OpenMed/multicare-articles huggingface dataset:
Severe Symptomatic Hypocalcemia from HIV Related Hypoparathyroidism
Authors: Sartaj Sandhu, Akshata Desai, Manav Batra, Robin Girdhar, Kaushik Chatterjee, E Helen Kemp, Antoine Makdissi, Ajay Chaudhuri
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

We report the case of a 54-year-old Caucasian female who presented with a two-year history of persistent hypocalcemia requiring multiple hospitalizations. Her medical history was significant for HIV diagnosed four years ago. She denied any history of prior neck surgery or radiation. Her vital signs were stable with an unremarkable physical exam. Pertinent medications included calcium carbonate, vitamin D3, calcitriol, efavirenz, emtricitabine, tenofovir disoproxil, hydrochlorothiazide, and inhaled budesonide/formoterol. Laboratory testing showed total calcium of 5.7 mg/dL (normal range: 8.4-10.2 mg/dL), ionized calcium of 2.7 mg/dL (normal range: 4.5-5.5 mg/dL), serum phosphate of 6.3 mg/dL (normal range: 2.7-4.5 mg/dL), and intact PTH of 7.6 pg/mL (normal range: 15-65 pg/mL). She was diagnosed with primary hypoparathyroidism. Anti-calcium-sensing receptor antibodies and NALP5 antibodies were tested and found to be negative. During subsequent clinic visits, doses of calcium supplements and calcitriol were titrated. Last corrected serum calcium level was 9.18 mg/dL. She was subsequently lost to follow-up. This case gives insight into severe symptomatic hypocalcemia from primary hypoparathyroidism attributed to HIV infection. We suggest that calcium levels should be closely monitored in patients with HIV infection.
Esophageal Pemphigus Vulgaris: A Rare Etiology of Upper Gastrointestinal Hemorrhage
Authors: Jennifer Rose F Del Castillo, Muhammad Nadeem Yousaf, Fizah S Chaudhary, Nahar Saleh, Lawrence Mills
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Pemphigus vulgaris (PV) is an autoimmune blistering disorder of the skin and mucosal surfaces characterized by acantholysis (loss of adhesion between epidermal cells). Esophageal involvement of PV is an underdiagnosed entity as routine diagnostic endoscopy is not recommended in asymptomatic patients. Dysphagia and odynophagia are common presenting symptoms; however, upper gastrointestinal bleeding (UGIB) associated with esophageal involvement of PV without a history of mucosal blistering is extremely uncommon. We present a case of esophageal involvement of PV associated with active UGIB that was diagnosed on endoscopic evaluation. This case illustrated the importance of early endoscopy to identify the esophageal involvement of PV especially in patients with preexisting disease who present with gastrointestinal symptoms such as dysphagia, odynophagia, and hematemesis. Early recognition of esophageal involvement of PV and initiation of corticosteroid and/or immunosuppressant therapy may improve the outcome of the disease.
Using Micro-CT Derived Bone Microarchitecture to Analyze Bone Stiffness - A Case Study on Osteoporosis Rat Bone
Authors: Yuchin Wu, Samer Adeeb, Michael R Doschak
Journal: Front Endocrinol (Lausanne) (2015)
Keywords: bone stiffness, finite element analysis, micro-computed tomography, microstructural parameters

Micro-computed tomography (Micro-CT) images can be used to quantitatively represent bone geometry through a range of computed attenuation-based parameters. Nonetheless, those parameters remain indirect indices of bone microarchitectural strength and require further computational tools to interpret bone structural stiffness and potential for mechanical failure. Finite element analysis (FEA) can be applied to measure trabecular bone stiffness and potentially predict the location of structural failure in preclinical animal models of osteoporosis, although that procedure from image segmentation of Micro-CT derived bone geometry to FEA is often challenging and computationally expensive, resulting in failure of the model to build. Notably, the selection of resolution and threshold for bone segmentation are key steps that greatly affect computational complexity and validity. In the following study, we evaluated an approach whereby Micro-CT derived grayscale attenuation and segmentation data guided the selection of trabecular bone for analysis by FEA. We further correlated those FEA results to both two- and three-dimensional bone microarchitecture from sham and ovariectomized (OVX) rats (n = 10/group). A virtual cylinder of vertebral trabecular bone 40% in length from the caudal side was selected for FEA, because Micro-CT based image analysis indicated the largest differences in microarchitecture between the two groups resided there. Bone stiffness was calculated using FEA and statistically correlated with the three-dimensional values of bone volume/tissue volume, bone mineral density, fractal dimension, trabecular separation, and trabecular bone pattern factor. Our method simplified the process for the assessment of trabecular bone stiffness by FEA from Micro-CT images and highlighted the importance of bone microarchitecture in conferring significantly increased bone quality capable of resisting failure due to increased mechanical loading.
Renal Endometriosis Mimicking Cystic Renal Tumor: Case Report and Literature Review
Authors: Ye Yang, Xinxin Zhao, Ying Huang
Journal: Front Med (Lausanne) (2021)
Keywords: computed tomography, cystic renal tumor, endometriosis, renal endometriosis, ultrasonography
MeSH terms: Case Reports

