Clinics and Practice <p><strong>Clinics and Practice</strong>&nbsp;[ISSN 2039-7283] is a peer-reviewed, Open Access, online-only journal that publishes both&nbsp;<em>brief reports</em>&nbsp;and&nbsp;<em>case reports</em>&nbsp;in all areas of clinical medicine. Our journal would welcome any interesting description of patients, procedures and treatment in any condition or disease that can contribute to develop scientifically rigorous and clinically meaningful practice methods. <br><strong>Clinics and Practice</strong> aims at creating an innovative, rapid and collaborative background intended to help healthcare professionals finding the latest advances to answer the most pressing questions coming from the medicine/patients relationship.</p> PAGEPress Scientific Publications, Pavia, Italy en-US Clinics and Practice 2039-7275 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> Diode laser assisted excision of a gingival pyogenic granuloma: A case report <p>exuberant, reactive lesion seen in response to local irritation or trauma caused by dental calculus, bacterial plaque, caries and restorations, with a strong predilection for the gingiva. It is among the frequently encountered oral lesions, occurring at a challenging oral site, the gingiva. Herein, we report a 71-year-old medically compromised Caucasian female who presented with a relatively large lobulated pyogenic granuloma on the buccal gingiva of the maxillary molar-premolar region. Total surgical excision was performed with an 840nm diode laser followed by the placement of hyaluronate gel and relevant periodontal dressing. Two weeks after surgical excision, complete healing was observed, but patient denied replacement of dental restoration. After 4 months of follow-up, an overall reduction of associated teeth mobility was also observed, with a minor recurrence in gingival inflammation. The objective of this report is to briefly review clinical, radiographic and histological findings of pyogenic granuloma along with a detailed discussion on its management through a diode laser.</p> Dimitrios Andreadis Ioanna Lazaridi Eleftherios Anagnostou Athanasios Poulopoulos Prashanth Panta Shankargouda Patil ##submission.copyrightStatement## 2019-08-27 2019-08-27 9 3 10.4081/cp.2019.1179 An unusual infection in an immunocompetent male from a non-endemic area: Lessons from a vacation <p>Primary pulmonary histoplasmosis is found worldwide, and is particularly endemic in some areas of the North America, usually those surrounding the Ohio and Mississippi river valleys. It is not common in the East Coast of the United States, and is in fact, reportable in Pennsylvania. It has been rarely described in immunocompetent individuals residing in a non-endemic region. We present a case of a previously healthy middle-aged male, a Pennsylvania resident, who presented with mid-sternal chest discomfort, fatigue, chills and mild shortness of breath, and was diagnosed with primary pulmonary histoplasmosis.</p> Ritesh Neupane Munish Sharma Divakar Sharma Rajeev Thachil Mahesh Krishnamurthy Gerald Lowman ##submission.copyrightStatement## 2019-08-09 2019-08-09 9 3 10.4081/cp.2019.1141 Mycoplasma pneumoniae-associated transverse myelitis presenting as asymmetric flaccid paralysis <p>Acute transverse myelitis is a rare spinal cord inflammatory disorder that manifests as sudden onset of motor, sensory, and autonomic dysfunctions. Here, we report a case of acute transverse myelitis in a 13-year-old boy secondary to <em>Mycoplasma pneumoniae</em> infection. He presented with left facial palsy and contralateral upper extremity weakness without sensory or autonomic changes. The patient was diagnosed with transverse myelitis based on his magnetic resonance imaging findings, although his presentation was mainly motor dysfunction, which is more consistent with acute flaccid paralysis.</p> Shafee Salloum Ajay Goenka Elizabeth Ey ##submission.copyrightStatement## 2019-09-12 2019-09-12 9 3 10.4081/cp.2019.1142 Giant aggressive forehead tumor: A 15-year follow-up <p>Proliferating trichilemmal tumors are rare tumors that originate from adnexal structures – specifically from the outer root sheaths of hair follicles. These tumors can be benign or malignant. We report a rare case of a giant aggressive forehead trichilemmal tumor that was paradoxically benign on pathology. It was surgically excised and followed-up for 15 years.</p> Raymond Challita Said Halabi ##submission.copyrightStatement## 2019-08-02 2019-08-02 9 3 10.4081/cp.2019.1172 Cardiac papillary fibroelastoma of a bicuspid aortic valve in an adolescent: A case report <p>Cardiac papillary fibroelastomas (CPFE) are exceptional primary benign cardiac tumours affecting the heart valves. We report here the case of a 15-year-old boy in whom echocardiography performed for non-specific chest pain during follow-up for bicuspid aortic valve showed as accidental finding the presence of a round mobile mass without stalk attached on the inferior side of the aortic valve. The mass did not cause any outflow tract obstruction or aortic insufficiency. Electrocardiogram-gated cardiac computed tomography and magnetic resonance imaging allowed to suspect CPFE. Although the patient was asymptomatic, open cardiac surgery with elective surgical resection of the tumour was performed to avoid systematic emboli. Histology confirmed the diagnosis of CPFE. This is an exceptional case of acquired CPFE in a young patient with bicuspid aortic valve. Due to the risk of systemic embolization, aortic or coronary ostium obstruction, elective excision of such lesions is recommended.