Response to Accidental vs. Abusive Head Trauma in Infancy: Is Revival Shaking the Missing Link?We appreciate the opportunity to respond to the concerns raised regarding our recent case report 26 cm fall caught on video causing subdural hemorrhages and extensive retinal hemorrhages in an 8-month-old infant 11Brook C, Squier W, Mack J. 26 cm fall caught on video causing subdural hemorrhages and extensive retinal hemorrhages in an 8-month-old infant. Clin Case Rep. 2024 Jun 25;12(7):e9105.We agree with the author of the Letter that aging of retinal hemorrhages is not precise, which is why we did not use language that portrayed certainty regarding this issue. Instead, we stated that the evidence “indicates” the RHs occurred “around the time” of the fall and it is “reasonable to attribute” them to the incident. We did not mean to imply that the findings regarding the RHs can definitively attribute the RHs to the fall. However, we point out that there is no evidence of any other event prior to the infant becoming symptomatic that would plausibly explain the findings of retinal hemorrhage.The author of the Letter then asserts that “acuteness of RH onset would have been better supported by disappearance of most of them after 1 week, rather than the observed persistence.” We are not sure why the author makes this assertion. The longer the RH persisted, the more likely it is that they were acute at the time they were first found.The issue of whether the retinal folds are “typical of acute traumatic retinoschisis” is also raised. Is the author suggesting that there is a non traumatic cause of the retinal fold in this case? We do not believe there is sufficient evidence to accurately determine cause by reference to the “type” of retinal fold, and found no such evidence in the articles cited.The Letter then raises concerns about the period immediately following the recorded incident, noting that “the video ends abruptly”, and raises the possibility of revival shaking. We clarify that after the fall, a worker at the creche picked up and comforted the infant, and this was captured on video. The baby was not subjected to revival shaking. We also clarify that the mother arrived between 15 and 30 minutes after the fall, at which time the infant was lethargic and lacked focus in the eyes, presumably signs of concussion.The Letter suggests that video evidence should follow the infant from the time of the accident to the time of passing the infant to medical care. We wonder if the author applies the same evidentiary requirements for establishing that shaking can cause the findings commonly associated with abusive head trauma. We are not aware of any videotaped shaking event that has resulted in such findings (either violent or in revival attempts). Nor are we are of any independently witnessed shaking event that has led to such clinical findings in a healthy infant. If the evidentiary requirement for these cases was an extended videotape until delivered to medical care, then no case or case series would have ever been published in the field.The author of the Letter also discusses the historical narratives of shaking done by caregivers in order to revive or resuscitate the infant. We agree that such narratives are common, and are often dismissed or wrongfully intrerpreted as being confessions. However, with respect to shaking in revival attempts, we do not know how cerebral or ocular findings could be attributed to the act of revival shaking rather than to whatever caused the collapse in the first place.Finally, the author of the Letter questions whether our study helps clarify the pathogenesis of ocular or cerebral hemorrhage. Our case study should not be read in isolation, but as adding to the growing list of cases compiled over the past decades that, taken as a whole, provide strong evidence that short falls can result in both cerebral and extensive ocular hemorrhages.Chris BrookWaney SquierJulie Mack

Title PageManuscript type Case Report

Title PageManuscript type Case Report

RMND1 and PLN variants are the underlying cause of Perrault-like syndrome and cardiac anomalies in a patientXiaoli Du1, Cara L. Barnett1, Kimberly M. Widmeyer1, Xinjian Wang1, Diana S. Brightman1, Carolee W. Noonan1, Kathryn N. Weaver2,*, Robert J. Hopkin2,*, Yaning Wu2,*1 Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USADivision of Human Genetics, Cincinnati Children’s Hospital Medical Center, and Department ofPediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA*co-corresponding author

