Unsafe abortion, though preventable, contributes significantly to maternal morbidity and mortality, especially in countries with restrictive abortion laws. Post-abortal tetanus is a rare but life-threatening complication associated with high mortality. An 18-year-old single P0[+1] Senior Secondary School (SSS) 2 student with eight weeks history of amenorrhoea who presented with complaints of generalised spasms, difficulty with speech and a fever of three days duration. This followed an unsafe surgical termination of pregnancy at a patent medicine shop a month before presentation. Her immunisation status was unknown. Examination revealed trismus and generalised muscle rigidity with opisthotonus. Laboratory findings showed leukocytosis (20,000cells/mm[3]) and mild anaemia (PCV 30%). A clinical diagnosis of septic abortion complicated by generalised tetanus was made. A multidisciplinary team was instituted to care for the patient; she received intravenous fluids, parenteral antibiotics, tetanus toxoid, human tetanus immunoglobulin, analgesics, diazepam infusion for spasm control, and other supportive care in a low-stimulation environment. Despite resuscitative efforts, the patient deteriorated rapidly and died within three hours of admission. Various complications, including tetanus infection, can arise following an unsafe abortion, leading to an increase in our already high maternal mortality rates. Ensuring access to contraception, providing post-abortion care services, promoting adolescent health-friendly services, promoting women's rights, health and status and expanding the legal conditions for abortion will help to curtail this menace.

Parathyroid hormone (PTH) is the primary regulator of calcium and phosphate balance via direct action on the kidneys and bones and indirect action on the intestine. Hypoparathyroidism is caused by insufficient levels of PTH, leading to 1,25-dihydroxy vitamin D (1,25[OH]2D) deficiency. PTH-induced 1,25(OH)2D production is a highly regulated process essential for physiological functions that is reduced or absent in hypoparathyroidism.

West syndrome (WS) is a severe developmental and epileptic encephalopathy of infancy, defined by the triad of epileptic spasms, hypsarrhythmic electroencephalography, and developmental delay. Recent limited studies have suggested that the RYR3 gene is involved in the pathogenesis of WS. Our study presents an Iranian patient with WS and aims to provide further evidence to support the role of RYR3 variants in this condition. The proband was a male patient aged 2 years and 2 months with drug-resistant epileptic spasms and developmental regression. Trio-based whole-exome sequencing (Trio-WES) was conducted, and a novel de novo heterozygous variant in RYR3 (NM_001036.6: c.4112T>C, p.Leu1371Pro) was identified in the proband. The variant was not found in population databases, and bioinformatics analyses also predicted the deleterious impact of the variant. This study describes a novel RYR3 variant in a patient with WS, supporting a potential pathogenic role for RYR3 in early-onset epileptic encephalopathy. Therefore, it should be considered during the genetic assessment of unexplained WS cases.

Severe hypothyroidism left untreated can lead to the progression of a distinct hypothyroid myopathy. This unique thyroid myopathy is characterized by weakness of the proximal limb muscles with an increase in muscle mass, muscle stiffness, and cramps. There is no consistent concept or guidelines for diagnostic work-up with the typical findings of this specific myopathy. While muscle biopsy can provide additional clinical information, the majority of cases can be diagnosed clinically by the hallmark signs of muscular weakness and pseudohypertrophy of muscles in combination with elevated creatine kinase (CK) and thyroid-stimulating hormone (TSH) levels. We present a patient who developed the hallmark findings of this rare hypothyroid myopathy, in which physical exam and laboratory data provided the diagnosis. Magnetic resonance imaging or muscle biopsy could have been performed to confirm the presence of muscular pseudohypertrophy, but the cost of testing would not have altered the treatment course. Therefore, the diagnosis can be cost-effectively made without invasive diagnostic and radiologic measures.

Generalized tetanus presents a formidable therapeutic challenge, especially when refractory to conventional management. Standard treatment involves toxin neutralization, muscle spasm control (sedation and magnesium sulfate), and supportive care. However, refractory cases often necessitate prolonged intensive care and risk secondary complications. Intrathecal baclofen (ITB), a gamma-aminobutyric acid type B agonist that reduces spinal hyperexcitability, is highly effective. Although continuous ITB infusion is the established gold standard, its implementation is often constrained in resource-limited environments due to high equipment and technical demands. We studied three patients with severe, conventional treatment-resistant generalized tetanus. A history of incomplete booster immunization among these patients leaves them vulnerable. Unable to use a continuous pump for ITB, we turned to intermittent bolus ITB injections as a pragmatic clinical strategy. Administered with meticulous caution, this bolus approach-often requiring repeat, titrated doses-proved successful in achieving promising control of the dangerous muscle spasms while monitoring closely for complications.

[This corrects the article DOI: 10.3389/fped.2026.1839525.].

Muscle cramps are among the most common acute complications of hemodialysis (HD), often occurring even in the absence of electrolyte disturbances. Most cramps are painful and may cause patients to fear future dialysis sessions. We hypothesized that susceptibility to muscle cramps may be related to impaired skeletal muscle myokine secretion. No significant differences in pre-dialysis myokine levels were observed between patients with and without muscle cramps (myostatin 36.2 vs. 86.9 (p = 0.09), fibronectin type III domain-containing protein 5 (FNDC5) 0.6 vs. 0.6 (p = 0.61), interleukin-6 (IL-6) 2.4 vs. 2.0 (p = 0.4). However, after adjustment for lean tissue mass (LTM) and lean tissue index (LTI), myostatin levels were significantly lower in patients with cramps (0.80 [0.35-1.84] vs. 1.49 [0.45-6.31], respectively, (p = 0.048) for LTM, and 2.26 [1.04-4.06] vs. 3.89 [1.52-19.47], respectively, (p = 0.04) for LTI). In multivariable logistic regression analysis, log2-transformed myostatin concentration was independently and inversely associated with muscle cramps after adjustment for dialysis vintage, body mass index (BMI), and extracellular water. No association was found between muscle cramps and ultrafiltration volume or serum sodium and potassium levels. The study included 67 hemodialysis patients (HD patients), of whom 39 experienced repeated muscle cramps during dialysis. Muscle cramps were defined as painful involuntary muscle contractions lasting more than one minute during or shortly after a dialysis session. Plasma levels of myokines-myostatin, FNDC5, and IL-6-were assessed. Pre-dialysis myostatin, but not FNDC5 or IL-6, was independently associated with the occurrence of intradialytic muscle cramps. Further studies are needed to confirm its clinical utility.