Artificial intelligence (AI) has emerged as a promising strategy to improve access to fetal ultrasound in low-resource settings, where shortages of trained personnel, limited infrastructure, and unequal access to diagnostic imaging continue to compromise maternal and fetal healthcare. This narrative review synthesizes current evidence on AI-assisted fetal ultrasound, focusing on its clinical applications, implementation experience, challenges, and future directions. The reviewed evidence demonstrates that AI can support multiple stages of the fetal ultrasound pathway, including gestational age estimation, automated biometry and image quality assessment, structural anomaly detection, fetal cardiac and movement monitoring, image enhancement, and edge deployment for resource-constrained environments. These technologies have shown encouraging diagnostic performance and the potential to facilitate task-shifting by enabling non-specialist healthcare providers to acquire and interpret ultrasound examinations with greater accuracy and consistency. However, widespread implementation remains constrained by limited representation of low-resource populations in training datasets, insufficient prospective multicenter validation, infrastructure and connectivity limitations, workforce training requirements, and unresolved regulatory, ethical, and governance issues. Future research should emphasize the development of locally representative datasets, prospective multicentre validation, resource-efficient AI models, robust regulatory frameworks, and implementation studies that assess real-world feasibility. In addition, health economic evaluations, including cost-effectiveness analyses, are needed to determine the affordability and sustainability of AI-assisted fetal ultrasound in resource-constrained healthcare systems. With these advances, AI-assisted fetal ultrasound could play an important role in expanding equitable access to quality antenatal imaging and improving maternal and fetal healthcare in low-resource settings.
This report describes the rare complete restoration of reduced intraepidermal nerve fibre density (IENFD) following the administration of intravenous immunoglobulins (IVIG) in a patient with post-acute COVID-19 vaccination syndrome (PACVS) that manifested, among other symptoms, as small-fibre neuropathy (SFN). The patient was a 53-year-old woman who developed SFN in June 2021 following her second BNT162b2 vaccination. Clinically, the SFN presented with symptoms including sensory disturbances, arterial hypotension, and orthostatic tachycardia. After eight cycles of IVIG therapy from June 2024 to February 2025, three years after the onset of PACVS, a significant improvement in the clinical SFN symptoms was observed. Additionally, the IENFD improved from 6 at the ankle and thigh before IVIG therapy to 9 at the ankle and 8 at the thigh after therapy. The skin biopsy in 2026 was unremarkable. The spike protein was detectable in peripheral blood mononuclear cells, as were vaccine plasmid DNA remnants in the skin biopsies before and after IVIG therapy. S100 protein staining was weakly positive before and after IVIG administration. We report the case of a 53-year-old female patient who presented with sensory and autonomic disturbances; following a skin biopsy, she was diagnosed with PACVS-associated SFN. Treatment with IVIG over several months led to an improvement in symptoms and a complete restoration of IENFD. This case highlights the importance of diagnosing PACVS-associated SFN and the beneficial effect of IVIG, which not only improves the clinical manifestations of SFN but also normalises IENFD.
Barriers to treatment in people with human immunodeficiency virus (HIV) are often multifactorial and can lead to devastating outcomes. The authors present the case of a young woman with HIV who eventually developed acquired immunodeficiency syndrome (AIDS) attributed to barriers to continuous treatment, including difficulty attending appointments, obstacles to obtaining medication, untreated depression, lack of a support system, and other unmet social needs. She unfortunately developed multiple complications related to her AIDS diagnosis, including numerous hospital admissions and several severe infections. At only 27 years old, she entered hospice. While treatment for HIV has greatly improved, treatment interruptions continue to contribute to dangerous and potentially lethal sequelae. These barriers are often intricately intertwined with systemic failures in care delivery and support systems. This case underscores the need for more comprehensive implementation of multi-level interventions that address both individual barriers and systemic failures in the delivery of care for people with HIV. Evidence-based, patient-centered strategies that should be more widely enacted include multidisciplinary care teams with case management and social work, assistance with essential needs such as housing and food, flexible appointment scheduling, accessible medication programs, and individually tailored care delivery models. More effectively addressing social determinants of health such as housing instability, food insecurity, and transportation barriers is critical to improving care retention and treatment adherence.
