International Journal of Scientific Reports

A case study of a 10-year-old child with Ehlers Danlos syndrome alongside hematoma and cellulitis at the left lower limb

2025-10-24T08:28:14+0530

A 10-year-old child was admitted with a soft, non-tender, fluctuant swelling over the left lower limb following minimal trauma at school, complicated by overlying cellulitis. The patient had a history of joint hypermobility for one year and easy bruising for six years after trivial injuries. Examination revealed numerous atrophic scars, skin hyperextensibility of 1.5 cm, and a Brighton hypermobility score of 9/9, confirming generalized joint hypermobility. Classical features included elbow and knee hyperextension >10°, fifth metacarpophalangeal joint extension >90°, thumb-to-forearm opposition, and positive Gorlin’s sign. Growth parameters were normal, with an arm span-to-height ratio of 0.95 and upper-to-lower segment ratio of 0.85. A diagnosis of Ehlers-Danlos syndrome (EDS) with secondary hematoma and cellulitis was made. Laboratory tests, including blood counts and coagulation profiles, excluded bleeding disorders, while chest X-ray and echocardiography were performed to assess systemic involvement. Management was multidisciplinary: physiotherapy for joint stabilization, hydrotherapy for muscle strengthening, vitamin C supplementation to enhance collagen synthesis, and psychological and genetic counseling. Due to risks of aortic root dilatation and mitral valve disease, regular cardiac monitoring was initiated. The patient improved with conservative therapy, cellulitis resolved, and functional status improved. Long-term follow-up included annual echocardiography, orthopedic review, and genetic counseling. This case highlights the importance of recognizing connective tissue disorders like EDS in children presenting with unexplained bruising, poor wound healing, and skin changes, as early diagnosis and comprehensive management are essential to improve outcomes and prevent complications.

Silent sella, silent glands: a case of secondary adrenal insufficiency in partial empty sella

2025-10-24T08:28:12+0530

Empty sella syndrome (ESS) is a rare cause of hypopituitarism and may lead to secondary adrenal insufficiency (SAI). Atypical presentations without classic signs such as hypotension or electrolyte imbalance can delay diagnosis. We report a 41-year-old woman presenting with recurrent generalized tonic-clonic seizures and persistent hypoglycemia unresponsive to dextrose. Her medical history included anemia, alopecia, prior bariatric surgery, and bilateral oophorectomy. Laboratory tests revealed low adrenocorticotropic hormone (ACTH) levels with normal thyroid function. Brain magnetic resonance imaging (MRI) showed partial empty sella without mass lesions, indicating pituitary dysfunction and central adrenal insufficiency. The patient received intravenous hydrocortisone and glucose, leading to rapid resolution of seizures and hypoglycemia. She was transitioned to oral corticosteroid therapy and discharged with endocrine follow-up. No further hypoglycemic or seizure episodes occurred during follow-up. This case highlights the importance of considering central adrenal insufficiency in adults with unexplained seizures and refractory hypoglycemia. Partial empty sella may cause subtle pituitary hormone deficiencies that are easily overlooked. Early recognition and prompt glucocorticoid therapy are essential to prevent adrenal crisis and improve outcomes.

Transient neonatal diabetes in a moderate preterm neonate: tailoring therapy beyond insulin

2025-10-24T08:28:14+0530

Congenital diabetes is a rare form of neonatal diabetes mellitus (NDM), typically resulting from monogenic mutations that impair pancreatic beta-cell development, insulin secretion, or function. It is broadly classified into two types: transient NDM (TNDM), which typically resolves within weeks to months but may relapse later in life, and permanent NDM (PNDM). Unlike type 1 or type 2 diabetes, congenital diabetes manifests within the first six months of life and often requires a distinct diagnostic and therapeutic approach. We present a rare case of congenital diabetes in a 32-week preterm female neonate, born small for gestational age, who developed persistent hyperglycemia from the first day of life. Initial management with intravenous fluids and insulin therapy yielded limited glycemic control, raising the suspicion of insulin resistance. Based on clinical grounds, oral sulfonylurea therapy was initiated, leading to rapid glycemic stabilization and notable catch-up growth. This case underscores the importance of early recognition of monogenic diabetes, the potential effectiveness of sulfonylureas even in preterm neonates, and the need for a high index of suspicion in atypical neonatal hyperglycemia. We describe the clinical course, diagnostic evaluation, and successful management strategy in this infant.

Oral squamous cell carcinoma with prominent clear-cell features: a case report and diagnostic review

2025-10-24T08:28:09+0530

Clear-cell variants of oral squamous cell carcinoma (OSCC) are exceedingly rare and present a diagnostic challenge due to their uncommon histomorphological features and overlap with other clear-cell neoplasms. We report a case of a 65-year-old male presenting with a persistent ulceroproliferative lesion in the lateral oropharyngeal wall. Histopathological examination revealed nests of squamous epithelial cells with abundant clear cytoplasm and marked pleomorphism. Periodic acid–Schiff with diastase (PAS-D) staining indicated glycogen accumulation, and immunohistochemistry confirmed epithelial origin via strong pan-cytokeratin expression. These findings supported the diagnosis of the clear-cell variant of OSCC. The differential diagnosis encompassed salivary gland tumors, odontogenic lesions, and metastatic clear-cell malignancies. Accurate identification required a combination of histological, histochemical, and immunohistochemical analyses. Although the World Health Organization has not yet classified this variant formally, its recognition is crucial due to the possibility of a more aggressive clinical course. This case contributes to the limited literature and underscores the importance of comprehensive diagnostic approaches to improve our understanding of this rare entity.