Background: Endometriosis mainly affects female pelvic tissues and organs, and the presence of endometriosis in the kidney is extremely rare. Case Presentation: We report a case of a 48-year-old woman who presented with intermittent hematuria. She was found to have a cystic mass on renal ultrasonography, and contrast-enhanced computed tomography (CT) showed slight enhancement of the cystic wall and septa. These findings were indicative of cystic renal tumor. The patient subsequently underwent partial right nephrectomy. Histopathology revealed endometriosis of the right renal parenchyma. The patient recovered well and had no evidence of a recurrent renal mass at the 3 months' follow up. Conclusion: The possibility of renal endometriosis should be considered in a female patient with a cystic renal mass and clinical symptoms related to the menstrual cycle.
A Novel Mutation in ABCA1 Gene Causing Tangier Disease in an Italian Family with Uncommon Neurological Presentation
Authors: Marco Ceccanti, Chiara Cambieri, Vittorio Frasca, Emanuela Onesti, Antonella Biasiotta, Carla Giordano, Sabina M Bruno, Giancarlo Testino, Marco Lucarelli, Marcello Arca, Maurizio Inghilleri
Journal: Front Neurol (2016)
Keywords: tangier, demyelinating, hypoalphalipoproteinemia, neuropathy
MeSH terms: Case Reports

Tangier disease is an autosomal recessive disorder characterized by severe reduction in high-density lipoprotein cholesterol and peripheral lipid storage. We describe a family with c.5094C > A p.Tyr1698* mutation in the ABCA1 gene, clinically characterized by syringomyelic-like anesthesia, demyelinating multineuropathy, and reduction in intraepidermal small fibers innervation. In the proband patient, cardiac involvement determined a myocardial infarction; lipid storage was demonstrated in gut, cornea, and aortic wall. The reported ABCA1 mutation has never been described before in a Tangier family.
Effectiveness of a Peer-Led Pain Management Program in Relieving Chronic Pain and Enhancing Pain Self-Efficacy Among Older Adults: A Clustered Randomized Controlled Trial
Authors: Mimi M Y Tse, Shamay S M Ng, Paul H Lee, Xue Bai, Raymond Lo, Shuk Kwan Tang, Ka Long Chan, Yajie Li
Journal: Front Med (Lausanne) (2021)
Keywords: chronic pain, nursing home residents, pain management program, peer-led, randomized controlled trial
MeSH terms: Case Reports

Chronic pain is common in nursing home residents, who may have difficulty seeking out pain management strategies. Peer support model show promise as a strategy for managing chronic conditions. This was a clustered randomized controlled trial. A peer-led pain management program was provided for the experimental group. Pain situation, depression, quality of life, non-drug strategies used, and pain knowledge were measured. A total of 262 participants joined the study (146 were allocated as experimental group and 116 as control group). Before our intervention, the mean pain score reported was as high as 6.36 on a 10-point Likert Scale. The high intensity of their pain very much interfered with the daily activities of the participants. Pain interference was high and the participants had poor coping as indicated by the low pain self-efficacy. Depression and a low quality of life score was found. Upon completion of our PAP, there was a significant increase in pain self-efficacy, pain interference as well as quality of life for the participants in the experimental group and not in the control group, and this improvement sustained in 3-month follow up. The present study used a peer support models and proven to be effective in managing pain and pain related situations for nursing home residents with chronic pain. The peer volunteers involved in the pain management program taught relevant pain knowledge and pain management strategies to help our participants. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03823495, NCT03823495.
Avoidance of total abdominal wall loss despite torso soft tissue clostridial myonecrosis: a case report
Authors: Chad Geoffrey Ball, Jean-Francois Ouellet, Ian Bruce Anderson, Andrew Wallace Kirkpatrick
Journal: J Med Case Rep (2013)

