OpenMed/multicare-articles huggingface dataset:
Closure of Orocutaneous Fistula Using Submandibular Gland as a Pedicled Flap
Authors: Erol Cansiz, Emine Deniz Gozen, Murat Yener
Journal: Case Rep Dent (2019)
MeSH terms: Case Reports

Orocutaneous fistulas in the maxillofacial region may be due to tumor resection, osteoradionecrosis, or trauma, and these defects limit the function of the patients and effect aesthetic and also psychological condition. Articulation and nutrition are also affected by these fistulas. Local flaps can be used for the reconstruction of small- and medium-sized defects with ease. Submandibular gland with its rich blood supply from the facial artery is a practical and useful choice for the reconstruction of mandibular region defects.
Esophageal tuberculosis as an unusual cause of dysphagia: a case report
Authors: Moufida Mahmoudi, Samir Bradai, Amal Khsiba, Asma Ben Mohamed, Jawhar Bradai, Mouna Medhioub, Lamine Hamzaoui, Mohamed Mousadek Azouz
Journal: Pan Afr Med J (2022)
Keywords: dysphagia, case report, esophageal localization, tuberculosis
MeSH terms: Deglutition Disorders / etiology, Mediastinal Diseases / diagnosis, Tuberculosis, Miliary / complications, Case Reports, Granuloma, Humans, Ulcer

Esophageal tuberculosis is a rare cause of infectious esophagitis, even in countries with endemic tuberculosis. This impairment is often secondary. We report a case of secondary esophageal tuberculosis in an immunocompetent patient, clinically revealed by dysphagia. Esophagogastroduodenoscopy showed a large ulcer in the middle third of the esophagus with a fistula opening in the center of the ulcer. Histopathological examination of multiple esophageal tissue biopsies revealed epithelioid cell granulomas without caseous necrosis. We completed with Computed Tomography (CT) scan of the chest which revealed a fistula of the middle third of the esophagus, multiple mediastinal necrotic adenopathies and diffuse pulmonary micronodules suggesting miliary tuberculosis. Sputum examination for acid-fast-bacilli was positive. Anti-tuberculosis treatment resulted in a good response with complete remission. It is therefore important to recognize and include this entity in the differential diagnosis of patients with dysphagia particularly in countries with a high incidence of tuberculosis.
Diffuse alveolar hemorrhage: a rare life-threatening condition in systemic lupus erythematosus
Authors: Ravi Paul Singh Virdi, Adeel Bashir, Ghulamullah Shahzad, Javed Iqbal, Jose O Mejia
Journal: Case Rep Pulmonol (2012)
MeSH terms: Case Reports

Diffuse alveolar hemorrhage (DAH) is a rare life-threatening complication in systemic lupus erythematosus (SLE) associated with high mortality rates. DAH is more common in women, and mean age of onset is around 30 years. It mostly occurs in patients with established diagnosis of SLE but can be the initial presentation of lupus in approximately 20%. DAH should be suspected in lupus patient presenting with new pulmonary infiltrates, decline in hemoglobin, hemoptysis, dyspnea, hypoxemia, and increase in carbon monoxide diffusion capacity. Radiographic evidence of bilateral pulmonary alveolar infiltrates that are usually perihilar or basilar with sparing of apices is seen. DAH can often mimic clinically and radiologically severe pneumonia or ARDS. Treatment includes high-dose corticosteroids, cyclophosphamide, and plasmapheresis. We report a case of diffuse alveolar hemorrhage complicating SLE flare-up in a male patient.
Bilateral Retinal Angiomatous Proliferation in a Variant of Retinitis Pigmentosa
Authors: G Aloe, C M De Sanctis, C Strafella, R Cascella, F Missiroli, M Cesareo, E Giardina, F Ricci
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Purpose:
To describe the first case of bilateral retinal angiomatous proliferation (RAP) in a patient with a variant of retinitis pigmentosa (RP).
Case report:
An 85-year-old man with RP presented with visual acuity decrease and metamorphopsia in the left eye (LE). Fundus examination revealed typical signs of RP in both eyes, associated with intraretinal macular hemorrhage in the LE. Multimodal imaging, using Colour fundus Photography, Fluorescein (FA), and Indocyanine Green Angiography (ICGA) as well as Spectral-Domain Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCTA), revealed a type 3 neovascular lesion in the involved eye. Genetic testing (NGS analysis) was performed to search for genetic variants correlated with the disease phenotype displayed by the patient. The patient was treated with intravitreal injections of bevacizumab, according to a fixed protocol of bimonthly injections plus a booster dose at second month. After 9 months, he was referred for visual acuity decrease and metamorphopsia in the fellow eye, where SD-OCT/OCTA showed a type 3 neovascular lesion in the right eye (RE). He was scheduled for intravitreal injections of bevacizumab. In both eyes, treatment with intravitreal bevacizumab was successful.
HHV-6 Infection in a 19-Year-Old Liver Transplant Recipient - Much More Than Roseola!
Authors: Alleyna Dougherty, Nathan DeRon Jr, Leigh Hunter
Journal: IDCases (2023)
Keywords: hhv-6, human herpesvirus-6, immunosuppression, liver transplant, roseola
MeSH terms: Case Reports

