Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Malignant Transformation of Primary Acquired Melanosis into Conjunctival Melanoma in an Adolescent Male: A Clinico-Pathological Case Report and Management Review
Full text linkBackground: Conjunctival malignant melanoma (CMM) is a rare but potentially lethal ocular surface malignancy, especially uncommon in adolescents. It often arises from a precursor lesion known as primary acquired melanosis (PAM) with atypia. We present a case of CMM developing from long-standing PAM in an 18-year-old male, highlighting the diagnostic and therapeutic challenges in this unusual demographic.
Case presentation: An 18-year-old male presented with a pigmented conjunctival lesion in his right eye, which had been present for over a decade but had recently shown progressive enlargement and darkening. Slit-lamp biomicroscopy revealed a 5x2 mm, variegated, hyperpigmented lesion on the bulbar conjunctiva with a prominent feeding vessel. The patient underwent an excisional biopsy using a "no-touch" technique with 4 mm margins and adjunctive double freeze-thaw cryotherapy. Histopathological analysis confirmed an invasive malignant melanoma, Breslow thickness of 1.8 mm, arising from PAM with severe atypia. Surgical margins were clear of the tumor.
Conclusion: This case underscores that malignant transformation of conjunctival melanocytic lesions can occur even in young patients. The presence of a changing pigmented lesion, regardless of patient age, necessitates a high index of suspicion and a low threshold for excisional biopsy. Meticulous surgical technique combined with adjuvant therapy and vigilant long-term surveillance is paramount for optimizing patient outcomes
Systemic HIV-1 Viremia as an Independent Predictor of Reduced Intraocular Pressure: A Multivariable Regression Analysis in Cohorts with and without Cytomegalovirus Retinitis
Full text linkBackground: The association between human immunodeficiency virus (HIV) and reduced intraocular pressure (IOP) is recognized, yet its independence from confounding opportunistic infections like cytomegalovirus retinitis (CMVR) remains unquantified. This study aimed to determine the independent association between systemic HIV-1 viral load and IOP by employing a robust multivariable analysis in cohorts with and without CMVR.
Methods: A comparative, cross-sectional study was conducted on 100 HIV-positive patients (50 with CMVR, 50 without CMVR) at a tertiary referral hospital. Data included demographics, HIV clinical stage (WHO), quantitative HIV-1 viral load, and IOP measured by applanation tonometry. The primary analysis utilized a multivariable linear regression model to assess the association between log-transformed viral load and continuous IOP, adjusting for age, gender, HIV stage, and CMVR status. An interaction term was used to test for effect modification by CMVR.
Results: After adjusting for all covariates, log₁₀ HIV-1 viral load was a powerful and highly significant independent predictor of lower IOP. For every 10-fold increase in viral load, IOP decreased by an average of 0.88 mmHg (β = -0.88; 95% CI: -1.15 to -0.61; p < 0.001). Advanced HIV stage was also independently associated with lower IOP (Stage IV vs. Stage I: β = -1.25; 95% CI: -2.10 to -0.40; p = 0.004). The effect of viral load on IOP did not significantly differ between the CMVR and non-CMVR groups (p for interaction = 0.762), confirming its independent systemic effect.
Conclusion: Systemic HIV-1 viremia is a dominant, independent predictor of reduced intraocular pressure, irrespective of CMVR status. This dose-dependent relationship highlights a direct pathophysiological link between viral replication and aqueous humor dynamics. IOP measurement represents a potential adjunctive clinical indicator for monitoring systemic HIV-1 disease activity
A Masquerading Giant: Unprecedented Sebaceous Gland Carcinoma with Massive Orbito-facial Invasion and the Diagnostic and Therapeutic Challenges of an Extreme Presentation
Full text linkBackground: Sebaceous gland carcinoma (SGC) is a rare, aggressive adnexal malignancy of the eyelid, notorious for masquerading as benign inflammatory conditions. Presentations involving massive, destructive orbito-facial invasion are exceptionally rare and pose profound diagnostic and therapeutic challenges, often reflecting a confluence of biological aggression and systemic delays in care.
Case presentation: A 68-year-old male presented with a one-year history of a progressively enlarging mass on his left upper eyelid, which had evolved into a giant, 15 x 15 x 7 cm fungating tumor, causing complete destruction of the orbital contents and extensive invasion into adjacent facial structures. An initial incisional biopsy was paradoxically interpreted as benign sebaceous hyperplasia. Due to the stark clinico-pathological discordance, a repeat, deeper biopsy was performed. The subsequent histopathological examination revealed a high-grade carcinoma, and the diagnosis was definitively confirmed by a panel of immunohistochemical stains, including strong positivity for Epithelial Membrane Antigen (EMA) and Cytokeratin 7 (CK7). The disease was staged as T4dN1M0 and deemed unresectable.