Introduction:
Clostridial necrotizing soft tissue infections are often fatal. Myonecrosis of the torso is a particularly lethal combination given the classic need for radical debridement of the abdominal and thoracic walls, and therefore total exposure of the intraperitoneal and intrathoracic viscera. This case is unusual do to our ability to preserve anatomical separation between the viscera and the atmosphere.
Case presentation:
We present a 42-year-old Caucasian man with obesity and diabetes who developed clostridial myonecrosis of his right torso following a mesenteric lymph node biopsy. This required an aggressive debridement (sparing subcutaneous flaps and internal oblique aponeurosis) followed by reconstruction of his right hemi-torso with a biologic prosthesis to prevent subsequent hernia formation.
Conclusion:
Although basic principles associated with radical debridement were maintained, a full thickness torso wall resection was avoided. This provided reconstruction advantages that included endogenous subcutaneous flap coverage, separation of the peritoneal cavity by the internal oblique aponeurosis, and prevention of a subsequent hernia below the arcuate line. This technique would be of interest to any surgeon or clinician who treats patients with life-threatening torso soft tissue infections.
Pulp revascularization in immature permanent tooth with apical periodontitis using mineral trioxide aggregate
Authors: Katsura Saeki, Yuko Fujita, Yasuhiro Shiono, Yasuhiro Morimoto, Kenshi Maki
Journal: Case Rep Med (2014)

Mineral trioxide aggregate (MTA) is a material that has been used worldwide in several clinical applications, such as apical barriers in teeth with immature apices, repair of root perforations, root-end filling, pulp capping, and pulpotomy. The purpose of this case report was to describe successful revascularization treatment of an immature mandibular right second premolar with apical periodontitis in a 9-year-old female patient. After preparing an access cavity without anesthesia, the tooth was isolated using a rubber dam and accessed. The canal was gently debrided using 5% sodium hypochlorite (NaOCl) and 3% hydrogen peroxide irrigant. And then MTA was packed into the canal. X-ray photographic examination showed the dentin bridge 5 months after the revascularization procedure. Thickening of the canal wall and complete apical closure were confirmed 10 months after the treatment. In this case, MTA showed clinical and radiographic success at revascularization treatment in immature permanent tooth. The successful outcome of this case suggests that MTA is reliable and effective for endodontic treatment in the pediatric dentistry.
Effect of intravitreal C3F8 gas in patients with vitreomacular traction: A retrospective case series
Authors: Anna-Maria Haas, Christoph Mayer, Anton Haas, Werner Wackernagel
Journal: Spektrum Augenheilkd (2018)
Keywords: intravitreal gas, perfluoropropane (c3f8), pneumatic vitreolysis, vitreomacular adhesion, vitreomacular traction

Background:
We aimed to assess the efficacy of a single intravitreal perfluoropropane (C3F8) gas injection for the treatment of vitreomacular traction with or without a macular hole.
Methods:
In this retrospective case series, seven eyes of six patients with symptomatic vitreomacular traction documented on optical coherence tomography, one with a macular hole additionally, received a single intravitreal C3F8 gas injection of up to 0.3 ml. The primary endpoint was vitreomacular traction release at 1 month after injection. Secondary endpoints included resolution of vitreomacular adhesion within 6 months, nonsurgical closure of macular holes, and change in central foveal thickness and best-corrected visual acuity.
Results:
Overall, on optical coherence tomography, six of seven eyes (85.7%) had release of vitreomacular traction during the entire study duration: three within 1 month of injection and the other three within 6 months. Of the latter group, two of the three eyes showed a concurrent epiretinal membrane and one concurrent diabetic retino- and maculopathy. The patient with a macular hole had resolution of vitreomacular traction within 1 month but had to undergo vitrectomy because of nonclosure of the macular hole. Associated adverse events were macular edema with a consequent lamellar hole after injection in one patient, and another patient developed retinal detachment.
Conclusion:
Intravitreal C3F8gas injection is an inexpensive and promising minimally invasive option for the treatment of symptomatic and persistent vitreomacular traction with or without a macular hole. Further larger studies, especially comparing C3F8 gas injection with other treatment options, are needed.
Thoracolumbar Chance fracture during a professional female soccer game: case report
Authors: Alberto Ofenhejm Gotfryd, Fernando José Franzin, Roger Hartl
Journal: Einstein (Sao Paulo) (2016)
MeSH terms: Lumbar Vertebrae / injuries, Soccer / injuries, Spinal Fractures / surgery, Case Reports, Female, Humans, Lumbar Vertebrae / surgery, Spinal Fractures / diagnosis, Spinal Fusion / rehabilitation, Young Adult

