Search Results (1,530)

Background: Nocardia are a group of bacteria known to cause pulmonary, cutaneous, neurologic, or disseminated diseases, usually in immunocompromised hosts. Within the Nocardia family is Nocardia transvalensis, a rarely encountered and underreported organism in the clinical literature. Case: Here, we report the case of an immunocompetent patient presenting with lumbar pain diagnosed and treated for disseminated Nocardia transvalensis infection. Our patient underwent magnetic resonance imaging (MRI), demonstrating possible abscess and subtle osteomyelitis of the L3-L4 facet joint and transverse process; a subsequent biopsy and culture resulted in Nocardia transvalensis. Further imaging with a computed tomography (CT) scan of the head revealed a 9 mm enhancing supratentorial lesion. The patient was treated with empiric antibiotics, but this was narrowed to levofloxacin, linezolid, and trimethoprim-sulfamethoxazole after antibiotic sensitivities cropped up. Conclusions: Within this case, we extensively discuss the clinical pathogenesis of Nocardia transvalensis in an unusual host, the diagnostic approach to confirming active Nocardia infection, and the susceptibility patterns in a relatively unstudied organism. Full article

Background: Typhoid fever (TF) is a systemic infection caused by Salmonella enterica serovar Typhi, typically associated with regions where sanitation and access to clean water are inadequate. Although rare in non-endemic countries, TF remains a diagnostic consideration in travelers returning from endemic areas with febrile illness. Case report: We present the case of an 18-year-old female who developed TF following recent travel to Nigeria. The initial clinical presentation, including fever, dysuria, and abdominal pain, led to a misdiagnosis of acute pyelonephritis. Malaria, arboviral infections, acute viral hepatitis, and parasitic diseases were systematically ruled out through clinical evaluation, serological testing, and parasitological analysis. The clinical course was marked by fever, abdominal pain, somnolence, and hematological and hepatic abnormalities. Blood cultures confirmed the diagnosis, with the isolate verified and serotyped by the National Center of Infectious and Parasitic Diseases. Targeted antimicrobial treatment with ceftriaxone and levofloxacin resulted in full recovery, with no evidence of relapse or chronic carriage over a three-month follow-up period. Conclusions: This case highlights the critical importance of a structured differential diagnostic approach and microbiological confirmation in febrile patients with relevant travel history. In non-endemic settings, where TF may be underrecognized, early recognition, pathogen identification, and appropriate antimicrobial therapy remain essential to favorable outcomes and public health safety. Full article

Background and Objectives: Ultrasound (US)-guided peripheral regional anesthesia (pRA) is gaining increasing importance in emergency medicine as an effective, low-ridsk alternative to general anesthesia (GA), procedural sedation (PS), or opioid therapy. By enabling rapid, direct pain management in the emergency department (ED), pRA can help preserve scarce surgical and anesthetic resources and, in some cases, avoid inpatient admissions. The aim of this study was to analyze the indications, techniques, and clinical impact of pRA in the orthopedic-focused ED of an affiliated hospital. Materials and Methods: All pRA and PS procedures performed over a six-year period were retrospectively reviewed among 35,443 orthopedic-trauma emergency patients. pRA was carried out under US guidance with standardized monitoring. Diagnoses, block techniques, effectiveness, and complications were analyzed descriptively. Results: A total of 1292 patients (3.7%) underwent either pRA (n = 1117; 3.2%) or PS (n = 175; 0.5%). pRA was performed in 22% of cases for interventions such as reductions or extensive wound management. In 78%, pRA was applied for analgesia, for example, in the diagnostic work-up and treatment of non-immediately operable fractures, lumbago, or arthralgia. The most common pRA techniques were brachial plexus blocks (54%) and femoral nerve blocks (25%). Fascial plane blocks (6.1%) and paravertebral blocks (1.5%) were rarely used. PS was performed in 175 of 1292 patients (13%), although pRA would have been feasible in 159 of these cases. No complications of pRA were observed, and GA could routinely be avoided. Conclusions: US-guided pRA proved to be an effective and safe alternative to PS, GA, or systemic analgesia for selected indications, allowing immediate treatment without the need for operative capacities. To ensure safe application, these techniques should be an integral part of the training curriculum for ED personnel. Full article

