, capturing the birds may also have a significant positive effect on their fat reserve. Overall, these results improved our understanding of the flexibility in adaptation of small passerine birds wintering in a subtropical forest and provided vision for considering the inevitable influence by ornithology field methods.

Title: An unusual adverse effect during crusted scabies treatment

Infected charcot spineHiromu Yoshizato (MD)Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan5-1-1 Nabeshima, Saga, 849-8501, [email protected] Morimoto (MD, PHD)Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan5-1-1 Nabeshima, Saga, 849-8501, [email protected] Nonaka (MD)Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan5-1-1 Nabeshima, Saga, 849-8501, [email protected] Hirata (MD, PHD)Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan5-1-1 Nabeshima, Saga, 849-8501, [email protected] Author’s InformationTadatsugu [email protected] relating to ethics and integrity policiesWe declare that we follow the ethical policies of the journal, including patient consent, disclosure of funding information, and data availability.Manuscript Type: Case ImagesKey words: Pain-Free, Low Back Pain, Spondylitis, Diagnosis, Differential, StphilisIntroduction.Low back pain is an often encountered complaint among clinical physicians. Although it can be caused by various conditions, there may be diseases that, if overlooked, could lead to serious consequences. Examples include aortic aneurysm, pyogenic spondylitis, metastatic spinal tumors, etc. Charcot spine, which occurs as a result of syphilis or spinal cord injury, exhibits severe deformity despite mild lower back pain. Infected Charcot spine (ICS), even if accompanied by fever, may not present lower back pain or only exhibit mild symptoms. As a result, the diagnosis may not be accurately made until the vertebral destruction progress severely and neurological paralysis emerges.CaseA 44-year-old man was admitted with complaints of weakness in the lower extremities. He had no low back pain and walked unaided. Although he had no history of diabetes or spinal trauma, he had positive syphilis was serology. A physical examination revealed right tibialis anterior muscle weakness, decreased pain sensation in the lateral thigh, decreased vibration sensation in both medial calves, and bladder dysfunction. There was no heat or redness in the lumbar region. Blood tests showed C-reactive protein (CRP) 30 mg/µL. X-rays showed severe destruction of the L4 vertebra (figure1, arrow) and angulated kyphosis, and magnetic resonance imaging revealed fluid retention in the destroyed L4 vertebra (figure2, arrow). The severe spinal destruction without back pain was diagnosed as an infected Charcot spine (ICS) , and an anterior-posterior lumbar fusion was performed.DiscussionTabes dorsalis occurs 20 to 30 years after the initial infection of syphilis, causing progressive degeneration of the posterior columns and posterior nerve roots. As a result, proprioception and vibratory sensation are lost, contributing to the development of Charcot spine and Charcot joints. In this case, the patient had no low back pain, despite a paralyzing severe spinal deformity. The reason for facing difficulty in diagnosing such a condition lies in the pathophysiology of ICS, which results in few complaints of back pain due to diminished sensation, and the rapid progression of vertebral destruction due to concurrent infection. Due to the paucity of symptoms, comprehensive examination by a physician may not be performed, resulting in a delayed diagnosis until there is evidence of progressive vertebral destruction or the onset of nerve palsy. What points should be noted when diagnosing ICS? First, it is crucial to understand the symptoms of Charcot spine. Churruca et al. reported that 92% of Charcot spine cases exhibit any symptoms. Specifically, these include increased spasticity, reflex disorders, autonomic nervous system symptoms, and pain (2). Second, having knowledge of differential diagnosis is essential. Differential diagnoses should include pyogenic vertebrates, osteomyelitis, Paget’s disease of bone, and destructive tumors. While ICS is rare, it should be included in the differential diagnoses for febrile patients with a history of syphilis or spinal cord injury. Early diagnosis allows prompt initiation of suitable treatments, preventing severe spinal damage and nerve paralysis.Author ContributionHiromu Yoshizato : Writing-original draft. Tadatsugu Morimoto : Writing- review and editing.Toshihiro Nonaka : Writing-original draft. Hirohito Hirata : Writing – review and editing.Funding InformationThe authors have no current financial arrangement or affiliation with any organization that could directly influence their work.Conflict of Interest StatementWe do not have any conflict of interest.Data Availability statementAdditional data related to this patient case, beyond what is presented in this publication, isnot publicly available to maintain patient consent, confidentiality, and anonymity.ConsentThe patient provided written informed consent to publish this report in compliance with thejournal’s patient consent policy.ORCIDHiromu Yoshizatohttps://orcid.org/0009-0004-7933-3744Refferenceskarthik Yelamarthy P krishna, Rustagi T, Mahajan R, Singh V, Das K, Bansal ML, et al. Infected charcot spine arthropathy. Spinal Cord Ser Cases. 2018;4:73.Arco Churruca AD, Vázquez Bravo JC, Álvarez SG, Donat SM, Llona MJ. Charcot arthropathy in the spine. Experience in our centre. About 13 cases. Review of the literature. Rev Esp Cir Ortop Traumatol. 2021 S1888-4415(21)00014-X.Suda Y, Saito M, Shioda M, Kato H, Shibasaki K. Infected Charcot spine. Spinal Cord. 2005;43:256–259.