A 41-year-old woman presented with a two-year history of a gradually enlarging, tender nodule on the left forearm. Ultrasonography revealed a subcutaneous mass with both solid and cystic components. The lesion was surgically excised in its entirety with local flap closure, and the postoperative course was uneventful. Pathological evaluation confirmed a solid-cystic hidradenoma, a rare tumor of sweat gland origin. While the coexistence of solid and cystic components is an inherent, defining feature of this tumor subtype rather than an atypical finding, this case is notable for its occurrence on the volar forearm, a site with very few comparable adult cases in the published literature. Because hidradenoma is easily mistaken for more common and, in the case of dermatofibrosarcoma protuberans, potentially malignant, cutaneous lesions, recognizing this diagnosis at atypical sites has direct implications for surgical planning and patient counseling. We present this case to contribute to the limited literature on adult extremity hidradenomas and to reinforce the value of including hidradenoma in the differential diagnosis of nodular cutaneous lesions arising outside its typical head, neck, and trunk distribution.
Rhabdomyolysis is a potentially life-threatening condition that may be complicated by acute kidney injury (AKI), requiring prompt recognition and early treatment to prevent adverse outcomes. We report the case of a young female patient who developed rhabdomyolysis complicated by AKI. Initial laboratory evaluation demonstrated a peak creatine kinase (CK) level of 3,976 U/L, together with biochemical evidence of AKI. The patient was managed with aggressive intravenous crystalloid therapy, close monitoring of urine output and renal function, and adjunctive low-dose mannitol after individualized clinical assessment. During hospitalization, she showed progressive clinical improvement, recovery of urine output, normalization of renal function, and a marked decline in CK levels without requiring renal replacement therapy. She was discharged in stable condition with complete clinical recovery. This case highlights the importance of early recognition, prompt fluid resuscitation, and individualized management of rhabdomyolysis complicated by AKI while emphasizing that the favorable outcome observed in this patient does not establish a causal benefit of adjunctive mannitol.
Constrictive pericarditis (CP) typically develops after a chronic course of infection or other etiologies. We report a rare case of acute CP that manifested rapidly following purulent pericarditis (PP). A 63-year-old woman with a history of hematologic disease presented with dyspnea and fever. Pericardial effusion with signs of infection was noted, and emergency pericardial drainage was performed because of hemodynamic instability. Haemophilus influenzae was detected in the pericardial fluid; consequently, antibiotic therapy was initiated. However, the patient's condition deteriorated. Transthoracic echocardiography revealed diastolic dysfunction, leading to the diagnosis of acute CP on hospital day 10 after pericardiocentesis. Given the progressive hemodynamic compromise and treatment failure, open pericardiectomy with pericardial lavage was performed, resulting in rapid improvement in hemodynamics. The patient was discharged ambulatory on postoperative day 28. Although rare, PP can rapidly progress to CP; therefore, early surgical intervention should be considered in cases that do not respond to antibiotic therapy or pericardial drainage.
Bowel perforation with transanal extrusion of a ventriculoperitoneal shunt is a rare and potentially serious complication. We report a 22-month-old boy with spina bifida and hydrocephalus who presented with the distal catheter protruding through the anus nine weeks after shunt placement. Laparoscopy identified a single approximately 10-mm sigmoid colon perforation without abscess, feculent contamination, or macroscopic peritonitis. Under direct visualization, the previous catheter was mobilized into the abdominal cavity and removed transanally through the existing perforation. The defect was closed primarily, followed by peritoneal lavage. Given the absence of gross contamination, neurological manifestations, or initial evidence of cerebrospinal fluid infection, a completely new shunt was placed through a separate tract during the same operation. Cerebrospinal fluid and blood cultures remained negative. The patient resumed enteral feeding on postoperative day 3, was discharged on postoperative day 5, and remained asymptomatic at the three-month follow-up. This case highlights the diagnostic and therapeutic utility of laparoscopy in selected patients.