Human herpesvirus 6 (HHV-6) infections, most commonly occurring during childhood, are frequently mild and self-limited. However, immunosuppression due to transplantation may cause reactivation of HHV-6 with manifestations ranging from fever and skin exanthem to pneumonitis, hepatitis, encephalitis, and myelitis. Because these infections may be devastating for liver transplant recipients leading to transplant organ fibrosis and failure, it is imperative that internists recognize the manifestations, establish early diagnosis, institute appropriate therapy, and make timely referrals to transplant specialists. We present a case of a 19-year-old liver transplant recipient with HHV-6 viremia, encephalopathy, and hepatitis. The patient's symptoms improved with ganciclovir and intravenous immunoglobulin treatment, serum HHV-6 copies gradually decreased, and she was discharged with outpatient follow-up. After approximately one month of antiviral therapy, the patient's viral load was undetectable. Early recognition of HHV-6 viremia, appropriate laboratory assessment, and early institution of therapy is important for internal medicine physicians to decrease morbidity and mortality in liver transplant recipients.
Case Report: Synchronous primary malignancy including the breast and endometrium
Authors: Elham Sadat Banimostafavi, Sepideh Tayebi, Maryam Tayebi, Fatemeh Montazer
Journal: F1000Res (2017)
Keywords: breast, cancer, endometrium, multiple primary malignancy

Breast and endometrial cancer are the most common types of female cancers, but the incidence of both of these malignancies in a single patient is a rare event. Multiple primary malignancy has been increasingly reported over the past decade, and double primary cancer is considered as the most common type. In this study, we present a 53-year-old woman with synchronous primary malignancy of breast and endometrium. This patient had a history of breast and endometrial cancer in her family. Mammography and chest CT of the patient revealed a mass in the right breast and left supraclavicular region. However, the patient did not want to initiate treatment. Subsequently, the patient returned with a chief complaint of persistent abnormal vaginal bleeding. Abdominopelvic CT scan of the patient revealed a huge soft tissue mass in the pelvic cavity. She underwent hysterectomy, and pathology revealed endometrioid carcinoma, which had invaded the full thickness of uterine wall. Since this type of malignancy is rare and several risk factors are associated with it, it is worth being considered by clinicians when making decisions about screening or strategy for prevention.
A Case of Terson-Like Syndrome in a Patient with Viral Meningoencephalitis
Authors: Masumi G Asahi, Stephanie J Weiss, Krishi Peddada, Deepika Malik
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