Background: Acute chest pain is a common emergency with only 10–20% of cases attributable to acute coronary syndrome (ACS). Rapid and accurate pre-hospital diagnosis remains challenging, particularly for non-ST elevation ACS, where ECG findings may be inconclusive. AI-guided focused cardiac ultrasound (FoCUS) using handheld devices offers a potential solution by enabling immediate functional cardiac assessment. The aim was to investigate the feasibility and diagnostic performance of pre-hospital AI-guided FoCUS for detecting ACS in patients with acute chest pain. Methods: In this single-center, prospective pilot study, 75 patients with acute chest pain were enrolled. FoCUS examinations were performed by experienced sonographers (72%) and EMS paramedics (28%) using AI-guidance for obtaining the apical 4-chamber (AP4CH), apical 2-chamber (AP2CH), and apical 3-chamber (AP3CH) views. The quality of the obtained images was assessed, and quantitative measurements—including left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS)—were analyzed. Diagnostic performance was subsequently evaluated using ROC curve analysis. Results: At least one apical view was acquired in 91% of patients, with sonographer achieving higher acquisition rates than paramedics (96% vs. 67% for the AP4CH view). Complete acquisition of all apical views was achieved in 67% of cases (83% vs. 24%), and image quality was high across views, with median scores ranging from 83% to 100%. GLS yielded an AUC of 0.76 (89% sensitivity, 56% specificity) and LVEF yielded an AUC of 0.65 (75% sensitivity, 73% specificity). In patients with intermediate to high HEAR-scores (>3), lower LS-AP4CH values were associated with ACS. Conclusion: Pre-hospital AI-guided FoCUS is feasible and shows promise for ACS detection, although quantitative parameters do not yet outperform established clinical scores. Enhanced training and further refinement of AI algorithms are needed before widespread implementation. Full article

Introduction: Transient osteoporosis of the hip (TOH) is a rare, self-limiting disorder characterized by acute hip pain and reversible osteopenia. The aim of this study was to evaluate clinical outcomes following treatment with Neridronate, Clodronic Acid, Cholecalciferol, and pulsed electromagnetic field therapy (PEMF). Materials and Methods: A total of 45 patients presenting with non-traumatic hip pain were screened using a standardized diagnostic protocol. Magnetic resonance imaging (MRI) identified 8 patients (17.8%) with transient osteoporosis of the hip (TOH), who were subsequently enrolled in this analysis. Pain was evaluated using the Visual Analog Scale (VAS). Patients received a three-phase therapeutic protocol, including pharmacological therapy and PEMF. Clinical evaluations using the Harris Hip Score (HHS) were performed monthly, and follow-up MRI was conducted at the end of treatment. Results: We identified 8 cases of TOH (17.8%); the mean baseline HHS for these patients was 68.5 (range 51–83, SD 10.36). Pain reduction became evident within the first month of treatment. At the end of treatment, clinical improvement was observed in 7 patients, with mean HHS increasing to 88.0 (range 67–95, SD 8.84). Post-treatment MRI demonstrated complete resolution of bone marrow edema in all patients. One patient developed avascular necrosis despite therapy and required surgical intervention. Conclusions: TOH remains a controversial condition in terms of diagnosis and treatment. Early diagnosis and timely intervention are essential to progression to osteonecrosis. A combined therapeutic approach using bisphosphonates, vitamin D, and PEMF appears effective in reducing symptoms, promoting bone healing, and ensuring good patient compliance. Full article

Background and Clinical Significance: Sleeve gastrectomy is an effective and widely performed bariatric procedure that provides long-term, sustained weight loss, but it carries risks of early and late complications. Among these, gastric fistula is a rare occurrence associated with an increased mortality rate and must be carefully considered to ensure timely diagnosis and appropriate management. Case Presentation: We will present the complex case of a patient who was referred to the general surgery department due to severe abdominal pain, exertional dyspnea, nausea, fever and fatigue, symptoms that appeared one month after a robotic gastric sleeve. The investigations led to the diagnostic of high gastric fistula secondary to a gastric sleeve procedure. The patient underwent exploratory laparotomy with jejunostomy, peritoneal lavage, drainage, and endoscopic placement of an endoluminal vacuum assisted closure (E-VAC) system. Close clinical, laboratory, imaging, and endoscopic monitoring demonstrated progressive improvement, with complete resolution of the fistula achieved after seven weeks of E-VAC therapy. Conclusions: The particularity of this case lies in the occurrence of a delayed mechanical gastric suture dehiscence, with late diagnosis, managed using E-VAC. Even though rare, gastric fistulas represent a potentially life-threatening complication of sleeve gastrectomy. Early diagnosis and a multidisciplinary approach, which includes infection control, surgical intervention and minimally invasive techniques like E-VAC, are essential for effective management and favorable outcomes. Full article

