Sahar Ahmed Abdalbary

Background and Clinical Significance: Clavicular fractures account for approximately 2.6% of all fractures, with 80% of clavicular fractures occurring in the middle-third of the bone. The middle-third of the clavicle lies directly under the skin without any protection from soft tissue or muscle attachments. The purposes of this case report are as follows: (1) to represent the prosthesis and its operative implantation and (2) to assess the radiological and clinical outcomes of using the prosthesis after a 2.5-year follow-up of the patient; Case Presentation: We present the case of a midshaft clavicle fracture in a 26-year-old, right-handed, male patient following a failure of conservative and open reduction and internal fixation of the fracture. A three-dimensional (3D) customized prosthesis with polyamide was designed for the patient. The patient presented 2.5 years after surgery with a VAS score of 2 and a DASH score of 21, and radiographic evaluation revealed good prosthesis position and no evidence of a stress fracture or unanticipated complications; Conclusions: This is a single case with successful polyamide prosthesis fixation in the treatment of a midshaft clavicle fracture after the failure of plate fixation.

Background: 3D-printed resin composite and hybrid ceramic materials are widely used in prosthetic dentistry for their esthetic, mechanical advantages, and digital compatibility, though their surface properties may be affected by drinking habits. This study aimed to evaluate the influence of a carbonated nutritional beverage multivitamin drink (Oronamin C) on the surface microhardness, roughness, solubility, and color changes in a recently introduced 3D-printed resin composite (Permanent Crown Resin), hybrid ceramic material (Vita Enamic) and a nanohybrid resin composite (Luna). Methods: A total of 120 disk-shaped specimens were distributed according to the type of material into three groups (n = 40). These were divided into four subgroups of specimens for each test (n = 10). The specimens were examined before and after immersion in Oronamin C solution for 12 days. Results: The results showed that there was no significant change in surface microhardness and surface roughness in both 3D-printed resin composite and hybrid ceramic after immersion, while microhardness decreased significantly in the nanohybrid resin composite with an increase in surface roughness. Solubility increased significantly in the nanohybrid and 3D-printed resin composites, but not in the hybrid ceramic. All materials presented clinically acceptable color changes, with mean values lower for both nanohybrid and hybrid ceramic. Conclusions: This study concluded that the hybrid ceramic and 3D-printed resin composite exhibited good stability after Oronamin C beverage exposure, whereas the nanohybrid resin composite exhibited the most impairment among all materials. All materials demonstrated clinically acceptable color changes.

The prevalence of diabetic foot ulcers (DFU), one of the most common complications of diabetes mellitus (DM), varies significantly across different countries, but remains high globally. The presence of DFU is associated with escalated healthcare expenditures, compromised physical functioning, and diminished quality of life, with a 5-year mortality rate 2.5 times higher than diabetes patients without foot ulcers. Common therapeutic strategies for DFU include glycemic control, eradication of infections, alleviation of pressure on the ulcers, and facilitation of wound healing. CHM, a fundamental element of Traditional Chinese Medicine, has gained widespread recognition in both oral and topical applications for the management of chronic wounds, owing to its functions of detoxification, promotion of blood circulation, removal of blood stasis, and enhancement of wound healing, as outlined in Chinese Medicine theories. Therefore, it is imperative to conduct a comprehensive literature review on the utilization of topical CHM for treating DFU in order to provide evidence-based guidance for clinical practice.

The prevalence of diabetic foot ulcers (DFU), one of the most common complications of diabetes mellitus (DM), varies significantly across different countries, but remains high globally. The presence of DFU is associated with escalated healthcare expenditures, compromised physical functioning, and diminished quality of life, with a 5-year mortality rate 2.5 times higher than diabetes patients without foot ulcers. Common therapeutic strategies for DFU include glycemic control, eradication of infections, alleviation of pressure on the ulcers, and facilitation of wound healing. CHM, a fundamental element of Traditional Chinese Medicine, has gained widespread recognition in both oral and topical applications for the management of chronic wounds, owing to its functions of detoxification, promotion of blood circulation, removal of blood stasis, and enhancement of wound healing, as outlined in Chinese Medicine theories. Therefore, it is imperative to conduct a comprehensive literature review on the utilization of topical CHM for treating DFU in order to provide evidence-based guidance for clinical practice.