LETTER TO THE EDITOR

INTRODUCTIONThe maxillary first molar is one of the most commonly treated teeth in endodontic due to its complex anatomy, which has intrigued clinicians for a long time. The primary goal of endodontic therapy is the accurate identification, thorough cleaning and shaping, and three-dimensional obturation of the entire root canal system.(1) Failure to detect additional roots or canals can lead to endodontic treatment failure.(2)Typically, maxillary molars are described as having three roots and three canals, with one canal in each root. However, studies have shown considerable variation in the number and configuration of root canals in these teeth. The occurrence of a third canal in the mesiobuccal root (MB3) of the maxillary first molar is rare, with a reported incidence ranging from 1.1% to 1.6%.(3,4) Similarly, the presence of a second canal in the distobuccal root (DB2) has been reported in 1.7% of cases.(5)This clinical report presents a rare case of a maxillary first molar with six root canals. Successful identification and treatment of all root canals in this patient were confirmed through the use of 20-degree horizontally angulated radiographs, aided by magnification with loupes.

Short Root Anomaly. A rare case of distortion in dental anatomy

Correction to [Anti-PL-12 anti-synthetase syndrome manifesting with multiple digital ischemia: Case report & review of the literature ][Doumeth SA, Petrinec E,Chaudhary H, Mattar M. Anti-PL-12 anti-synthetasesyndrome manifesting with multiple digitalischemia: Case report & review of the literature. ClinCase Rep. 2024;12:e9408. doi:10.1002/ccr3.9408]In the published article,”Anti-PL-12 anti-synthetasesyndrome manifesting with multiple digitalischemia: Case report & review of the literature”, the corresponding author’s name was formatted incorrectly. It should read as Abi Doumeth S.We apologize for this error.

Simplifying implant planning and placement in the fully edentulous arch with in-office guide fabricationSean W. Meitner, DDS1, Charles M. Oster, DDS2 and Gregori M. Kurtzman, DDS3Clinical Professor  – University of Rochester, Eastman Dental Center, Department of Dentistry, Rochester, NY and private practice Periodontics, Pittsford, NY.Clinical Associate Professor  – University of Rochester, Eastman Dental Center, Department of Dentistry, Rochester, NY.Private practice, Silver Spring, MD.

Title: Streptococcus pneumoniae Parotitis in a Patient with Poor Oral HygieneAuthor/corresponding author and Affiliation: Dr Mohammad Salhab, Centre for Bone Disease and Surgery (CBDS), Beirut, Lebanon. Email: [email protected]: We report a case of a 23-year-old female university student with poor oral hygiene who presented with recurrent right parotid gland swelling and pain. Despite multiple courses of antibiotics, the patient experienced persistent symptoms. Methodology: Magnetic resonance sialography revealed two intraductal stones in the right parotid gland. Purulent discharge from the parotid duct grew Streptococcus pneumoniae . Results: The patient was successfully treated with levofloxacin, parotid massage, and hydration. She was also advised to receive pneumococcal vaccination and reported no side effects after the first dose. Conclusion: This case highlights the importance of considering S. pneumoniae as a potential cause of parotitis in patients with poor oral hygiene, the role of imaging, microbiology, and targeted therapy in managing recurrent parotitis, and the potential benefits of pneumococcal vaccination in preventing future infections.KeywordsStreptococcus pneumoniae; parotitis; pain; vaccination; magnatic saliogram.Key Clinical Message: Streptococcus pneumoniae should be considered as a potential cause of recurrent parotitis, especially in patients with poor oral hygiene. Comprehensive management includes targeted antibiotic therapy based on culture results, addressing underlying factors like sialolithiasis, and considering pneumococcal vaccination to prevent future infections. This case highlights the importance of thorough diagnostic workup and multidisciplinary approach in managing challenging parotitis cases.Introduction: Acute bacterial parotitis is an uncommon condition, usually caused by Staphylococcus aureus or oral anaerobes (McQuone 1999). Streptococcus pneumoniae is a rare cause of parotitis, primarily seen in immunocompromised individuals (Yii, Tan, and Fong 2016). Risk factors for parotitis include poor oral hygiene, dehydration, and ductal obstruction (Brook 1992). The management of acute parotitis that can develop to acute on chronic suppurative condition can be challenging and also impactful on patient’s quality of life (Patel, Scott, and Cunningham 2017). We present a case of recurrent S. pneumoniae parotitis in a young female with poor oral hygiene and subacute sialolithiasis and discuss the role of pneumococcal vaccination in preventing future infections.Case History and Examination: A 23-year-old female university student presented to the ENT clinic with a 10-day history of right parotid gland swelling that became painful over the last 48 hours. She had no previous episodes but reported a few episodes of colds and sore throat during the past year. The patient was a smoker with poor oral hygiene, including several dental caries, and did not regularly brush her teeth. She was also anaemic and vitamin D insufficient. She had no significant medical or surgical history and no family history of parotitis or cancer. She had a compete up to date record of vaccinations including mumps, measles, and rubella.Method: On examination, she had right parotid gland swelling and enlargement of submental, submandibular, and neck lymph nodes. Oral examination revealed poor oral hygiene and dry mucosa without halitosis. Bimanual palpation of the parotid gland showed a mobile soft, painful swelling.Results: Investigations including FBC, CRP, ESR, electrolytes, vitamin D, LFTs, TFTs, calcium, lipid profile, and urinalysis were unremarkable except for vitamin D insufficiency. The patient was treated with amoxicillin for one week and vitamin D3 supplementation and discharged.Two weeks later, the patient returned with recurrent right parotid swelling. Symptoms had initially improved with antibiotics but recurred two days after completing the course. A ”wait and watch” approach was adopted, but the patient reported fluctuating swelling and pain. She was given another course of amoxicillin-clavulanate and discharged.One month later, the patient presented again with painful parotid swelling. An MRI sialogram demonstrated a relatively enlarged and hyperintense right parotid gland measuring 59x42x29mm, without nodules or ductal dilation-see fig 1a. Contrast injection revealed two intraductal stones- see fig 1b. Interestingly, blood works, inflammatory markers and cultures were negative. The patient was advised to maintain hydration and discharged.