Background/Objectives: Epidermoid cysts are benign lesions originating from germinative epithelium, characterized by a keratin-filled cavity. They are histopathologically classified as epidermoid, dermoid, or teratoid. Intraoral cases are exceedingly rare, comprising less than 0.01% of all oral cystic lesions, most frequently affecting the floor of the mouth. While usually asymptomatic, they may become painful due to infection or growth. Because of their rarity in sites such as the upper lip, they may be clinically misdiagnosed, making awareness crucial for accurate management. Methods: Diagnosis is primarily clinical and histopathological, with imaging reserved for complex or deep-seated lesions. Complete surgical excision is the standard treatment to prevent recurrence. In this case, diagnostic evaluation included careful clinical inspection, assessment of consistency and mobility, and excisional biopsy with subsequent histopathological confirmation. Results: We report a rare case of a 68-year-old female presenting with a painless, slow-growing swelling of the upper lip. Clinical examination revealed a solitary, whitish, mobile lesion. Histopathological analysis confirmed an epidermoid cyst. The lesion was surgically excised under local anesthesia, with no recurrence observed at six-month follow-up. The outcome highlights the success of surgical management and the importance of monitoring even when the lesion appears benign. Conclusions: Although uncommon in the upper lip, epidermoid cysts should be considered in the differential diagnosis of submucosal swellings. Complete surgical excision offers a favorable outcome and prevents recurrence. Reporting such rare presentations expands clinical awareness and assists in differentiating these lesions from other pathologies of the oral cavity. Full article

Several pieces of evidence have demonstrated the sigma-1 receptor (S1R) as a druggable protein with important therapeutic potentials, including neurodegeneration, cancer, and neuropathic pain. The density of S1R is altered in pathological processes so that its imaging is under study for diagnostic purposes. Thus, research has been focused on the development of S1R positron emission tomography (PET) radioligands, not only as diagnostic tools but also as powerful means to assist in the drug-development process. Herein, we comprehensively review the most important S1R PET radiotracers belonging to different classes that have been developed in the last two decades. Starting from the structural modifications impacting on the S1R affinity and selectivity, we report (i) the differences in metabolism and pharmacokinetics, (ii) the in vivo behavior in different animal models, (iii) the in vitro autoradiography outcomes, and (iv) the dosimetric profiles. The successful use of the best-performing S1R PET radiotracers in the characterization of novel S1R drugs is also reported together with the approaches to assess the potential for clinical translation. What emerges from this review is that, although the development of reliable PET agents appears to be extremely challenging, these radiotracers hold incredible potential and play a fundamental role in the exploitation of S1R in health and disease. Full article

Brown tumors (BTs) are rare osteolytic lesions that typically occur in association with primary or secondary hyperparathyroidism (PHP and SHP). Excessive secretion of parathyroid hormone induces increased bone resorption, resulting in lesions characterized by fibrosis, vascularization, and hemosiderin deposition. The most common sites include the jaws, ribs, pelvis, and long bones. Clinical manifestations may involve pain, swelling, or pathological fractures. We present the case of a mandibular BT in a 48-year-old female with chronic renal failure and secondary hyperparathyroidism. The patient exhibited progressive mandibular swelling with radiological features resembling an aggressive odontogenic or malignant lesion. Laboratory analysis confirmed markedly elevated parathyroid hormone levels, while scintigraphy demonstrated increased focal uptake in the mandible and ribs. Histopathological evaluation revealed multinucleated giant cells within a fibrous stroma, consistent with BT. Despite initiation of systemic endocrine therapy, the lesion continued to enlarge, necessitating complete surgical excision of the mandibular mass. This case underscores the diagnostic dilemmas of mandibular BT, which may closely mimic aggressive jaw pathologies. Importantly, while many BTs regress after systemic management of hyperparathyroidism, this case illustrates that surgical excision may be unavoidable in patients with unstable systemic status or progressive local disease. Comprehensive clinical, radiological, laboratory, and histopathological evaluation remains essential to ensure timely diagnosis and appropriate treatment. Full article

