Illegal silicone injections for body enhancement can lead to serious complications, including the formation of siliconomas - granulomatous reactions caused by silicone leakage and spread through tissues and lymphatic drainage pathways. This paper presents the case of a 31-year-old transgender man who developed widespread silicone-related soft tissue deposits and sepsis following unauthorized silicone injections into the gluteal region. The patient presented with fever, hypotension, tachycardia, and multiple palpable subcutaneous nodules. Imaging studies, including computed tomography, magnetic resonance imaging, and ultrasound, demonstrated extensive silicone deposits and regional lymphadenopathy. Sepsis was diagnosed and managed with intravenous antibiotics and surgical consultation. This case highlights the dangers of unregulated silicone injections and the importance of early imaging to assess the extent of complications.

Inflammatory cloacogenic polyps are rare and often discovered either during routine colorectal cancer screenings or in symptomatic patients presenting with hematochezia. In unusual cases, they can present as an adhesive obstruction with radiological and clinical findings suggestive of a suspicious recurrent colorectal malignancy lesion. Because these polyps can mimic cancer during endoscopy, a detailed tissue examination is crucial for making the correct diagnosis and planning treatment. In this report, we share a challenging case where a patient with a history of cancer presented with signs that strongly suggested a malignant recurrence, but the final diagnosis was an inflammatory cloacogenic polyp. This case highlights the critical role of regular endoscopic monitoring in managing such complex conditions.

Diaphragmatic mesothelial cysts are rare, benign congenital lesions of the diaphragm, presumed to originate from coelomic remnants. Typically identified in pediatric populations, adult presentations - though uncommon - can pose diagnostic challenges due to vague or non-specific symptoms. We present the case of a 30-year-old African male with no prior imaging history, experiencing persistent epigastric pain exacerbated by deep inspiration. An inconclusive ultrasound was followed by a contrast-enhanced computed tomography scan, revealing a midline cystic lesion located adjacent to the posterior diaphragmatic pillar. This case highlights the importance of considering diaphragmatic mesothelial cysts in the differential diagnosis of chronic abdominal pain and details the characteristic imaging findings.

Von Hippel-Lindau (VHL) syndrome is a rare hereditary disorder characterised by the development of multiple benign and malignant tumours across various organs. Caused by mutations in the VHL tumour suppressor gene, it presents a wide range of clinical manifestations, including retinal haemangioblastomas, central nervous system tumours, renal cell carcinoma, pancreatic lesions, and phaeochromocytomas. This report describes the case of a 35-year-old woman who presented with visual impairment and abdominal masses. Imaging revealed typical VHL manifestations, including bilateral renal lesions and pancreatic involvement. Genetic testing confirmed the diagnosis. The patient underwent staged partial nephrectomies, with histopathology confirming clear cell renal cell carcinoma in both kidneys. This case highlights the importance of recognising the variable clinical and radiological presentations of VHL syndrome. Early diagnosis and multidisciplinary management are essential to reduce morbidity and mortality. Increased awareness and regular surveillance are critical for timely detection and intervention in patients with VHL syndrome.

Hepatitis B virus remains a significant public health threat, especially in regions with limited access to healthcare services. The main objective of the study was to assess the effectiveness of vaccination and identify the main barriers to its implementation, which could serve as a basis for optimizing immunization programmes in the region. In Jalal-Abad (Kyrgyz Republic), the screening study showed that the vaccination coverage rate among the adult population was critically low at only 3%, which is significantly lower than the level required for the formation of herd immunity. In 2023, 2,126 people were tested out of a total of 71,307 adult residents of the city, which is only 3% of the target group. A positive result for HBsAg was found in 70 people (3.3%). The vaccination procedure was completed by 2,483 people, most of whom were in the 50-59 age group (63.4 per 1,000 population). Gender analysis showed that 68.1% of those vaccinated were women, while the share of men was only 31.9%. The study identified a number of barriers, including limited access to healthcare services, lack of awareness of the risks of hepatitis B and the importance of vaccination, and logistical challenges. The findings support expanding vaccination through mobile units, integrated public health services, and culturally adapted information campaigns to improve uptake and reduce hepatitis B prevalence among underserved adults.

The study aimed to analyse the dynamics of mortality among people living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in the Kyrgyz Republic, identify the main factors influencing mortality, and propose ways to improve national programmes aimed at combating HIV and AIDS. The study used the methods of analysis, synthesis, systematisation, induction and deduction. The study examined 2005-2024 government data on geographical inequalities, death reasons, and antiretroviral medication efficacy. The data showed that HIV-positive Kyrgyz people now die at 1.8 per 100,000, down from 5.5. Osh and Jalal-Abad provinces, where up to 58% of drug users inject, have minimal medical care, and severe stigma, had the greatest fatality rates. Tuberculosis was the top cause of mortality (36%), notably among drug injectors, who had a 4.7-fold higher risk. Liver illness killed 12% of people owing to viral hepatitis. From 42% in 2005 to 95% in 2024, antiretroviral therapy coverage considerably lowered mortality and improved prognosis for most patients. HIV mortality was lower in Chui and Issyk-Kul, where treatment is more accessible, than in the south. The findings showed that HIV mortality can be reduced by improving prevention programs, increasing access to antiretroviral medication, and lowering societal stigma, especially among vulnerable groups. The results could improve national HIV/AIDS preventive and treatment programs by boosting access to antiretroviral therapy and addressing regional health service inequities.