The proposed mechanism of Terson's syndrome is increased intracranial pressure that leads to dilation of the retrobulbar optic nerve and compression of the central retinal vein. Terson's syndrome has been associated with many conditions that increase intracranial pressure such as venous sinus thrombosis, Moyamoya disease, leukemia, direct head trauma, and intraocular hemorrhage related to shaken baby syndrome. We present a novel case of a patient with recent viral prodrome found to have papilledema and multilayered retinal hemorrhages consistent with Terson syndrome. Computed tomography and magnetic resonance venography of the brain did not reveal any subdural, subarachnoid, or intracranial hemorrhages. However, cerebrospinal fluid analyses were significant for increased opening pressure and elevated protein levels, which were suggestive of viral meningoencephalitis. We describe this case as a Terson-like syndrome because the etiology of intraocular hemorrhage is increased intracranial pressure. However, this case does not fit the traditional presentation of Terson's syndrome as the intracranial pressure is secondary to meningeal inflammation instead of subdural, subarachnoid, or intracranial hemorrhage. We strongly feel that it is important for physicians to be aware of the link between viral meningoencephalitis and retinal conditions such as Terson-like syndrome because it can facilitate rapid diagnosis and treatment.
Unique case reports associated with ovarian failure: necessity of two intact x chromosomes
Authors: Lakshmi Rao Kandukuri, Venkata Padmalatha, Murthy Kanakavalli, Raseswari Turlapati, Mangalipally Swapna, Metuku Vidyadhari, Govindaraghavan Saranaya, Kattera Himaja, Mamata Deenadayal, Bipin Kumar Sethi, Prasun Deb, Nalini Gupta, Baidyanath Chakraborthy, Pratibha Nallari, Lalji Singh
Journal: Case Rep Genet (2012)
MeSH terms: Case Reports

Premature ovarian failure is defined as the loss of functional follicles below the age of 40 years and the incidence of this abnormality is 0.1% among the 30-40 years age group. Unexplained POF is clinically recognized as amenorrhoea (>6 months) with low level of oestrogen and raised level of Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH > 20 IU/l) occurring before the age of 40. It has been studied earlier that chromosomal defects can impair ovarian development and its function. Since there is paucity of data on chromosomal defects in Indian women, an attempt is made to carry out cytogenetic evaluation in patients with ovarian failure. Cytogenetic analysis of women with ovarian defects revealed the chromosome abnormalities to be associated with 14% of the cases analyzed. Interestingly, majority of the abnormalities involved the X-chromosome and we report two unique abnormalities, (46,XXdel(Xq21-22) and q28) and (mos,45XO/46,X+ringX) involving X chromosome in association with ovarian failure. This study revealed novel X chromosome abnormalities associated with ovarian defects and these observations would be helpful in genetic counseling and apart from, infertility clinics using the information to decide suitable strategies to help such patients.
Pregnancy and Lactation in a 67-Year-Old Elderly Gravida following Donor Oocyte In Vitro Fertilization
Authors: Leila Magistrado, Mary C Tolcher, Anju Suhag, Sonal Zambare, Kjersti M Aagaard
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

There is limited data on the anticipated perinatal course among gravidae in their sixth and seventh decades. Our objective was to describe the relatively uncomplicated prenatal, intrapartum, and postpartum course of a 67-year-old essential primigravida. Briefly, our patient conceived a singleton pregnancy via IVF with donor oocytes, then presented at 13 6/7 weeks of gestation to initiate prenatal care. Her medical history was significant for chronic hypertension, hyperlipidemia, and obesity. Her cardiac function was monitored throughout pregnancy, and she delivered at 36 1/7 weeks by cesarean for a decline in left ventricular function with mitral regurgitation. Her intrapartum and postpartum course was uncomplicated, and she was able to successfully breastfeed for six months and resume prepregnancy activity. For comparison, we analyzed deliveries among gravidae > 45 years of age from our institutional obstetrical database (2011-2018). This case represents the eldest gravidae identified in the literature and illustrates the potential for a relatively uncomplicated perinatal course with successful lactation. This case may enable other providers to counsel elderly patients on anticipated outcomes inclusive of ability to breastfeed.
Management of a measles outbreak in a reception facility for asylum seekers in Regensburg, Germany
Authors: Benedikt M J Lampl, Markus Lang, Matthias Pregler, Marc Zowe, Rainer Beck, Katharina Schönberger
Journal: GMS Hyg Infect Control (2019)
Keywords: asylum seekers, infection control, measles outbreak, reception facility
MeSH terms: Case Reports