Conclusion: This case documents a catastrophic outcome of SGC, resulting from a combination of delayed patient presentation and initial diagnostic error. It highlights that giant SGC, while rare, must be considered in the differential of destructive facial tumors and underscores that immunohistochemistry is mandatory for resolving clinico-pathological paradoxes in ocular adnexal pathology. This case serves as a call to action for improved public health awareness and enhanced diagnostic acumen to prevent such devastatingly advanced presentations
Conservative versus Interventional Management of Ingested Straight Pins in Adolescent Females: A Retrospective Case Series Illustrating Guideline-Based Decision-Making
Full text linkBackground: The ingestion of sharp foreign bodies (FBs) in adolescents presents a critical management dilemma, balancing conservative observation against the risk of gastrointestinal perforation. In certain cultural contexts, the accidental ingestion of straight pins used for hijabs creates a unique patient cohort. This study aims to illustrate the practical, guideline-based application of divergent management strategies in these specific clinical scenarios.
Methods: We conducted a retrospective case series of five female adolescents, aged 13 to 15 years, managed at a single tertiary center for accidental straight pin ingestion. Data on clinical presentation, radiological findings, management strategy (conservative versus endoscopic), and outcomes were extracted and analyzed. Management decisions were dictated by established international guidelines.
Results: Three asymptomatic patients (60%) with pins located distal to the duodenum were managed conservatively and experienced spontaneous passage within 2-4 days. Two patients (40%) required therapeutic endoscopy. One underwent emergent removal for a proximally located pin causing respiratory symptoms. The other, despite being asymptomatic, underwent urgent intervention due to the development of a radiological "sentinel loop" and rising inflammatory markers, which revealed an impacted duodenal pin. No complications occurred in any patient.
Conclusion: This series demonstrates that while active surveillance is a safe strategy for asymptomatic patients with distally located sharp FBs, clinical silence does not preclude impending complications. Subtle radiological findings, such as a sentinel loop, are crucial indicators that must prompt timely endoscopic intervention to prevent morbidity. The educational value lies in highlighting these critical decision-making triggers
UVB-Induced Oxidative Collapse and Melanogenic Activation in a Rat Model of Cutaneous Hyperpigmentation: A Multi-Parametric Analysis
Full text linkBackground: Ultraviolet B (UVB) radiation is a primary driver of cutaneous hyperpigmentation disorders, with oxidative stress recognized as a key pathogenic mechanism. However, a comprehensive, multi-level characterization of the causal link between chronic UVB exposure and the resulting oxidative, histological, and melanogenic responses is needed. This study aimed to quantitatively validate a preclinical model of UVB-induced hyperpigmentation by characterizing the reciprocal regulation of key oxidative stress biomarkers and correlating these changes with objective histological evidence of hyperpigmentation.
Methods: This controlled in vivo experimental study used 14 male Sprague Dawley rats, divided into a control group (KN; n=7) and a UVB-exposed group (KP; n=7). The KP group received chronic UVB radiation (300 mJ/cm² daily, 5 days/week for 4 weeks). Dorsal skin tissue was harvested for analysis. Oxidative stress was assessed by quantifying malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) levels via ELISA. Hyperpigmentation was objectively validated and quantified using Fontana-Masson staining for melanin deposition and immunohistochemistry for microphthalmia-associated transcription factor (MITF).
Results: Chronic UVB exposure induced significant hyperpigmentation, confirmed by a 5.8-fold increase in epidermal melanin content (p < 0.001) and a 4.1-fold increase in the number of MITF-positive melanocytes (p < 0.001) in the KP group. This was accompanied by a profound oxidative imbalance: MDA levels increased by 7.5-fold (p < 0.001), while the activities of SOD, CAT, and GPx decreased by 80.5%, 65.2%, and 71.4%, respectively (all p < 0.001). A strong negative correlation was observed between MDA and all antioxidant enzymes, particularly SOD (r = -0.985, p < 0.001).