We report a rare case of an unstable flexion-distraction spine fracture with ligament involvement that occurred during a professional female soccer game. There were no neurological déficit. The patient had a painful midline gap which suggested ligamentar injury that was not immediately recognized. Despite that, proper immobilization and referral to hospital for further evaluation avoided additional spinal cord damage. The patient underwent a monosegmental posterior instrumentation spine fusion and after 6 months returned to professional soccer activities. This paper alerts to the possibility of occurrence of severe and unstable spine injuries during soccer practice and the importance of an adequate initial care at the game field in order to avoid iatrogenic neurological injuries.
Trapezium Fracture Associated with Thumb Carpometacarpal Joint Dislocation: A Report of Three Cases and Literature Review
Authors: Sho Kohyama, Toshikazu Tanaka, Akira Ikumi, Yasukazu Totoki, Kosuke Okuno, Naoyuki Ochiai
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Isolated trapezium fracture in combination with thumb carpometacarpal (CMC) joint dislocation is extremely rare, and no treatment consensus exists. Herein, we report 3 successfully treated cases of isolated trapezium fracture with thumb CMC joint dislocation. While good short-term results have been reported in the literature, the possibility of substantial ligament injuries that can lead to future instability of the thumb CMC joint must be noted. In order to obtain an excellent long-term clinical result, we propose the consideration of the anatomical repair of the CMC joint in terms of both bony and ligamentous structures in cases where instability remains after fracture fixation.
Awake fibreoptic intubation in the sitting position in a patient with a huge goitre
Authors: Kirti Nath Saxena, Sudhir Kumar, Bharti Taneja, Prachi Gaba
Journal: Case Rep Anesthesiol (2011)
MeSH terms: Case Reports

A 46-year-old woman was anesthetized for total thyroidectomy. The thyroid was massive, deviating the trachea to the right and causing attenuation of the trachea radiologically. She had symptoms of respiratory obstruction in the supine position. Awake FOB-guided intubation was done in sitting position after airway topicalisation, and the airway was intubated with difficulty with 7.0 mm cuffed orotracheal tube. We describe this case in detail and discuss the significance of careful approach to planning and preparation in the management of such a case.
Postoperative management with dexmedetomidine in a pregnant patient who underwent AVM nidus removal: a case report
Authors: Chanatthee Kitsiripant, Kotoe Kamata, Rie Kanamori, Koji Yamaguchi, Makoto Ozaki, Minoru Nomura
Journal: JA Clin Rep (2017)
Keywords: dexmedetomidine, intracranial arteriovenous malformation, normal perfusion pressure breakthrough, pregnancy