Optimizing nutritional strategies in type 2 diabetes patients receiving sodium-glucose cotransporter-2 inhibitor therapy

2025-10-24T08:28:13+0530

Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve glycaemic control via insulin-independent glycosuria and offer cardiovascular and renal benefits. However, their safety and effectiveness are significantly influenced by dietary context, particularly in high-carbohydrate environments like India, where refined grain consumption and periodic fasting are common. This review discusses how SGLT2 inhibitor-induced energy loss, ketone production, and fluid shifts interact with regional dietary patterns. Key nutritional concerns arise in this context, including sarcopenia from caloric and protein deficits, euglycemic diabetic ketoacidosis (euDKA) triggered by carbohydrate restriction, and volume depletion due to inadequate hydration. To manage these risks, targeted nutritional strategies are essential. These include moderating carbohydrate intake (around 45-50% of total energy), maintaining sufficient protein intake (15-20% of energy), maintaining hydration (2.0-2.5 L/day), and avoiding ketogenic or overly carbohydrate restrictive diets. Furthermore, individualized dietary planning during religious fasts is important for maintaining metabolic balance. In South Asian populations, where dietary habits are deeply rooted in culture, nutrition counseling is not merely supportive but holds a central role in optimizing therapeutic outcomes with SGLT2 inhibitors.

Bacteremia and antimicrobial resistance among febrile under five children attending pediatric clinic in Bahir Dar, Northwest Ethiopia: a retrospective study (2018–2024)

2025-10-24T08:28:12+0530

Background: Bacteremia is a major cause of illness and death in febrile under-five children, particularly in low- and middle-income countries like Ethiopia. Rising antimicrobial resistance (AMR) further complicates treatment. This study assessed bacteremia prevalence and AMR patterns among febrile under-five children at the Amhara Public Health Institute, northwest Ethiopia.

Methods: A retrospective review was conducted using blood culture and antimicrobial susceptibility data (2018–2024) from febrile children under five. Bacterial identification and susceptibility testing followed the modified Kirby–Bauer disk diffusion method per CLSI 2020 guidelines. Data were analyzed with statistical package for the social sciences (SPSS) v26.0.

Results: Of 746 blood cultures, 157 (21.0%) were positive. Gram-negative bacteria predominated (76.5%), with Klebsiella pneumoniae (31.8%) most common, followed by Acinetobacter baumannii (10.8%) and Enterococcus spp. (10.8%). Infants under one year accounted for 82.2% of cases; males comprised 56.1%. High resistance was observed to ampicillin (90.6% Gram-negatives; 79.1% Gram-positives), ceftriaxone (77.6%), cotrimoxazole (72.8%), and gentamicin (60.3%). Meropenem resistance in Gram-negatives was lower (19%). K. pneumoniae showed 100% resistance to ampicillin, 88% to ceftriaxone and cotrimoxazole, and 82% to gentamicin. Staphylococcus aureus exhibited 100% resistance to ceftazidime and 87.5% to ciprofloxacin.

Conclusion: Bacteremia remains a significant burden in febrile under-five children, with high AMR rates limiting treatment options. Strengthening antimicrobial stewardship, implementing local AMR surveillance, and updating empirical treatment guidelines are critical to improving outcomes and reducing preventable child mortality in Ethiopia.

Determinants of cervical pre-cancer and cancer among women attending cervical cancer clinic in Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia

2025-10-24T08:28:10+0530

Background: Cervical cancer is a leading cause of cancer-related morbidity and mortality in low- and middle-income countries, with over 85% of cases occurring in these settings. In Ethiopia, it ranks as the second most common cancer among women. This study examined determinants of cervical pre-cancer and cancer among women attending Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in northwest Ethiopia.

Methods: A facility-based cross-sectional study was conducted among 350 women aged 21–65 years at FHCSH. Data on socio-demographic, reproductive, behavioral, and clinical characteristics were collected using a standardized questionnaire. Participants underwent visual inspection with acetic acid (VIA), high-risk human papillomavirus (HR-HPV) DNA testing, and histopathology. Cervical intraepithelial neoplasia grade II or worse (CIN II+) was the primary outcome. Logistic regression identified associated factors (p<0.05).

Results: Cervical cancer and pre-cancer prevalence were 12% and 20%, respectively. HR-HPV infection was found in 39% of participants. CIN II+ was strongly associated with HPV infection (OR=90.9), VIA positivity (OR=79.2), age ≥30 years (OR=8.1), history of sexually transmitted infections (OR=9.8), hormonal contraceptive use (OR=3.3), comorbidities (OR=2.9), early sexual debut, multiple sexual partners, non-condom use, and high parity.

Conclusion: Both modifiable and non-modifiable factors contribute to cervical pre-cancer and cancer in Ethiopia. Strengthening HPV vaccination, promoting safer sexual practices, integrating STI management, and expanding VIA and HPV testing are critical for prevention, aligning with World Health Organization (WHO’s) 90-70-90 elimination strategy.