Lemmels's syndrome is obstructive jaundice due to periampullary duodenal diverticula in the absence of a neoplasm or choledocholithiasis. The aim of this study is to present our 15-year experience on this rare pathology. Endoscopy, imaging, and histopathology records of all the patients with obstructive jaundice who were managed in surgical unit 3 in our institute between January 2010 and December 2024 were reviewed retrospectively. Patients who were found to have periampullary duodenal diverticula were included in this study. Descriptive statistics were used to summarize the data. Of 10 cases of Lemmel's syndrome, there were 4 male and 6 female patients. Contrast enhanced computed tomography was done in all the cases and confirmed the diagnosis. Upper gastrointestinal endoscopy was done in all the cases to rule out any other associated mucosal pathology of stomach or duodenum. Surgical intervention was done in 4 cases. Duodenal diverticula were detected in up to 27% of patients requiring upper gastrointestinal endoscopy and imaging studies; while they became symptomatic in only 1-2% of the cases and were causing complications in up to 5% of the cases. Before attributing periampullary diverticula as a cause of obstructive jaundice, it is important to rule out other benign as well as malignant pathologies causing obstructive jaundice.

The aim of this study was to evaluate the correlation between tumour size and the clinical manifestation of hepatic hemangiomas, with the overarching goal of improving criteria for surgical decision-making. This study was conducted at the Surgery Clinics of the Military Medical Academy in Sofia, Bulgaria, between 2010 and 2023, and analysed clinical presentation, imaging diagnosis, and surgical management of hepatic hemangiomas in 101 patients based on prospective and retrospective data. Approximately 58.42% of patients presented with such symptoms as abdominal discomfort, and palpable masses during examination, while another 31.68% incidentally discovered the condition, highlighting the importance of routine imaging. Statistical analyses revealed a very strong positive correlation between the tumour size and the intensity of clinical symptoms (Spearman's rs=0.628, p<0.001) and hence, larger lesions were more likely to produce symptomatic manifestations. It was further shown through logistic regression that patients above 75 years had an 18-fold increase in the chances of diagnostic uncertainty than younger patients (odds ratio = 18.8%, confidence interval: 1.5-217.8, p=0.023). Despite the presence of variations in tumour size and presentation, operative outcomes remained consistent across both symptomatic and asymptomatic groups. These findings provided a robust rationale for the implementation of a standardized, size-based classification system to guide clinical decision-making and personalized treatment strategies. The results of this study provide practical guidance for improving the selection criteria for surgical intervention in hepatic hemangiomas, enabling clinicians to better stratify patients based on tumour size, symptomatology, and diagnostic clarity.

The aim of the study was to determine optimal methods for preparing platelet-rich plasma to maximise the yield of key growth factors, which is essential for standardising clinical applications in regenerative medicine. The study, conducted on 30 healthy volunteers, compared four centrifugation protocols for their effect on protein composition: method 1 (single centrifugation without gel), method 2 (single centrifugation with gel), method 3 (double centrifugation without gel), and method 4 (double centrifugation with gel), followed by activation with calcium gluconate and quantitative analysis. It was found that double centrifugation with a separating gel provided consistently high concentrations of transforming growth factor-β1 (25.17-25.37 ng/ml) without activation, exceeding the values obtained from single centrifugation by 2.4 times. In contrast, single centrifugation with a gel followed by activation resulted in peak concentrations of platelet-derived growth factor-AB (10.59 ± 2.129 ng/ml), which was 44% higher than those achieved with double centrifugation. Statistical analysis confirmed significant differences between the methods (Student's t-test, p<0.05), and correlation analysis revealed an association between average platelet volume (>10.5 fl) and increased yield of platelet-derived growth factor-AB by 22-25%. The findings demonstrate that the maximum bioavailability of TGF-β1 is achieved with double centrifugation using gel, whereas plasma rich in growth factors is obtained by single centrifugation with gel combined with activation. The proposed optimisation enables targeted plasma preparation: double centrifugation with gel without activation for bone regeneration, and single centrifugation with gel with activation for angiogenic procedures, reducing costs by 20% and improving regenerative efficacy.

Metabolic dysfunction-associated steatohepatitis (MASH) represents a significant global health burden, affecting 3-5% of the population and projected to become a leading cause of liver transplantation by 2030. This review examines Resmetirom, the first FDA-approved drug for non-cirrhotic MASH with moderate to severe hepatic fibrosis. As a selective thyroid hormone receptor beta (THR-β) agonist, Resmetirom enhances hepatic lipid metabolism through increased mitochondrial β-oxidation and improved lipoprotein profiles. Multiple clinical trials have demonstrated its efficacy in reducing hepatic fat content, improving liver histology, and resolving MASH without worsening fibrosis. While generally well-tolerated, gastrointestinal side effects including diarrhea and nausea were more common with Resmetirom than placebo. This breakthrough therapy offers a promising option for MASH management, though long-term studies and broader geographic representation in trials remain necessary to fully establish its role in clinical practice.