Background:
Following cerebral arteriovenous malformation (AVM) surgery, severe brain edema and hemorrhage may be caused by postoperative normal perfusion pressure breakthrough (NPPB). Sedation is necessary for this population. It is a challenge for the anesthesiologist to maintain hemodynamic stability without interfering with the neurological assessment. In Japan, propofol is contraindicated for pregnant patients. Dexmedetomidine is a versatile drug in anesthesia practice and may be useful for this situation. There is no report using dexmedetomidine for the purpose of NPPB control in pregnant patients. We describe the postoperative management with dexmedetomidine for a pregnant patient who underwent cerebral AVM nidus removal.
Case presentation:
A 32-year-old patient presented with headache at the 16th week of gestation. Neuroimaging revealed an intraventricular hemorrhage and an AVM at the right anterior horn of the lateral ventricle which caused bleeding. A multidisciplinary team discussion was done, and then a craniotomy for AVM nidus removal was performed under general anesthesia. Preanesthetic aspiration prophylaxis and rapid sequence induction were added to our conventional anesthetic management. Hypotension occurred after anesthetic induction but the patient recovered by volume resuscitation and vasopressors. Anesthesia was maintained with 50% O2 in air and sevoflurane. The AVM was completely removed, and no perioperative complications occurred. Postoperative sedation with dexmedetomidine was used to prevent breakthrough hyperperfusion and cerebral edema.
Conclusions:
Dexmedetomidine infusion was used for postoperative sedation without causing any side effects, and it can be an alternative for sedation, especially when propofol is contraindicated.
Case Report: EBV Chronic Infection and Lymphoproliferation in Four APDS Patients: The Challenge of Proper Characterization, Therapy, and Follow-Up
Authors: Beatrice Rivalta, Donato Amodio, Cinzia Milito, Maria Chiriaco, Silvia Di Cesare, Carmela Giancotta, Francesca Conti, Veronica Santilli, Lucia Pacillo, Cristina Cifaldi, Maria Giovanna Desimio, Margherita Doria, Isabella Quinti, Rita De Vito, Gigliola Di Matteo, Andrea Finocchi, Paolo Palma, Antonino Trizzino, Alberto Tommasini, Caterina Cancrini
Journal: Front Pediatr (2021)
Keywords: apds, ebv, pi3k-akt-mtor, pi3kdelta kinase, lymphoproliferation, p110δ, p85α
MeSH terms: Case Reports

Activated PI3K-kinase Delta Syndrome (APDS) is an autosomal-dominant primary immunodeficiency (PID) caused by the constitutive activation of the PI3Kδ kinase. The consequent hyperactivation of the PI3K-Akt-mTOR pathway leads to an impaired T- and B-cells differentiation and function, causing progressive lymphopenia, hypogammaglobulinemia and hyper IgM. Patients with APDS show recurrent sinopulmonary and chronic herpes virus infections, immune dysregulation manifestations, including cytopenia, arthritis, inflammatory enteropathy, and a predisposition to persistent non-neoplastic splenomegaly/lymphoproliferation and lymphoma. The recurrence of the lymphoproliferative disorder and the difficulties in the proper definition of malignancy on histological examination represents the main challenge in the clinical management of APDS patients, since a prompt and correct diagnosis is needed to avoid major complications. Targeted therapies with PI3Kδ-Akt-mTOR pathway pharmacologic inhibitors (i.e., Rapamycin, Theophylline, PI3K inhibitors) represent a good therapeutic strategy. They can also be used as bridge therapies when HSCT is required in order to control refractory symptoms. Indeed, treated patients showed a good tolerance, improved immunologic phenotype and reduced incidence/severity of immune dysregulation manifestations. Here, we describe our experience in the management of four patients, one male affected with APDS1 (P1) and the other three, a male and two females, with APDS2 (P2, P3, P4) presenting with chronic EBV replication, recurrent episodes of immune dysregulation manifestations and lymphomas. These cases highlighted the importance of a tailored and close follow-up, including serial endoscopic and lymph nodes biopsies control to detect a prompt and correct diagnosis and offer the best therapeutic strategy.
A Rare Incidence of Sweating Sickness-Like Symptoms in a Crossbred Holstein Friesian Cow in Chattogram, Bangladesh
Authors: Omar Faruq, Eti R Sarkar, Suchandan Sikder
Journal: Case Rep Vet Med (2023)
MeSH terms: Case Reports

In this report, an incidence of sweating sickness-like symptoms in a crossbred Holstein Friesian cow was diagnosed. The cow was suffering from vaporization of the skin, dehydration, wet hair coat, and matting of hair due to excessive sweating. There were several ticks, flies, and mosquitoes in tail switch and other parts of the body. Blood and urine parameters were tested. We treated the patient successfully with ivermectin as ectoparasite control, ceftiofur sodium antibiotic to treat bacterial infections, ketoprofen as analgesics and antipyretics, chlorpheniramine maleate as H2-blocker, and trichlorfon and povidone-iodine skin spray to prevent fly invasion and prevent opportunistic bacterial infection, respectively. Acyclovir and oil of turpentine were suggested to be sprayed on the floor and wall of the shed for viral and ectoparasitic control. Our treatment regime successfully recovered the cow with no recurrence.