We present the case of a 33 year old patient who has been followed since the age of 16 for autosomal dominant spondyloepiphyseal dysplasia (SED), in an evocative familial context (his sister has the same clinical picture). The disease began in adolescence with disabling mechanical pain in the hips and knees, with a walking distance limited to 500 metres. Clinical examination showed bilateral knee flexion contracture, generalised stiffness of the hips, shoulders, elbows, wrists and fingers, girdle muscle wasting, and a BMI of 16 (47 kg for 1.67 m). The patient walks with a cane. Symptomatic treatment combining analgesics, NSAIDs and physiotherapy was initiated. The article details the diagnostic arguments, indications for bilateral hip arthroplasty, anaesthetic precautions and the role of genetic counselling. Medium term outcome was favourable, with improvement in pain and walking distance after total hip replacement.

Neurologic symptoms during recovery from spinal anesthesia may reflect residual neuraxial block, but severe pain or persistent motor block can also indicate a compressive neuraxial emergency. A 49-year-old man underwent right knee arthroscopic surgery under spinal anesthesia with 14 mg of 0.5% hyperbaric bupivacaine. The neuraxial procedure was uncomplicated, and perioperative coagulation status was normal. At 225 minutes after intrathecal injection, he developed severe bilateral lower-extremity tightening and twisting pain extending to the buttock/saddle region, with Medical Research Council grade 0 motor strength in bilateral hip, knee, and ankle movements. Gross distal sensation in both feet was documented as present. Because cauda equina syndrome, spinal epidural hematoma, or another acute compressive neuraxial lesion could not be excluded clinically, urgent lumbosacral magnetic resonance imaging was obtained. Magnetic resonance imaging demonstrated left-sided disc extrusion at L4-L5 and L5-S1 with compression of the left L4 and S1 nerve roots; no epidural hematoma, central canal compression, or acute cauda equina compression was reported. The patient was managed conservatively with close observation and symptomatic treatment. Motor function recovered within hours, and at outpatient follow-up 29 days after surgery, no specific abnormality was documented. Severe bilateral leg pain with persistent motor block after spinal anesthesia should prompt structured neurologic reassessment and urgent imaging when compressive neuraxial pathology cannot be excluded clinically.

Background: Chronic caregiver stress is a frequently under-recognised contributor to physical and mental health morbidity. Sustained caregiving imposes significant psychosocial burden that often remains unaddressed within conventional biomedical frameworks. Case Presentation: We present the case of a 57-year-old married woman who has served as the primary caregiver for her adult daughter with cerebral palsy since birth. Over decades of caregiving, she developed multiple chronic gastrointestinal and systemic health problems, including gastroesophageal reflux disease (GERD), gastritis, hiatus hernia, irritable bowel syndrome (IBS), fatigue, and generalised musculoskeletal discomfort largely attributed to chronic stress and prolonged self-neglect. Management and Outcome: A holistic, psychosocially informed management plan incorporating pharmacological therapy, dietary counselling, stress management strategies, and connection to community and governmental social support services led to significant and sustained improvements in her gastrointestinal symptoms, fatigue, sleep quality, and overall well-being. Conclusion: This case highlights the critical importance of integrating psychosocial assessment and social support into routine primary care practice. Recognition of caregiver burden as a driver of physical illness is essential for delivering comprehensive, patient-centred care.

The research examined the changes in the gut microbiome in relation to acute diarrhea in Al-Qadisiyah Province, Iraq, which is the subject of a high public health burden in low- and middle-income communities where the regional patterns of the microbiome are scarcely known. The proposed cross-sectional case-control study was to be conducted at three hospitals in Al-Diwaniyah between March and November 2025, including 100 acutely diarrhea hospitalized patients and 100 controls who perfectly matched them in terms of age, sex, and residency. Analysis of fecal samples was conducted with the 16S rRNA V3-V4 sequencing on the Illumina MiSeq platform and bioinformatics analysis with QIIME2 2023.11. The findings showed that the microbial alpha diversity of cases relative to controls was significantly reduced and the Shannon index was significantly lower, which reveals a breakdown in microbial richness and evenness. Beta diversity analysis also showed distinct patterns of separation in compositions between groups. At the phylum level, patients showed a strong increase in Proteobacteria and a decrease in Firmicutes and Bacteroidetes, which indicates a change in microbiome towards a dysbiotic and inflammation-related one. Differential abundance analysis revealed the enriched presence of the important bacterial genera in patients, including Escherichia-Shigella and Streptococcus, and the positive taxa such as Faecalibacterium were more abundant in controls. It is noteworthy that microbial diversity was negatively correlated with the severity of dehydration and therefore the clinical implications of microbial diversity. The diagnostic potential of microbiome profiles was supported by the high accuracy in classification by a Random Forest model. Also, the presence of urban-rural gradients in the abundance of Proteobacteria suggests environmental factors, especially water quality, as the potential cause of dysbiosis. On the whole, these results have created a specific microbial profile of acute diarrhea in this area and have justified the creation of microbiome-based diagnostics and specific therapeutic interventions like probiotics.

Proliferating pilar tumors (PPTs) are rare neoplasms arising from the outer root sheath of hair follicles, with approximately 90% occurring on the scalp. These tumors predominantly affect women over 50 years of age and may occasionally undergo malignant transformation, necessitating careful histopathological evaluation. We present the case of a 60-year-old female who presented with a gradually enlarging, non-tender lump on the right cheek of 1.5 years' duration. Local examination revealed a firm, 3×2 cm solid mass with no overlying skin changes or palpable cervical lymphadenopathy. Excisional biopsy was performed and histopathological analysis demonstrated a lobulated lesion composed of proliferative squamous cells with hyperchromatic nuclei, brisk mitotic activity, and abrupt keratinization — findings consistent with a proliferating pilar tumor. Post-operative MRI of the head, face, and neck with contrast revealed no evidence of residual or recurrent tumor. This case highlights an uncommon presentation of PPT on the cheek, a site rarely reported in the literature.

Pemphigus vulgaris (PV) is a rare, chronic autoimmune blistering disorder affecting the skin and mucous membranes. It is characterized by the production of IgG autoantibodies against desmoglein-1 and desmoglein-3, which are essential components of desmosomes responsible for cell-to-cell adhesion in the epidermis. Loss of adhesion between keratinocytes leads to acantholysis and the formation of painful blisters and erosions, commonly beginning in the oral cavity before involving the skin. PV most frequently affects middle-aged individuals and shows higher prevalence among certain ethnic groups, including those of Mediterranean and Ashkenazi Jewish descent. Diagnosis is confirmed by clinical features, histopathology, and direct immunofluorescence studies. Early diagnosis and prompt treatment with systemic corticosteroids and immunosuppressive agents, such as azathioprine or rituximab, significantly reduce morbidity and mortality. Although once associated with high fatality rates, advances in immunotherapy have markedly improved patient prognosis.

Glomus tumors are rare mesenchymal tumors usually located in the skin or subcutaneously, most often benign, however they can exceptionally be of gastric location appearing in the intramuscular layer, and generally present in the form of a solitary submucosal nodule in the antral and pyloric region. We report the case of a 36-year-old patient who consulted the surgical emergency department for severe upper gastrointestinal bleeding associated with abundant melena evolving for 3 days due to a glomus tumor of gastric location and effectively treated by an atypical gastrectomy following an exploratory laparotomy performed in emergency whose origin could not be specified by endoscopic explorations.