Purpose To compare screw subsidence and screw penetration in proximal humerus fracture fixation using the PANTERA plate with cross-elements (Toby Orthopaedics, Miami, FL, USA) versus the conventional PHILOS plate (Synthes, West Chester, PA, USA). Methods Twenty-seven patients treated with the PANTERA plate (cross-element group) were matched by age, gender, and injury side with sixty patients treated using the PHILOS plate (conventional group). Intraoperative and post-operative radiographs were analysed for humeral head subsidence (HHS), defined as the change in corrected distance from the screw tip to the articular surface along the screw axis, measured on coronal (Cor-HHS) and axial (Ax-HHS) views. Results The mean patient age was 55.03 ± 18.57 years, with similar gender distribution and fracture patterns between groups. Mean coronal HHS was lower in the cross-element group than in the conventional group, although the difference was not statistically significant (1.07 ± 2.29 mm versus 2.11 ± 2.64 mm, p=0.096). Axial HHS was similar between the groups (0.89 ± 3.93 mm versus 0.75 ± 3.34 mm, p=0.863). Conclusion The use of cross-elements in the PANTERA plate may reduce humeral head subsidence compared to a conventional plate system, potentially lowering the risk of screw penetration through the articular surface in proximal humerus fracture fixation.
Dry eye disease (DED) is a common, multifactorial disorder of the ocular surface, and rising digital device use is increasingly recognised as a modifiable contributor. Digital eye strain (DES), a related but distinct symptom construct that also encompasses uncorrected refractive error and binocular vision anomalies, is reported in 50-90% of regular device users, compared with 5-50% for DED itself depending on diagnostic criteria; these figures should not be conflated. Reduced blink rate during screen viewing appears driven substantially by cognitive task demand rather than the screen itself, since a controlled comparison of matched digital and hard-copy reading found no difference in blink rate between formats. Incomplete blinking, however, was higher with the digital device and is independently associated with dry eye signs and symptoms in cross-sectional data, though that data did not measure device exposure and cannot establish that screen use causes the incomplete blinking seen in habitual users. No additional effect of contact lens wear on screen-related dryness was detected in one experimental study using 20-minute exposures; this is not evidence of no effect. Behavioural interventions, including the 20-20-20 rule, and oral omega-3 carry only low-certainty evidence, and a large randomised trial found omega-3 ineffective for dry eye more broadly. The 2023 Tear Film and Ocular Surface Society (TFOS) Lifestyle report comprehensively reviewed this literature and identified an unanswered question: no study has systematically tracked how ocular surface measurements change over time after digital device exposure ends. This review takes that gap as its focus. It argues that recent, unstandardised device exposure before ocular surface testing is a source of measurement error that has not been controlled for across the dry eye literature, examines the evidence for this effect, and proposes a research design and, informed by imaging tools that have become available since 2022, a feasible way to close the gap.
Rathke's cleft cyst (RCC) is a benign sellar lesion that is frequently detected incidentally, while symptomatic cases are uncommon. Endocrine dysfunction may occur due to compression of the pituitary gland, but profound hyponatremia as the initial manifestation of RCC-related hypopituitarism is rare and may delay diagnosis. We report the case of a 76-year-old woman who presented with persistent dizziness and severe euvolemic hyponatremia. Further endocrine assessment demonstrated secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, and mild hyperprolactinemia. Magnetic resonance imaging revealed an RCC with mild suprasellar extension and pituitary stalk deviation. The patient was treated with hydrocortisone followed by levothyroxine, resulting in clinical improvement and normalization of sodium levels. Although transsphenoidal surgery was recommended, she declined operative management and remained clinically stable with hormone replacement therapy during six months of follow-up. This case highlights that RCC-related hypopituitarism should be considered in patients presenting with unexplained euvolemic hyponatremia, even in the absence of headache, visual disturbances, or other classical sellar symptoms. Early endocrine evaluation and pituitary imaging are essential to establish the diagnosis, initiate appropriate hormone replacement, and prevent recurrent hyponatremia and potentially life-threatening adrenal insufficiency.