Osteomyelitis of the hand is relatively uncommon and often results from penetrating trauma or postoperative infection. Rare pathogens such as Actinomyces r

Malignancy-associated hypercalcemia (MAH) is one of the most frequent and life-threatening metabolic emergencies in oncology; however, it is rarely observed in cutaneous squamous cell carcinoma (cSCC). We report the perioperative management of a 48-year-old man with a left long-standing anterior knee scar complicated by recurrent ulceration. In August 2024, pathology confirmed well-differentiated cSCC; however, the patient was lost to follow-up. One year later, he presented with a progressive ulcer, fatigue, severe hypercalcemia, and renal impairment. Laboratory evaluation revealed suppressed parathyroid hormone (PTH) levels consistent with MAH. Computed tomography angiography showed extensive ulceration with bone destruction and vascular involvement, and FAPI-PET/CT confirmed local recurrence and skeletal metastases in the contralateral tibia. Preoperative optimization consisted of isotonic crystalloid resuscitation, calcitonin, antiresorptive therapy with intravenous bisphosphonates or denosumab, and short-course continuous renal replacement therapy as indicated, allowing the patient to meet the physiologic criteria required for anesthesia induction. An above-knee amputation was performed using staged vascular control with continuous hemodynamic monitoring, followed by intensive care unit admission for targeted calcium-lowering therapy and organ support. The postoperative course was notable for the absence of fatal arrhythmias or deep surgical infection. This case highlights that, in cSCC complicated by MAH, skeletal metastases, and chronic infection, adherence to explicit physiologic thresholds for anesthesia induction within a standardized perioperative pathway -- combined with advanced imaging for metabolic and anatomic stratification -- can create a safe operative window of time, mitigate acute risks, and improve the feasibility and safety of definitive oncologic surgery in a high-risk setting.

Malignancy-associated hypercalcemia (MAH) is one of the most frequent and life-threatening metabolic emergencies in oncology; however, it is rarely observed in cutaneous squamous cell carcinoma (cSCC). We report the perioperative management of a 48-year-old man with a left long-standing anterior knee scar complicated by recurrent ulceration. In August 2024, pathology confirmed well-differentiated cSCC; however, the patient was lost to follow-up. One year later, he presented with a progressive ulcer, fatigue, severe hypercalcemia, and renal impairment. Laboratory evaluation revealed suppressed parathyroid hormone (PTH) levels consistent with MAH. Computed tomography angiography showed extensive ulceration with bone destruction and vascular involvement, and FAPI-PET/CT confirmed local recurrence and skeletal metastases in the contralateral tibia. Preoperative optimization consisted of isotonic crystalloid resuscitation, calcitonin, antiresorptive therapy with intravenous bisphosphonates or denosumab, and short-course continuous renal replacement therapy as indicated, allowing the patient to meet the physiologic criteria required for anesthesia induction. An above-knee amputation was performed using staged vascular control with continuous hemodynamic monitoring, followed by intensive care unit admission for targeted calcium-lowering therapy and organ support. The postoperative course was notable for the absence of fatal arrhythmias or deep surgical infection. This case highlights that, in cSCC complicated by MAH, skeletal metastases, and chronic infection, adherence to explicit physiologic thresholds for anesthesia induction within a standardized perioperative pathway -- combined with advanced imaging for metabolic and anatomic stratification -- can create a safe operative window of time, mitigate acute risks, and improve the feasibility and safety of definitive oncologic surgery in a high-risk setting.