Expanded-Access Use of Elamipretide Improves Quality of Life in Patients with Rare Mitochondrial Disorders Characterized by Ophthalmic Symptoms: A Case SeriesSharique Ansari1, Mary Kay Koenig21. Kane Hall Barry Neurology, 1305 Airport Freeway, Bedford, TX, USA2. University of Texas McGovern Medical School, Department of Pediatrics, Division of Child & Adolescent Neurology, Center for the Treatment of Pediatric Neurodegenerative Disease, Houston, TX, USACorresponding Author : Mary Kay Koenig, MD, [email protected]: Sharique Ansari, [email protected]: The authors wish to thank the patients and their families for participating, as well as Jamie Dermatis, DPM, and Jim Shiffer, RPh, Write On Time Medical Communications, LLC, for their writing and editorial assistance during the development of this manuscript. Mary Kay Koenig wishes to thank her research nurse, Lindsey Miller, for providing patient support and assisting with administration and education responsibilities.Conflict of Interest Statement: The authors have no conflicts of interest to declare.Data Availability: The data that support the findings of this case report are not publicly available due to the data containing information that could compromise the privacy of the patient, but may be available from the corresponding author upon reasonable request.Ethics Approval Statement: FDA and local IRB review and approval were obtained prior to initiating therapy with elamipretide subcutaneously daily under this EAP.Patient Consent Statement: Written informed consent was obtained from the patients to be included in this study.Funding: Stealth BioTherapeutics provided support in supplying elamipretide for the patients and publishing this case series. The authors confirm independence from the sponsor. The content of the article has not been influenced by the sponsor.Keywords: Elamipretide, Mitochondrial Disease, Cardiolipin, NARP syndrome, CPEOKey Clinical Message: This case series presents the use of elamipretide in two patients with different progressive mitochondrial disorders (chronic progressive external ophthalmoplegia [CPEO] plus and neuropathy, ataxia, and retinitis pigmentosa [NARP] syndrome) characterized by ophthalmic traits. Elamipretide was well tolerated and both patients demonstrated improvement in symptoms while on therapy.