Objective: To integrate the qualitative research on self-management experience of breast cancer patients, and conduct a systematic review on their self-management experience. Methods: Using a computer to search a series of databases such as CNKI, Wanfang, VIP, and China Biomedical Database, systematically collect and integrate qualitative research on the self-management experience of breast cancer patients, and the search time is limited to 2010 January to December 2022. The qualitative research quality evaluation standard of the Joanna Briggs Institute (JBI) Center for Evidence-Based Health Care in Australia was used as the evaluation standard of this project to complete the accurate evaluation of the literature; Meta-analysis was used to complete the effective integration of the results. Results: A total of 17 literatures were included in this project, and 37 research results with strong integrity were extracted accordingly. On this basis, 7 different categories were summarized, and 3 integrated results were obtained, which were experience of maintaining self-management, symptom recognition, and self-management. Conclusion: In the different stages of self-management of breast cancer patients, medical staff should give targeted guidance to help patients obtain good prognosis. Patient or Public Contribution： Patients, service users, care-givers, people with lived experience or members of the public were involved at several stages of the trial, including the design, management and conduct of the trial, but all the information was collected from public database. The statement is not applicable.

Background: Surgical resection remains the primary treatment option for gallbladder carcinoma (GBC). However, there is a pressing demand for prognostic tools that can refine patients’ treatment choices and tailor personalized therapies accordingly. Methods: The nomograms were constructed using the data of a training cohort (n=378) of GBC patients at Eastern Hepatobiliary Surgery Hospital (EHBH) between 2008 and 2018. The model’s performance was validated in GBC patients (n=108) at Guangzhou Centre from 2007 to 2018. Results: The 5-year overall survival (OS) rate in the training cohort was 24.4%. Multivariate analyses were performed using preoperative and postoperative data to identify independent predictors of OS. These predictors were then incorporated into preoperative and postoperative nomograms, respectively. The C-index of the preoperative nomogram was 0.661 (95% CI, 0.627 to 0.694) for OS prediction and correctly delineated four subgroups (5-year OS rates: 48.1%, 19.0%, 15.6%, and 8.1%, p<0.001). The C-index of the postoperative nomogram was 0.778 (95%CI, 0.756–0.800). Furthermore, this nomogram was superior to the 8th TNM system in both C-index and the net benefit on decision curve analysis. The results were externally validated. Conclusions: The two nomograms showed an optimally prognostic prediction in GBC patients after curative-intent resection.

Transference-focused psychotherapy (TFP) is an evidence-based, psychodynamic psychotherapy empirically validated for patients with borderline personality disorder (BPD) and successfully adapted for the treatment of narcissistic personality disorder (NPD). Personality disorders are characterized by the behavioral and affective dysregulation associated with pathological identity formation. Based on contemporary object relations theory (ORT), the goal of TFP is symptom relief through improvement in self and interpersonal functioning. The TFP treatment frame, established through an initial contracting phase and combined with the therapist’s technical neutrality, facilitates activation, identification and containment of affectively charged perceptions of self and other. These perceptions, or object relations dyads, are repeatedly identified, labeled and explored through the interpretative process. Over the course of treatment, the patient’s capacity for affect containment and reflection improves and a better integrated, realistic sense of self develops consistent with healthier personality functioning. Utilizing a compilation of several patients, the treatment of NPD with TPF is described and the evidence for the efficacy of TFP for NPD is summarized.