Background/Objectives: Satoyoshi syndrome is a rare, autoimmune disorder currently diagnosed based on clinical criteria: painful muscle spasms, diarrhea, and alopecia. Two previous reports showed a specific immunoreactive band in three Satoyoshi syndrome patients using Western blot analysis, with brain homogenate as the antigen source. These findings could be the basis for a future diagnostic test. The aim of our study was to evaluate the efficacy of using SH-SY5Y cell lysate instead of brain homogenate for a potential laboratory test for Satoyoshi syndrome using the Western blot technique. Methods: Western blot analyses were conducted using brain homogenate, SH-SY5Y cell lysates, and differentiated SH-SY5Y cell lysates. Serum samples were obtained from three Satoyoshi syndrome patients, alongside control samples from thirty blood donors and six patients with other neurological conditions. Results: Sera from patients with Satoyoshi syndrome displayed a three-band pattern in the 70–100 kDa range. This pattern was reproducible across all tested antigen sources (brain homogenate, SH-SY5Y lysate, and differentiated SH-SY5Y lysate) but was not observed for the sera from the control groups. The bands were more visible when using either type of SH-SY5Y lysate compared to brain homogenate. No differences were found between the SH-SY5Y lysate and the differentiated SH-SY5Y lysate. Conclusions: Sera from our Satoyoshi syndrome patients showed a specific band pattern that could be used for a future evaluation of Satoyoshi syndrome using Western blot. The use of SH-SY5Y cell lysate vs. brain homogenate as an antigen source may improve visualization and reproducibility of the immunobands and be less costly. Full article

Adenomyosis (AM) is a hormonally responsive uterine disorder defined by ectopic endometrial tissue within the myometrium, causing pain, abnormal bleeding, and subfertility. Non-coding RNAs (ncRNAs)—including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs)—are post-transcriptional regulators implicated also in uterine remodeling. We systematically reviewed original studies evaluating ncRNAs in AM using human samples, in vitro and animal models, or bioinformatic approaches. Data sources included PubMed and Google Scholar (inception up to 10 August 2025). Forty-one studies were included and synthesized across mechanistic, diagnostic, and translational domains. miRNAs (n = 31) were the most studied subclass, followed by lncRNAs (n = 10) and circRNAs (n = 5). Recurrent miRNAs such as miR-10b and miR-30c-5p (downregulated, inhibitory) and miR-145 (upregulated, promotive) regulate epithelial invasion, epithelial–mesenchymal transition, and cytoskeletal remodeling via PI3K–AKT/MAPK and Talin1 signaling. The let-7a/LIN28B axis governed estrogen-sensitive proliferation in the junctional zone, while miR-21 exhibited compartment-specific roles in decidualization and ectopic cell survival. Extracellular-vesicle (EV)-bornemiRNAs (e.g., miR-92a-3p, miR-25-3p, miR-4669) contributed to immune polarization and show early diagnostic potential. lncRNAs and circRNAs acted via chromatin modifiers and ceRNA networks. Most findings remain at the discovery stage. Convergent dysregulation was observed in key signaling pathways, including JAK–STAT, Wnt/β-catenin, and Hippo–YAP. ncRNAs regulate critical axes of invasion, proliferation, immune modulation, and hormonal response in AM. Targets with preliminary causal support—miR-10b/ZEB1, let-7a/LIN28B, and miR-145/Talin1—warrant further validation. Circulating miRNAs—especially in EVs—offer promise for non-invasive diagnosis. Full article

Background: Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, unrefreshed sleep, and cognitive disturbances. Despite extensive research, its pathophysiology remains incompletely understood, and there are no validated biomarkers for diagnosis. Videocapillaroscopy is a non-invasive imaging technique that enables detailed visualization of microvascular structures and may provide insights into microcirculatory alterations associated with FM. Methods: Thirty patients with FM and 30 healthy controls underwent oral videocapillaroscopy at four sites: right and left buccal mucosa and upper and lower labial mucosa. Quantitative parameters, including capillary caliber, density, and length, were extracted using a validated neural-network-based software, while qualitative parameters, including visibility, orientation, and the presence of microhemorrhages, were assessed by the operator. Results: Capillary length was significantly reduced in fibromyalgia patients (297.49 ± 26.82 µm) compared to healthy controls (324.43 ± 37.59 µm; p = 0.002), and capillary orientation differed significantly between groups (p < 0.05). Capillary caliber, density, and visibility did not show statistically significant differences. Conclusions: These findings indicate subtle microvascular alterations in the oral mucosa of patients with fibromyalgia. Although the observed changes are not sufficient for diagnostic purposes or early detection, they provide preliminary evidence that videocapillaroscopy can detect microvascular features associated with FM in the oral mucosa. Further studies with larger cohorts and longitudinal designs are warranted to clarify the clinical relevance of these observations and to explore their potential association with symptom severity or disease progression. Full article