Navigating the Needles: Unveiling the Risks of Acupuncture, A Case ReportHarkesh Arora1, Dhiran Sivasubramanian2, Sinduja Sivakumar 3, Sivaguha Yadunath4, Sreekanth Avula5(corresponding author)1Lovelace Medical Center, 601 Dr. Martin Luther King Jr Ave NE, Albuquerque, NM USA 871022Christian Medical College and Hospital Vellore3Burrell College of Osteopathic Medicine4Mercy Catholic Medical Center - Mercy Fitzgerald Campus5University of Minnesota, Twin Cities, PWB, 516 Delaware St SE 6-207, Minneapolis, MN, USA 55455; [email protected]

Presenting with dysphagia and dyspnea, Rapidly worsening lung adenocarcinoma due to Diffusely spreading Lymphangitic carcinomatosis: A case reportSatoshi Tanaka, Ryo Matsubayashi, Shunichi Tamori,Katsuhiko Saito, Satoshi Nomura・Author affiliationsSatoshi Tanaka;Toyama City Hospital, Respiratory medicine.Kanazawa University Hospital, Respiratory [email protected], Investigation, and Writing – original draft.Ryo Matsubayashi;Toyama City Hospital, Respiratory medicine.Kanazawa University Hospital, Respiratory [email protected] – review & editing.Shunichi TamoriToyama City Hospital, Respiratory [email protected] – review & editing.Katsuhiko SaitoToyama City Hospital, [email protected] – review & editing.Satoshi NomuraToyama City Hospital, Respiratory [email protected] – review & editing.・Data availability statement; No datasets were generated or analyzed during this case report.・Funding statement; The authors received no specific funding for this work.・Conflict of interest disclosure; The authors declare no conflicts of interest in association with the present study.・Ethics approval statement; None・Patient consent statement; Written informed consent was obtained from the patient’s family.・Permission to reproduce material from other sources; No material from other sources was used for this work.・Clinical trial registration; NoneKey Clinical MessageLymphangitic carcinomatosis is a metastatic disease with a poor prognosis and poorly understood pathophysiology. We present a case of rapidly worsening lung adenocarcinoma with diffusely spreading cancerous lymphangitis in lung, mediastinum, retroperitoneum, and gastrointestinal tract. Our findings suggest cancer dissemination in this patient was predominantly caused by direct lymphatic invasion.Key words; Non-small-cell lung carcinoma, Lymphangitic carcinomatosisCase PresentationA 60-year-old man presented with progressive dysphagia and dyspnea for four days. He had an 80-pack-year smoking history. Chest radiography revealed a tumor in the right upper lung field and bilateral reticulations (Figure 1A). Computed tomography (CT) revealed a tumor in the right upper lobe with bilateral bronchovascular bundle thickening and esophageal wall thickening (Figure 1B). Magnetic resonance imaging (MRI) showed multiple brain tumors. Fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) demonstrated FDG uptake in these lesions, as well as in the left adrenal gland, and thoracic and abdominal lymph nodes (Figure 1C). Esophagogastroduodenoscopy (EGD) revealed esophageal stenosis with a relatively smooth epithelium (Figure 2A) and a duodenal ulcer (Figure 2B-left). Upon biopsy, only the duodenum yielded thyroid transcription factor-1 (TTF-1) positive adenocarcinoma cells in the lamina propria mucosae (Figure 2B-right). Endobronchial ultrasound-guided transbronchial biopsy with a guide sheath (EBUS-GS-TBB) of the right upper lobe tumor revealed TTF-1 positive poorly differentiated adenocarcinoma (Figure 2C), which was strongly positive for programmed death-ligand 1 (PD-L1). However, no driver gene abnormality was detected on the OncomineTM Dx Target Test (Thermo Fisher Scientific, Waltham, MA, USA). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the esophagus revealed adenocarcinoma cells (Figure 2D). Based on these findings, the patient was diagnosed with right upper lobe lung adenocarcinoma, cT4N3M1c, cStage IVB (BRA, LYM, ADR, OTH; esophagus and duodenum) (UICC-9th edition) with pulmonary lymphangitic carcinomatosis.Treatments included corticosteroid administration, stereotactic brain irradiation, and percutaneous endoscopic gastrostomy. While the respiratory symptoms temporarily improved, then eventually worsened. Forty days after the first visit, the patient died due to respiratory failure.A pathological autopsy was performed. The right upper lobe tumor consisted of poorly differentiated adenocarcinoma (Figure 3A, upper right). The lymphatic vessels throughout the lungs were enlarged and filled with adenocarcinoma cells, and the stroma surrounding these vessels also contained tumor cells (Figure 3A, lower right). In the esophagus, duodenum, and jejunum, carcinomatous cells were found in all layers, including the lymphatic vessels, while the wall structure was preserved (Figure 3B, C). Apart from the lung and upper gastrointestinal tract, adenocarcinoma was diffusely present in the stroma around the thyroid follicles (Figure 3D), cervical tissue, lymph nodes, pericardium, myocardium (Figure 3E), and adrenal glands (Figure 3F).DiscussionLymphangitic carcinomatosis is a form of metastatic disease characterized by the diffuse spread of malignant tumors through the lymphatic system, which is associated with poor prognosis.1 The pathophysiology is not well understood; however, direct invasion, lymphatic circulation, and hematogenous spread are considered to be possible pathways.2 In this case, adenocarcinoma was detected in the lung, thyroid, pericardium, myocardium, esophagus, duodenum, jejunum, adrenal glands, and brain. Except for the brain, the other cancerous sites were anatomically contiguous. The presence of tumor cells in the lymphatic vessels and stromal tissues suggested that the predominant routes of cancer dissemination in this patient was direct lymphatic invasion. This case is novel as it demonstrates pulmonary lymphangitic carcinomatosis alongside extensive mediastinal, retroperitoneal, and upper gastrointestinal tract invasion, a presentation not commonly associated with lung cancer.AcknowledgementsWe thank Editage (www.editage.com) for the English language editing.References1. Klimek M. Pulmonary lymphangitis carcinomatosis: Systematic review and meta-analysis of case reports, 1970-2018. Postgrad Med . 2019;131(5):309-318. doi: 10.1080/00325481.2019.1595982.2. Al-Bayati M, Al-Jobory O, Abu-Hassan F, Mohammed BU, Yaqoob S, Bazzaz O. Pulmonary lymphangitic carcinomatosis: An atypical presentation leading to discovery of multi-organ metastasis with unknown occult primary malignancy. Cureus . 2022;14(8):e27705. doi: 10.7759/cureus.27705