In July/August 2018, a measles outbreak occurred in a reception facility for asylum seekers in Regensburg, Bavaria, Germany. A five-year-old child and an 18-year-old man from Moldova were affected. At the time of the report, 491 people were accommodated at the facility. The outbreak was limited to the two cases mentioned by the consistent use of infection control measures. Decisive factors for successfully combating this outbreak were, in particular, the close cooperation of the local public health authority (Gesundheitsamt) with the district government officials, the institution's management, and the general practitioners on site. The measures taken included the early information of all parties involved, the timely and repeated implementation of containment vaccinations, a consequent segregation of contagion and/or disease suspects and the critical consideration of each individual case in connection with the separate risk-adapted segregation of particularly vulnerable cohorts.
Tolvaptan treatment in an adult Fontan patient with protein-losing enteropathy: a serial 23Na-MRI investigation
Authors: Julia Moosmann, Okan Toka, Peter Linz, Anke Dahlmann, Armin M Nagel, Mario Schiffer, Michael Uder, Robert Cesnjevar, Sven Dittrich, Christoph Kopp
Journal: Ther Adv Chronic Dis (2021)
Keywords: 23na-mri, congenital heart disease, fontan, raas, tolvaptan
MeSH terms: Case Reports

Background:
Protein-losing enteropathy (PLE) is a severe complication of the univentricular Fontan circulation and associated with disturbances in salt and water homeostasis. Fontan patients with PLE have a poor prognosis, with increased morbidity and mortality. Due to limited therapeutic strategies, patients are often treated only symptomatically.
Methods:
We report our first experience of Tolvaptan (TLV) treatment in a Fontan patient with PLE, severe volume retention and hyponatraemia, refractory to conventional diuretic therapy. In addition to clinical parameters, we monitored drug effects including tissue sodium and volume status via serial 23Na-magnetic resonance imaging (23Na-MRI) and bioimpedance spectroscopy compared with age-matched controls.
Results:

23Na-MRI identified elevated tissue sodium, which decreased under TLV treatment, as well as volume status, while serum sodium increased and the patient's symptoms improved. During long-term treatment, we were able to differentiate between sodium and volume status in our patient, suggesting that TLV uncoupled body sodium from water.
Conclusion:
TLV in addition to loop diuretics improved clinical symptoms of PLE and lowered tissue sodium overload. Long-term effects should be further evaluated in Fontan patients.
Challenges to the delivery of clinical diabetes services in Ghana created by the COVID-19 pandemic
Authors: Eunice Twumwaa Tagoe, Justice Nonvignon, Robert van Der Meer, Itamar Megiddo, Brian Godman
Journal: J Health Serv Res Policy (2023)
Keywords: covid-19, ghana, diabetes service delivery
MeSH terms: COVID-19 / epidemiology, Diabetes Mellitus / epidemiology, Diabetes Mellitus / therapy, Research Support, Non-U.S. Gov't, Delivery of Health Care, Ghana / epidemiology, Humans, Pandemics

Objective:
The barriers to delivering clinical non-communicable disease services in low- and middle-income countries have risen with the onset of COVID-19. Using Ghana as a case study, this article examines the changes COVID-19 has brought to diabetes service delivery and considers policy responses to deal with future such outbreaks.
Methods:
We conducted 18 interviews between November 2020 and February 2021 with health professionals and administrators from primary, secondary and tertiary facilities within the Ghana Health Service. The analysis was performed using deductive and inductive methods.
Results:
There were six general themes in interviewees' responses: (1) COVID-19 had exacerbated the problems of high medicine and service costs and medicine shortages, (2) the pandemic had exacerbated problems of poor patient record keeping, (3) COVID-19 had reduced the availability of suitably trained health providers, (4) staff had become demoralized by management's unwillingness to make innovative changes to cope with the pandemic, (5) COVID-19 led to a reorganization of diabetes services, and (6) the country's national health insurance scheme lacked flexibility in dealing with the pandemic.
Conclusions:
Access to resources is limited in LMICs. However, our study highlights practical policy responses that can improve health providers' response to COVID-19 and future pandemics.
A Synchronous Diagnosis of Metastatic Male Breast Cancer and Prostate Cancer
Authors: Leila Moosavi, Phyllis Kim, An Uche, Everardo Cobos
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: germline mutation, metastatic male breast cancer, pleural effusion, prostate cancer, synchronous
MeSH terms: Adenocarcinoma / diagnosis, Breast Neoplasms, Male / diagnosis, Neoplasms, Multiple Primary / diagnosis, Prostatic Neoplasms / diagnosis, Case Reports, Biopsy, Large-Core Needle, Breast / pathology, Humans, Male, Middle Aged, Nigeria