</p> Sarah Dénes Benoît Daron Marie Behaeghe Marie-Christine Seghaye ##submission.copyrightStatement## 2019-08-07 2019-08-07 9 3 10.4081/cp.2019.1135 Acute eosinophilic appendicitis after generalized skin reaction due to unknown cause in a child: Case report and literature review <p>Acute eosinophilic appendicitis (AEA) is a rare variant of appendix inflammation possibly linked to allergy. Histopathological evidence of eosinophilic infiltration of the <em>muscularis propria</em> and edema separating the muscle fibers is the gold standard for the diagnosis. Here, we report a case of a young boy with AEA following a skin reaction of possible allergic origin. A 6-year-old male was presented to the emergency department with a two-day diffuse abdominal pain and tenderness in the right lower quadrant. A possible allergic reaction had occurred five days before as a pruritic rash. There was no history of allergy and the stool examination was negative for parasites. The initial diagnosis was acute appendicitis, and appendectomy was performed. The histopathological diagnosis was AEA. Further studies on the proper diagnostic and treatment approach of AEA before surgery are required.</p> Maria Aggelidou Katerina Kambouri Maria Kouroupi Dimitrios Cassimos Soultana Foutzitzi Savas Deftereos ##submission.copyrightStatement## 2019-09-16 2019-09-16 9 3 10.4081/cp.2019.1177 Ewing's sarcoma with distant metastasis: A brief note on management and emerging therapies <p>Ewing’s sarcoma is an aggressive fatal malignancy of bones and soft-tissue. It predominantly affects the young population, with a worldwide incidence of three cases per million. The pelvis, extremities, and ribs are the most common sites. We present a case of massive Ewing’s sarcoma of the right femur with metastasis to bones and lungs. The patient was treated with chemotherapy. However, he succumbed to his illness before completion of therapy. In conclusion, Ewing’s sarcoma with distant metastasis is a high risk case with poor prognosis. Integrating novel molecular targets with conventional chemotherapeutic agents holds a promise for high-risk Ewing’s sarcoma patients.</p> Girish Gulab Meshram Neeraj Kaur Kanwaljeet Singh Hura ##submission.copyrightStatement## 2019-09-17 2019-09-17 9 3 10.4081/cp.2019.1111 Clinical and functional outcome of modified Quad surgery in adult obstetric brachial plexus injury patients: Case reports <p>Untreated adult obstetric brachial plexus injury (OBPI) patients, in general, use compensatory strategies to achieve their lost upper extremity functions; they cause some adverse effects. Our present study is a case series of 3 female adult OBPI patients, aged 46, 23 and 21 years old. They all had a modified Quad surgical procedure. All patients were assessed preoperatively and postoperatively by evaluating video recordings of standardized upper extremity movements using the modified Mallet scale. The average postoperative follow-up was 4.3 months (1 to 9 months). Total Mallet score significantly improved from 15 and 18 to 21 in two patients. Supination angle measured from active movement of these 3 patients improved from 40°, 0° and -60° to 80°, 40° and -40°, respectively. The modified Quad surgical procedure significantly improves active abduction and other shoulder functions not only in young pediatric and adolescent patients, as we have previously reported, but also in adult patients with muscle imbalance secondary to brachial plexus injury sustained at birth.</p> Rahul K. Nath Divya Goel Chandra Somasundaram ##submission.copyrightStatement## 2019-09-23 2019-09-23 9 3 10.4081/cp.2019.1140 Treatment of non-atopic dermatitis with polarized UV-free polychromatic light: A case report <p>Non-atopic dermatitis is a common inflammatory condition, which is potentially debilitating and can compromise life quality. Polarized ultraviolet-free polychromatic light is used as therapeutic option for the treatment of wound healing and dermatological conditions. It has not yet been tested in the management of non-atopic dermatitis. In this case report, we present a 67-year-old female patient who had suffered with moderate non-atopic dermatitis for the past 20 years, and had undergone multiple treatments during that time without significant improvement or relief from her symptoms. She was treated for six weeks only with daily light therapy applications (10 minutes/area). Our results showed that light therapy offered a significant reduction in erythema of the affected zones with a concomitant reduction in pruritus and dehydration of the skin, without side effects or discomfort.</p> Alberto Leguina-Ruzzi Kishan Rajnikant Raichura Sarah Karis Tonks Semira Kwabi Claudia Leitner ##submission.copyrightStatement## 2019-09-23 2019-09-23 9 3 10.4081/cp.2019.1161 Median raphe cyst: A clinically challenging diagnosis <p>Median raphe cyst is an uncommon developmental anomaly that can develop anywhere along the midline of the external genitals. Only a few hundred cases have been published in the English literature and the lack of awareness of this entity can lead to confusion and misdiagnosis. We report here a case of median raphe cyst located in the midline of the anterior scrotum of a 35-year-old man. Clinically, the patient presented with a scrotal mass increasing substantially in size over two days associated with tenderness, skin erythema, and scrotal pain. Radiologic interpretation of a sonogram and computed tomography scan suggested a thrombosed vessel. The patient was diagnosed with septic thrombophlebitis associated with overlying cellulitis. Despite conservative therapy with antibiotics, the patient developed pyrexia, tachycardia, and leukocytosis prompting surgical excision of the lesion. Histopathologic examination revealed an infected median raphe cyst. The cyst wall was lined by a stratified epithelium that included numerous Alcian blue positive goblet cells. The epithelial cells showed reactive changes with infiltration by numerous neutrophils. Our objective is to bring attention to and thereby facilitate the diagnosis of this unusual entity.</p> Chadi Hajar Ibrahim R. Hajjali Laura Oscar Daniel C. Mayes ##submission.copyrightStatement## 2019-09-27 2019-09-27 9 3 10.4081/cp.2019.1176