Grade III of blunt thoracic aortic injury and duodenal perforation due to multiple trauma; which is priority\RL? A case reportKey clinical message: Perforation of the duodenum after trauma has a low incidence and its coincidence with BTAI is very rare. The clinical condition of the patient is very important for deciding the treatment priority. In this patient, considering the stable condition and degree of aorta injury, we chose TEVAR before laparotomy.

Xanthogranulomatous Epithelial Tumor: A Case Report with One-Year Follow-UpMuna AbuHejleh1, Ahmed Mounir ElSayed2, Renan Elsadeg Ibrahem3, Asmaa Elhassan Mohamed4, Adham Ammar11Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar; [email protected], [email protected] of Orthopedics Surgery, Hamad Medical Corporation Doha Qatar; [email protected] of Clinical Imaging, Hamad Medical Corporation, Doha Qatar; [email protected] Hematology Department, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar; [email protected]

Brief report:

A document by fatemeh mohaghegh. Click on the document to view its contents.

IntroductionAngiomyofibroblastoma (AMFB) is a relatively recently described tumor in the expanding spectrum of benign mesenchymal tumors that predominantly arise in the lower genitalia of women. AMFB was first illustrated by Fletcher et al.1 as a benign soft tissue tumor of the vulvar region which should be distinguished from aggressive angiomyxoma in a series published in 1992. AMFB also occurs in men and can arise in the inguen, scrotum, spermatic cord, and bladder2. Only 23 cases of male AMF were reported in the English-language literature based on a review of PubMed data since 19923,4. In this article, we report a case of AMFB in a middle-aged male that arose in the para-vesical region. Salient histopathology, IHC, and genetic features contribute to the diagnosis of AFMB and surgical excision is curative. Our work has been documented according to the CARE guidelines.