Erythema elevatum diutinum: A rare dermatosis

Misplacement of a left internal jugular vein puncture into the subclavian vein in a patient with ECMO: a case reportWeiqiang Huang1,Chuchu Yuan2,Baoyi Huang3,Xiaofeng Zhong1,Yadong Yang4,Xudong Liu1,Ming Hu1（Weiqiang Huang and Chuchu Yuan should be considered joint first author）Department of Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, Hubei, ChinaDepartment of Tuberculosis Ward III, Wuhan Pulmonary Hospital, Wuhan, Hubei, ChinaDepartment of Anesthesiology, Yuebei People’s Hospital, Shaoguan, Guangdong, ChinaDepartment of Critical Care Medicine, Huanggang Central Hospital of Yangtze University,Huanggang, Hubei, ChinaCorrespondenceMing Hu, Department of Critical Care Medicine, Wuhan Pulmonary Hospital, No.28, Baofeng Road, Qiaokou District,Wuhan, Hubei, China. Email: [email protected]

In the study, the achene macro and micro morphological characters of the genus Artemisia distributed in Turkey have been researched with the target to know systematically important carpological structures for the examined species. Color, shape and dimension of achene have macro-morphologically shown variations. The examined achenes are separated into 4 shapes; fusiform-oblong, oblong, oblong-ovate and ovate. Oblong-ovate is the most common type. However, oblong is typical form for A. abrotanum. Achene dimensions range from 0.62 mm to 2.48 mm in length, from 0.30 mm to 1.21 mm in width. As A. santonicum subsp. patens is of the largest achenes , A. annua and A. verloitorum have the smallest achenes. Also, carpopodium diameter vary between 0.10 mm and 0.19 mm. The largest carpopodium diameter is found in taxa A. fragrans and A. taurica var. vanensis , while the narrowest one is A. alpina species. Achene surfaces of the examined taxa are micro-morphologically assessed, and the substantial differences are noticeably detected on behalf of the surface structures for instance, surface ornamentation, anticlinal and periclinal cell walls, epidermal cells and presence of secondary structures of the achenes. Surface ornamentation is separated into 10 types: irregularly sulcate, regularly sulcate, ruminate, sulcate-scalariform, rugose, favulariate, slightly sulcate, alveolate, tuberculate and reticulate. The most common types are irregularly sulcate (in 7 taxa) and regularly sulcate (in 7 taxa), while ruminate (in A. abrotanum), rugose (in A. chamaemelifolia), favulariate (in A. arborescens), alveolate (in A. santonicum subsp. patens), tuberculate (in A. taurica var. vanensis) and reticulate (in A. bashkalensis) ornamentation types are found as taxon-specific. A percentage comparison of the elements in the achene pericarp of the studied taxa have performed with SEM-EDS. Accordingly, pericarps in taxa include C, Ca, K, Mg, Cl, Si, Na and S elements. The most common seen element is C, which ranges from 77.4 (in A. austriaca) to 96.2 (in A. absinthium). Na element is observed only in A. santonicum subspecies and A. arborescens species. On the other hand, S element is found in low amounts only in A. alpina species. In the taxonomy of the genus Artemisia, the achene morphological characters are very significant characteristics that disclose inter-specific relations among the examined taxa. Moreover, a dichotomous key is offered for the identification of the studied taxa based on achene characters.

We designed and constructed a green, sustainable, and nongenetically modified organism (non-GMO) bioprocess to efficiently coproduce D-tagatose, bioethanol, and microbial protein from whey powder. First, a one-pot biosynthesis process involving lactose hydrolysis and D-galactose redox reactions for D-tagatose production was established in vitro via a three-enzyme cascade. Second, a nicotinamide adenine dinucleotide phosphate-dependent galactitol dehydrogenase mutant, D36A/I37R, based on the nicotinamide adenine dinucleotide-dependent polyol dehydrogenase from Paracoccus denitrificans was created through rational design and screening. Moreover, an NADPH recycling module was created in the oxidoreductive pathway, and the tagatose yield increased by 3.35-fold compared with that achieved through the pathway without the cofactor cycle. The reaction process was accelerated using an enzyme assembly with a glycine–serine linker, and the tagatose production rate was 9.28-fold higher than the initial yield. Finally, Saccharomyces cerevisiae was introduced into the reaction solution, and 266.5 g of D-tagatose, 371.3 g of bioethanol, and 215.4 g of dry yeast (including 38% protein) were obtained from 1 kg of whey powder (including 810 g lactose). This study provides a promising non-GMO process for functional food (D-tagatose) production. Moreover, this process fully utilized whey powder, demonstrating good atom economy.