Plasma cell vulvitis (PCV), also referred to as Zoon's vulvitis, is a rare and chronic inflammatory condition of the vulva characterized by distinctive red, glistening patches with a subtle red-orange hue. The condition can be asymptomatic or present with symptoms such as discomfort, dyspareunia, and pruritus, often mimicking other vulvar mucosal disorders like lichen planus. Due to its rarity and the overlap of symptoms with more common vulvovaginal conditions, PCV is frequently underreported and misdiagnosed. The exact etiology of PCV remains unclear, with possible associations to herpes simplex virus (HSV) and abnormal immune responses being hypothesized. This manuscript presents a case of PCV in a 46-year-old female who presented with a red, glistening, focally ulcerated patch on the vulva.

The increased demand for implants in the dental surgeon's clinical routine, methods and techniques have been created that involve non-invasive quantitative analysis, do not damage the bone-implant interface and objectively measure implant stability, such as resonance frequency analysis. The aim of this case report is to present a clinical case of a patient who came to the Dental School Clinic with a diagnosis of oblique root fracture with an indication for root extraction and immediate implant placement. The Osstell was used as another technique, in addition to the torque wrench, to measure the primary stability of the implant, which showed high stability, proving the importance of using the Osstell in the clinic.

Chronotherapy, the alignment of treatments with biological rhythms, has been explored in oncology, particularly for chemotherapy and targeted therapies, but its impact on immune checkpoint inhibitor (ICI) efficacy remains underexplored. This research aimed to examine the potential chronotherapeutic effects of morning ICI administration on the long-term response to pembrolizumab in metastatic non-small cell lung cancer (NSCLC), emphasising immune function stability via the neutrophil-to-lymphocyte ratio (NLR), and to assess the clinical significance of circadian synchronisation in immunotherapy. This study utilised a retrospective case study methodology, examining the treatment records and serial hematologic data of a patient with metastatic NSCLC. A patient diagnosed with metastatic NSCLC in 2019 showed a lasting full response to pembrolizumab for more than 6 years. A retrospective analysis revealed consistent morning ICI administration (08:00-11:00 h) and a stable NLR (2.16-3.66) during the treatment period. In addition, serial haematologic analysis showed a stable NLR, ranging between 2.16 and 3.66 throughout the treatment course. This immunological stability may reflect enhanced immune function aligned with early-day innate immune activity, particularly neutrophil and antigen-presenting cell priming, which is known to follow circadian patterns. Although specific molecular circadian markers were not examined, this case highlights a significant issue in current medical practice: there is almost no consistency in the timing of immunotherapy treatments. Taken together with emerging retrospective data, these findings underscore the need for prospective studies evaluating the influence of treatment timing on immunotherapy efficacy and durable immune surveillance in solid tumours.

Oral squamous cell carcinoma (OSCC) is a major global health concern, especially in India, where it is one of the primary causes of cancer-related fatalities. OSCC is notorious for its propensity to spread to distal sites such as the lungs, bones, and liver, but malignant pleural effusions resulting from OSCC are extremely uncommon. This case report details an unusual presentation of OSCC in a 61-year-old male presenting with bilateral malignant pleural effusion from a primary buccal mucosa squamous cell carcinoma with no lung involvement. Through cytological analysis and immunocytochemistry, we confirm the diagnosis of metastatic squamous cell carcinoma, highlighting the significance of comprehensive diagnostic approaches.

We reported a rare case of disseminated diffuse large B-cell lymphoma (DLBCL) initially presenting as refractory orbital cellulitis in a 53-year-old male. The patient presented with acute periorbital swelling, pain, and restricted ocular motility, unresponsive to broad-spectrum antibiotics. Magnetic resonance imaging (MRI) revealed extensive sinusitis with a peripherally enhancing medial extraconal orbital mass and adjacent bony erosions. A prompt functional endoscopic sinus surgery and histopathology revealed a poorly differentiated malignant neoplasm. Immunohistochemistry confirmed DLBCL, non-germinal center B-cell subtype. Systemic evaluation with whole-body MRI and fluorodeoxyglucose-positron emission tomography demonstrated widespread dissemination involving the lungs, gastrointestinal tract, adrenal glands, and skeleton. The patient was initiated on required chemoimmunotherapy with central nervous system prophylaxis and remains under oncology follow-up. This case highlights the diagnostic challenge posed by orbital lymphoma mimicking infectious orbital cellulitis and underscores the need for early imaging and tissue diagnosis in culture-negative, non-resolving cases. A high index of suspicion and multidisciplinary collaboration are essential for timely diagnosis and effective management.