Conclusion: Chronic UVB exposure directly triggers a collapse of the cutaneous antioxidant network, leading to severe lipid peroxidation. This state of profound oxidative stress is causally linked to melanocyte activation and excessive melanin synthesis, driving the hyperpigmentation phenotype. This robustly validated preclinical model provides a powerful platform for investigating the molecular pathophysiology of UVB-induced pigmentary disorders and for evaluating novel therapeutic interventions.
 
Beyond 'Blunt': A Pathophysiology-Guided Framework for Managing High-Risk Pediatric Foreign Body Ingestion
Full text linkBackground: Foreign body ingestion is a significant cause of pediatric morbidity. The traditional "blunt" classification is insufficient for risk stratification, as objects like magnets and impacted items pose distinct threats based on their intrinsic properties. This study analyzes how a pathophysiology-based approach, distinguishing active (magnetic) from passive (mechanical) injury mechanisms, guides clinical decision-making.
Methods: We conducted a retrospective, descriptive case series at a tertiary pediatric surgical center, reviewing cases from January 2022 to December 2024. Five illustrative cases of high-risk blunt foreign body ingestion were selected to demonstrate the spectrum of management based on the object's potential for harm.
Results: The series included five children (aged 3-7 years). A 7-year-old with a single gastric magnet retained for five days developed mucosal injury and required urgent endoscopic removal. A 5-year-old with a recently ingested solitary gastric magnet and a 3-year-old with an impacted pyloric pendant also underwent urgent endoscopic removal. A 6-year-old with a gastric coin had elective endoscopy due to socioeconomic factors. In contrast, a 5-year-old with a coin that passed the pylorus was managed conservatively with spontaneous passage. All patients had successful outcomes.
Conclusion: The management of pediatric foreign body ingestion should be dictated by the object's pathophysiological potential for injury, not its shape. Understanding the difference between active magnet-induced pressure necrosis and passive mechanical impaction is paramount for applying guidelines effectively and preventing severe complications. This framework supports a necessary shift from shape-based to mechanism-based risk assessment
Optimizing the Surgical Field via Multimodal Controlled Hypotension during Posterior Spinal Fixation for a T11 Burst Fracture: An Anesthetic Case Study
Full text linkBackground: Significant intraoperative blood loss is a major challenge in complex spinal surgeries, impairing surgical field visibility and increasing patient morbidity. Controlled hypotension is an established anesthetic technique to mitigate this challenge, yet the optimal combination of agents to ensure efficacy and safety remains an area of active investigation. This case study details the successful application of a multimodal anesthetic regimen, centered on the synergistic effects of dexmedetomidine and isoflurane, to achieve deliberate hypotension during posterior stabilization of a thoracic burst fracture.
Case presentation: A 39-year-old male, classified as American Society of Anesthesiologists (ASA) physical status II, presented with a traumatic, unstable burst fracture of the eleventh thoracic vertebra (T11) following a high-energy fall. He was scheduled for a posterior decompressive laminectomy and T10-T12 pedicle screw fixation. Anesthetic management was initiated with a multimodal approach utilizing intravenous infusions of dexmedetomidine and morphine, supplemented by maintenance with isoflurane. This strategy was employed to maintain a target mean arterial pressure (MAP) of 60-65 mmHg. Throughout the 135-minute procedure, the patient’s hemodynamics remained exceptionally stable within the target range. The estimated blood loss was minimal (approximately 350 mL), providing the surgical team with an excellent, clear operative field. The patient emerged smoothly from anesthesia with no neurological deficits and experienced a favorable postoperative recovery.
Conclusion: This case demonstrates that a multimodal anesthetic strategy incorporating dexmedetomidine, a volatile agent, and opioid infusions is a highly effective and safe method for inducing and maintaining controlled hypotension in major spinal surgery. This approach successfully optimized the surgical conditions by minimizing blood loss and enhancing visibility, without compromising hemodynamic stability or vital organ perfusion, thereby contributing to a positive patient outcome
The Effect of High-Intensity Interval Training on Interleukin-6 Levels in Hypertensive Individuals: A Systematic Review and Meta-Analysis
Full text linkBackground: High-intensity interval training (HIIT) has emerged as a time-efficient exercise modality with potential benefits for hypertensive individuals. Interleukin-6 (IL-6), a cytokine with both pro- and anti-inflammatory properties, has been implicated in the development and progression of hypertension. This meta-analysis aimed to investigate the effect of HIIT on IL-6 levels in hypertensive individuals.