Background, There were about 1,090,000 gastric cancer cases in 2020 in China. The incidence and mortality rates ranked the fifth and third among all kinds of cancers in China. Early diagnosis plays an important role in the treatment and prognosis of gastric cancer.plasma exosome lncRNAs, has become a promissing biomarkers with high specificity and sensitivity for early diagnosis of cancers. In this study, the exosomes in the plasma of patients with early gastric cancer were isolated by a commercial kit. After identified by electron microscopy observation, particle size analysis and Western-blot verification, the lncRNAs in the exosomes were extracted. The lncRNAs differentially expressed in the plasma exosomes of patients with gastric cancer were analysized by high-throughput RNA sequencing. The differentially expressed lncRNAs were verified by RT-qPCR in 93 patients with early gastric cancer and 49 normal controls. Electron microscopy, particle size analysis and Western blot showed that exosomes were successfully isolated from plasma. RNA-Seq results show that 76 lncRNAs were up-regulated and 260 lncRNAs were down regulated in plasma exosomes of early gastric cancer patients compared with normal controls. RT-qPCR analysis indicated that a total of 6 lncRNAs were significantly and differentially expressed in gastric cancer patients compared to normal controls, with 2 highly expressed and 4 lowly expressed (p < 0.05). The survival curve analysis indicated that lncmstrg.2441832.8 and lncmstrg.2312697 had higher sensitivity and specificity for the diagnosis of gastric cancer, respectively and AUC curve areas were 0.6211 and 0.631, p < 0.05, respectively, which were greater than the traditional clinical detection indexes CEA (0.61) and AFP (0.57). When combined lncmstrg.2441832.8 and lncmstrg.2312697 in gastric cancer diagnosis, AUC curve area reached 0.73, which was greater than CA199 (0.71). Conclusion, lncmstrg.2441832.8 and lncmstrg.2312697 may be a potential and promissing biomarkers for early diagnosis of gastric cance

Background: Laparoscopic liver resection (LLR) has not been widely accepted for recurrent liver cancer (RLC). This study aims to conduct a systematic review of the current literature for determining LLR effectiveness and safety for patients with RLC. Methods: Before April 2022, a comprehensive literature search was undertaken in Web of Science, PubMed, and Embase relied on a specified search strategy for eligible propensity score matching (PSM) studies comparing LLR or OLR. Meta-analysis of operative times, duration of stay, mortality, blood loss, overall survival rate, blood transfusion, recurrence-free survival rate, and overall complications was undertaken using a random/fixed-effects model. Results: Eight PSM studies of LLR versus OLR were incorporated, including 1128 patients. The current meta-analysis revealed nonsignificant variations between the two groups in overall survival rate, operation time, blood transfusion, mortality, overall complications, and long-term recurrence-free survival rate. Alternatively, when LLR is compared to OLR, LLR results in lower blood loss (p=0.002) and a shorter hospitalization (p=0.04). Conclusion: Although both techniques appear equal, LLR seems to have certain advantages over OLR. Notably, the evidence quality is generally confined to cohort studies, necessitating the performance of a high-quality randomized trial that compares both approaches. Keywords: Laparoscopic surgery, Liver resection, Recurrent liver cancer, Propensity score matching, Meta-analysis.

The application of metabolomics for studying modifications in host metabolism due to viral infections has proven to be a game-changing approach. Prior to our study, only one other ‘omics’ study has been carried out that investigates the interplay between the host and CCHFV and its subsequent pathogenesis. We employed NMR spectroscopy, given its advantages in terms of reproducibility, minimal sample preparation, and capability to analyze complex biofluids. Our methodology builds upon the proven success of metabolomics in the research of other viral hemorrhagic fevers such as Ebola, Marburg, and Dengue. Our research underlines the critical role of SAH, a metabolite involved in numerous biochemical reactions. We provide new insights into the metabolic alterations occurring in CCHF patients. These alterations not only shed light on the disease’s pathogenesis but also pave the way for potential biomarkers and therapeutic targets. Among all the metabolites detected, S-Adenosyl-L-homocysteine and Carnosine stood out as the most prevalent, warranting further exploration of their roles in CCHFV pathogenesis and their potential as therapeutic targets.