Background: Shoulder soft tissue disorders, such as rotator cuff tears and subacromial impingement, are among the most common causes of musculoskeletal disability. Both physical examination tests and imaging techniques are routinely used in clinical settings; however, their respective contributions to patient outcomes and their potential complementarity remain underexplored. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Controlled clinical studies comparing pre- and post-intervention outcomes in adults with suspected or confirmed shoulder soft tissue pathology were included. Two groups were analyzed: studies using musculoskeletal imaging (ultrasound or MRI) and studies applying orthopedic physical examination tests (e.g., Neer, Hawkins, and Jobe). Functional outcomes were converted into standardized mean differences (SMDs) and synthesized using a random-effects model. Heterogeneity was quantified using the I² statistic. Results: In total, 11 studies met the inclusion criteria (n = 6 imaging, n = 5 orthopedic tests). Imaging-based studies showed a pooled SMD of 4.85 (95% CI: 2.77–6.93), indicating substantial clinical improvement. Orthopedic test-based studies yielded a pooled SMD of 2.34 (95% CI: 1.27–3.41). Heterogeneity was high across both groups (I² > 90%). Conclusions: Imaging was associated with a larger overall clinical effect, while orthopedic tests provided functional insight valuable for screening and monitoring. These findings support the complementary use of both strategies to enhance diagnostic accuracy and treatment planning in shoulder care. Full article

Cancer-related pain remains one of the most frequent and burdensome symptoms in oncology, significantly impairing patients’ quality of life and functional status. Despite advances in treatment and the availability of evidence-based guidelines, pain continues to be undertreated worldwide. In Italy, legislative efforts such as Law 38/2010 have not fully translated into consistent clinical practice. On 28 March 2025, a national roundtable held in Rome, Italy, brought together experts from medical oncology, radiation oncology, palliative care, anesthesiology, and pain medicine, representing the main Italian scientific societies involved in oncology and supportive care, to examine the current status of cancer pain management and develop a consensus on actionable priorities. Four key gaps were identified: insufficient education and training of healthcare providers in pain management; fragmented care pathways and limited interdisciplinary integration; lack of clarity regarding professional roles; and challenges in implementing shared diagnostic and therapeutic care pathways (Percorsi Diagnostico Terapeutici Assistenziali). The roundtable proposed coordinated strategies to address these gaps, including expanding interdisciplinary educational initiatives and integrating pain management into undergraduate and specialty curricula; establishing local oncology orientation centers to provide joint, patient-centered assessments; promoting cross-specialty collaboration through congress sessions, educational activities, and practical workshops; and developing adaptable therapeutic frameworks to ensure standardized yet context-sensitive care delivery. This congress report formalizes a joint framework aimed at embedding pain management within comprehensive cancer care. Its implementation will require sustained advocacy, structured education, and alignment of clinical practice with policy support. By addressing these barriers through pragmatic, evidence-informed actions, the proposed strategies aim to optimize timely, integrated, and effective pain care, ultimately improving outcomes for patients with cancer. Full article

A butterfly vertebra is an uncommon but clinically and radiologically significant pathology. The etiological factor of this pathology is a congenital defect in the formation of the vertebral body during embryogenesis, resulting in a cleft within the vertebral body that, in an X-ray, resembles the shape of a butterfly. Butterfly vertebrae are most often found in the thoracic and lumbar spine and more rarely in the sacral region. The clinical manifestations of this condition do not differ from the symptoms of other diseases, and it may also be asymptomatic. Only the recognition of its characteristic radiologic signs allows for accurate and timely diagnosis, as well as differentiation from other pathological processes such as fractures, metastases, and inflammation. In these cases, magnetic resonance imaging is the first-choice method. An important aspect in recognizing this pathology is its correlation with other congenital syndromes, even in cases of a single vertebral defect. We present 2 cases with an isolated S1 butterfly vertebra. The first is a 47-year-old male who presented to the hospital with complaints of chronic pain in the lower back and sacral region, more pronounced on the right side. The second is of a 39-year-old male who also presented to the hospital with chronic pain. All diagnostic modalities for this pathology have been used to demonstrate high-quality pictures, including X-ray, computed tomography (CT), and magnetic resonance imaging (MRI). Full article