Wohlfahrtiimonas chitiniclastica is a rare Gram-negative bacterium typically associated with wound infections, particularly in immunocompromised patients or individuals exposed to unsanitary conditions. Although clinical cases are infrequent, the infection can lead to severe complications such as bacteremia, septic shock, and even death if unrecognized or inadequately treated. We present the case of a 76-year-old diabetic male who developed chronic, non-healing foot ulcers complicated by gangrene and maggot infestation. Diagnostic challenges were addressed using metagenomic next-generation sequencing, which identified W. chitiniclastica alongside Proteus mirabilis and Corynebacterium striatum. Management included aggressive surgical debridement to remove necrotic tissue, local application of gentamicin-impregnated bone cement, systemic antibiotic therapy with ertapenem, and wound reconstruction using a dorsally based fascial flap. This combined approach resulted in significant clinical improvement, progressive wound healing, and marked reductions in infection markers. The case highlights the decisive role of advanced sequencing technologies in identifying rare pathogens within polymicrobial infections, where conventional methods such as MALDI-TOF mass spectrometry may fail. It also emphasizes the importance of integrating precision diagnostics with surgical intervention, targeted antimicrobial therapy, and rigorous postoperative care to achieve successful outcomes. By documenting this unusual presentation, we aim to expand clinical awareness of W. chitiniclastica infections and provide a practical framework for managing similarly complex diabetic foot infections.

Wohlfahrtiimonas chitiniclastica is a rare Gram-negative bacterium typically associated with wound infections, particularly in immunocompromised patients or individuals exposed to unsanitary conditions. Although clinical cases are infrequent, the infection can lead to severe complications such as bacteremia, septic shock, and even death if unrecognized or inadequately treated. We present the case of a 76-year-old diabetic male who developed chronic, non-healing foot ulcers complicated by gangrene and maggot infestation. Diagnostic challenges were addressed using metagenomic next-generation sequencing, which identified W. chitiniclastica alongside Proteus mirabilis and Corynebacterium striatum. Management included aggressive surgical debridement to remove necrotic tissue, local application of gentamicin-impregnated bone cement, systemic antibiotic therapy with ertapenem, and wound reconstruction using a dorsally based fascial flap. This combined approach resulted in significant clinical improvement, progressive wound healing, and marked reductions in infection markers. The case highlights the decisive role of advanced sequencing technologies in identifying rare pathogens within polymicrobial infections, where conventional methods such as MALDI-TOF mass spectrometry may fail. It also emphasizes the importance of integrating precision diagnostics with surgical intervention, targeted antimicrobial therapy, and rigorous postoperative care to achieve successful outcomes. By documenting this unusual presentation, we aim to expand clinical awareness of W. chitiniclastica infections and provide a practical framework for managing similarly complex diabetic foot infections.

Introduction: Examine how aerobic exercises, relaxation techniques, and balance exercises affect patients’ anxiety and dizziness post-COVID-19 patients.Methods: Thirty participants post-COVID-19, complaining of anxiety and dizziness, aged 45–65 years, of both sexes, selected from the outpatient clinic of our hospital, were enrolled in the study after a COVID-19 infection. Treatment sessions were 3 times weekly for 4 weeks, and the patients were treated separately in group therapy. The 15 patients in group A were given aerobic, balancing, and relaxation techniques. The 15 patients in the control group (group B) were given only relaxation exercises. Assessments of the two groups were completed both before and after the course of treatment by the Hamilton Anxiety Scale (HAMA) and the Berg Balance Scale. Respiratory function was also assessed using maximum voluntary ventilation.Results: There were significant differences between the two groups after the treatment. The mean values of the HAMA after treatment were 17.2 ± 1.7 and 21.7 ± 1.4 in groups A and B, respectively. After treatment, the mean values of the Berg Balance Scale were 26.7 ± 5.7 and 22.2 ± 3.6 in groups A and B, respectively. The mean values of maximum voluntary ventilation were 117.2 ± 16.7 and 108.1 ± 16.3 in groups A and B, respectively. Both groups showed a significant decrease in anxiety and dizziness and a significant increase in maximum voluntary ventilation at the end of the 4 weeks of the training program. Participants in group A showed a significantly greater decrease in anxiety and dizziness and a significantly greater increase in maximum voluntary ventilation (p < 0.05) after the training program.Conclusions: Ultimately, it can be said that aerobic exercises, balance exercises, and relaxation techniques can raise maximal voluntary breathing and lessen anxiety and dizziness in post-COVID patients. Therefore, it might be regarded as a successful, secure, cost-effective, and efficient supplementary treatment method for lowering anxiety and vertigo in COVID-19 patients.