Esthetic replacement of missing teeth in the anterior maxilla requires coordinated management of gingival contours, pontic emergence profiles, restorative materials, and occlusal function. This case report describes the interdisciplinary rehabilitation of a 21-year-old female patient whose maxillary lateral incisors had been extracted following failed endodontic treatment. Clinical examination revealed a high smile line with approximately 4 mm of gingival display and bilateral Siebert Class I ridge defects at the healed extraction sites. Treatment comprised diode laser-assisted esthetic gingival recontouring, intentional endodontic treatment of the selected abutments, and progressive development of the ovate pontic sites using a provisional restoration over 6-8 weeks. A six-unit monolithic zirconia fixed dental prosthesis extending from 13 to 23 was subsequently fabricated and cemented. Occlusal adjustment maintained central-incisor guidance during protrusion and canine guidance during lateral excursions, while the ovate pontics remained free of centric and excursive contacts. At the one- and three-month follow-up visits, the peri-pontic tissues demonstrated stable contours, minimal plaque accumulation, and no bleeding, ulceration, debonding, or fracture. The patient reported satisfactory esthetics, phonetics, mastication, and comfort. Longer follow-up is required to confirm the stability of the soft tissues and prosthesis.
The neurologic manifestations of anti-GQ1b antibody syndrome continue to expand and include a spectrum of immune-mediated neuropathies such as Miller Fisher syndrome, Bickerstaff brainstem encephalitis, and optic neuropathy. Asialo-GM1 antibodies are associated with motor or sensorimotor neuropathies, particularly multifocal motor neuropathy. Reports describing concurrent seropositivity for anti-GQ1b and asialo-GM1 antibodies presenting with unilateral facial weakness and limb symptoms remain scarce. A 55-year-old woman with chronic back pain initially presented to an outside facility with new-onset left lower motor neuron facial palsy accompanied by paresthesia and extremity weakness. Neuro-axis MRI demonstrated moderate-to-severe multilevel spinal and neuroforaminal stenosis. She was discharged with prednisone and acyclovir for presumed idiopathic Bell's palsy. Shortly thereafter, she presented to our institution with worsening symptoms. Examination revealed diminished strength, hypoesthesia, and decreased reflexes with a persistent left lower motor neuron cranial nerve VII palsy. The remainder of the cranial nerve examination was normal, and there was no ophthalmoplegia or ataxia. Lumbar puncture demonstrated albuminocytologic dissociation. A ganglioside antibody panel was positive for anti-GQ1b and asialo-GM1 antibodies. This case highlights an unusual presentation of concurrent anti-GQ1b and asialo-GM1 antibody positivity manifesting as unilateral facial palsy and limb weakness initially attributed to Bell's Palsy. Recognition of ganglioside antibody syndromes as potential mimickers of Bell's palsy is essential to ensure prompt diagnosis and treatment, thereby reducing the risk of neurological morbidity.
Pasteurella multocida is a gram-negative coccobacillus commonly found in the oral and respiratory flora of cats and dogs. Human infection typically occurs following animal bites or scratches and most commonly presents as skin and soft tissue infection. Respiratory infections and bacteremia are less common and are usually reported in elderly or immunocompromised individuals. We present a case of a previously healthy male with a one-week history of fever, nonproductive cough, fatigue, myalgias, chills, and generalized weakness. Workup revealed left lower lobe pneumonia and Pasteurella bacteremia. Further history revealed ownership of a household cat and routine cleaning of the cat's feeding dishes with the same cloth used for personal dishes, representing a possible route of indirect exposure. The patient was treated with intravenous piperacillin-tazobactam followed by oral trimethoprim-sulfamethoxazole, with subsequent clearance of bacteremia and complete radiographic resolution of pneumonia. Pasteurella infections are most associated with animal bites and scratches; however, non-bite transmission through animal saliva and contaminated fomites has been reported. Pneumonia with bacteremia is an uncommon manifestation, particularly in young immunocompetent hosts. This case highlights an unusual presentation of Pasteurella multocida bacteremic pneumonia in a healthy young adult and underscores the importance of obtaining a detailed animal exposure history, including indirect exposures, when evaluating patients with invasive Pasteurella infections.