Methods: A systematic search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify relevant studies published between 2013 and 2024. Studies were included if they met the following criteria: (1) randomized controlled trials; (2) included hypertensive participants; (3) compared HIIT to a control group (no exercise or moderate-intensity continuous training); (4) measured circulating IL-6 levels; and (5) provided sufficient data for meta-analysis. Data were extracted and pooled using a random-effects model.
Results: Seven studies met the inclusion criteria, comprising a total of 328 participants. The meta-analysis revealed a significant decrease in IL-6 levels following HIIT compared to the control group (standardized mean difference [SMD] = -1.27, 95% confidence interval [CI] = (-1.81 to -0.73, p = 0.002). Subgroup analysis showed that HIIT interventions lasting ≥ 8 weeks were associated with a greater reduction in IL-6 levels compared to shorter interventions.
Conclusion: HIIT appears to be an effective exercise modality for reducing IL-6 levels in hypertensive individuals. This finding suggests that HIIT may have anti-inflammatory effects and could be a valuable non-pharmacological strategy for managing hypertension
From Patches to Plaques: A Diagnostic Challenge in a Case of Erythroderma Secondary to Pityriasis Rubra Pilaris
Full text linkBackground: Erythroderma, a dramatic and potentially life-threatening condition characterized by fiery redness engulfing over 90% of the skin's surface, presents a formidable diagnostic challenge due to its myriad underlying causes. Among these, pityriasis rubra pilaris (PRP), a rare inflammatory skin disorder, stands out with its distinctive features and often perplexing presentation. This case unveils the intricate diagnostic journey of a young man whose erythroderma masked an underlying PRP, further complicated by the subtle interplay of stress.
Case presentation: An 18-year-old male presented with a one-month history of alarming erythroderma accompanied by distressing itching, fever, and sleep disturbances. Adding to the complexity, he exhibited characteristic 'nappes claires' – islands of normal skin amidst the erythrodermic sea – a hallmark of PRP. Palmoplantar keratoderma, alopecia areata, and ectropion further painted an intriguing clinical picture. Histopathological examination revealed the telltale 'checkboard' pattern, confirming PRP as the culprit. Notably, the patient's history revealed a compelling link between stress and disease exacerbation, adding a psychosomatic dimension to the case. Systemic corticosteroids and methotrexate, alongside topical emollients, brought about significant clinical improvement, underscoring the importance of early diagnosis and targeted treatment.
Conclusion: This case underscores the critical need to consider PRP in the labyrinth of erythroderma diagnoses, particularly when 'nappes claires' and a history of stress are intertwined. By shining a light on the diagnostic subtleties and therapeutic nuances of PRP-associated erythroderma, this report empowers clinicians to navigate the complexities of this rare and challenging condition, ultimately improving patient outcomes and quality of life
A Rare Presentation of Choledochal Cyst in a Six-Month-Old Infant: Diagnostic and Surgical Challenges
Full text linkBackground: Choledochal cysts (CCs) are rare congenital anomalies of the biliary tree, characterized by cystic dilation of the intrahepatic and/or extrahepatic bile ducts. While the classic triad of abdominal pain, jaundice, and a palpable abdominal mass is well-described, the presentation in infants can be subtle and often involves diagnostic and surgical challenges. This case report describes a rare presentation of a Todani Type 1 choledochal cyst in a six-month-old infant who presented primarily with abdominal distension, highlighting the diagnostic pathway and surgical management.
Case presentation: A six-month-old female infant presented with a two-month history of progressive abdominal distension. There was a history of pale stools at two months of age that lasted for one week. Physical examination revealed a well-nourished infant with icteric skin and sclera and a distended abdomen with a palpable, mobile mass measuring 7x5 cm. Laboratory investigations revealed hyperbilirubinemia and elevated liver enzymes. Abdominal ultrasound and subsequent CT scan with contrast confirmed the presence of a Todani Type 1 choledochal cyst. The infant underwent successful surgical excision of the cyst and Roux-en-Y hepaticojejunostomy. The postoperative period was uneventful, and the patient was discharged in stable condition. Follow-up at one month showed good recovery and no signs of complications.
Conclusion: This case highlights an atypical presentation of a Todani Type 1 choledochal cyst in a young infant, where the primary symptom was abdominal distension rather than the classic triad. Early diagnosis through imaging modalities like ultrasound and CT scan, followed by complete surgical excision and Roux-en-Y reconstruction, resulted in a favorable outcome. This case underscores the importance of considering choledochal cysts in the differential diagnosis of abdominal distension in infants, even in the absence of jaundice or pain