In this article, we present a patient diagnosed synchronously with metastatic male breast cancer and prostate cancer. This is a 63-year-old male and recent immigrant from Nigeria, who sought medical attention for progressively worsening of shortness of breath and acute progression of a chronic right breast mass. An invasive breast carcinoma was diagnosed by the core biopsy of the right breast mass. Within 2 months of his breast cancer diagnosis, the patient also was diagnosed with prostate adenocarcinoma after being worked up for urinary retention. By presenting this patient with a synchronous diagnosis with metastatic male breast cancer and prostate cancer, history of chronic right breast mass, and gynecomastia, we speculate on possible cancer etiologies and risk factors.
Player Experience During the Junior to Senior Transition in Professional Football: A Longitudinal Case Study
Authors: Scott C Swainston, Mark R Wilson, Martin I Jones
Journal: Front Psychol (2020)
Keywords: elite sport, longitudinal, soccer, talent development, video diaries, within career transition

The purpose of this study was to explore the evolving perspectives of young players experiences going through the junior to senior transition in professional football. A primary objective was to adopt novel methods - weekly video diaries - to allow participants to control and report their own narratives as the transition unfolded over 40 weeks. Semi structured interviews, held at four time points, allowed the lead researcher to probe further on themes that were developing. Six participants from the academy volunteered to take part, but only the three who earned professional contracts completed the study. The primary themes in the academy were the pressure experienced waiting for the contract decision, and then preparation for senior football and the first team environment once contracts were awarded. Adaptation to senior football included not only increased physical and mental demands but also those related to the different style of play, the pressure to win, and how these both impacted decision-making. The football club set up two pathways to support this adaptation, loan moves and time with the U23's. In the following season, the move to the senior squad was characterized by a lack of opportunity to play for the first team, resulting in additional loan moves. These moves, and the associated perceived lack of support structures, led to the participants experiencing issues with their club identity, their motivation and their confidence. Internal (mindset) and external (social support) coping strategies were developed over the study's duration. Concluding comments from participants were related to greater acceptance of the need to be patient, perhaps reflecting on the club's reputation of giving young players a sound football education. These phases of the transition came with ups and downs for each participant illuminating key elements of the adaptation to senior competition, barriers to transition without early success, and social aspects of the transition. Enhanced detail to these key areas poses important questions for future research and applied practice.
Nivolumab and Ipilimumab Combination Immunotherapy for Patients with Metastatic Collecting Duct Carcinoma
Authors: Tetsuya Danno, Shohei Iwata, Fusako Niimi, Sachi Honda, Haruka Okada, Takeshi Azuma
Journal: Case Rep Urol (2021)
MeSH terms: Case Reports

Collecting duct carcinoma (CDC) is a rare, extremely aggressive form of renal cancer. Recently, immune checkpoint inhibitors (ICI), anti-programmed death-1 (PD-1) antibody, and anti-cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) antibody were approved for use against metastatic renal cell carcinoma. We herein described two cases of metastatic renal collecting duct carcinoma treated with a combination immunotherapy consisting of nivolumab and ipilimumab. In the first case, which included a bone metastasis, the best response achieved was stable disease (SD) for one year. In the second case, which was accompanied by a lung metastasis, the best response achieved was a partial response. The outcome of these cases suggested that the combination of nivolumab and ipilimumab is effective against renal collecting duct carcinoma.