OpenMed/multicare-articles huggingface dataset:
Huntington's disease: a forensic risk factor in women
Authors: Elvina May-Yin Chu, Mari O'Neill, Debasish Das Purkayastha, Caroline Knight
Journal: J Clin Mov Disord (2019)
Keywords: forensic risk, huntington’s disease, neuropsychiatry
MeSH terms: Case Reports

Background:
Huntington's disease (HD) is an autosomal dominant, neurodegenerative disorder. Associated cognitive deficits including impulsivity and disinhibition are the same factors that also predispose to forensic risk. Men tend to be perpetrators of more severe violent behaviours than women and women are less likely than men to be arrested for violence. This finding is not applicable in the case of women with Huntington's disease and explored in the three clinical cases of women with HD and their forensic histories that are subsequently described.
Case presentation:
'A' was admitted from court following a charge of arson and reckless behavior, with increasing severity and frequency of self-harm and attempted suicide. This case demonstrates someone who had previously presented to psychiatric services on multiple occasions for various reasons, culminating in a serious criminal charge of arson due to psychiatric symptoms associated with HD.'B' was arrested and imprisoned after having been charged with actual bodily harm (ABH) for assaulting her partner and young daughter then breaking her bail conditions. Although she was gene positive for HD she had no neurological symptoms of the disease. B was given leave but needed to be recalled to hospital by police. Six weeks later the medical recommendation for a court imposed hospital order was overturned as B presented and articulated her case so convincingly in court. This case demonstrates that even in the absence of psychiatric history or movement disorder there may be substantial forensic risk indicated by subtle underlying cognitive deficits due to changes in executive function affecting the frontal lobes.'C' was admitted to acute psychiatric services after being found wandering in traffic wanting to die. She had been diagnosed with HD in the previous year and had a long criminal record on a background of alcohol dependency. Following transfer to a specialist psychiatric unit, she engaged well with a neurobehavioural levels system which rewards desirable and appropriate behaviours and she responded well to a highly structured environment resulting in discharge to a community placement.
Conclusions:
These three case studies aim to highlight the need to raise awareness of the increased forensic risk in women with HD. Although criminal behaviour is less frequently observed in women than men and usually violence is less severe in women, HD may cause or contribute to criminal behaviour that can be violent in nature in women who are gene carriers for HD even in the absence of movement disorder, psychiatric symptoms or overt cognitive deficits. Assessment and earlier treatment in appropriate hospital settings may successfully contain and modify behaviours leading to reduced levels of risk and recidivism in this vulnerable patient group.
Severe Hyponatremia due to Levofloxacin Treatment for Pseudomonas aeruginosa Community-Acquired Pneumonia in a Patient with Oropharyngeal Cancer
Authors: Mihaela Mocan, Sorin Nicu Blaga
Journal: Case Rep Med (2016)

Hyponatremia (serum Na levels of <135 mEq/L) is the most common electrolyte imbalance encountered in clinical practice, affecting up to 15-28% of hospitalized patients. This case report refers to a middle-aged man with severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion related to four possible etiological factors: glossopharyngeal squamous cell carcinoma, cisplatin treatment, right basal pneumonia with Pseudomonas aeruginosa, and the treatment with Levofloxacin. This case report discusses a rare complication of common conditions and of a common treatment. To our knowledge this is the first case of hyponatremia related to Levofloxacin and the second related to fluoroquinolones.
No Severe Adverse Effects from Intravitreally Injected Putative Adipose Tissue-Derived Stem Cells
Authors: Carsten Faber, Steffen Heegaard, Jens Folke Kiilgaard
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

This study reports findings from a 56-year-old patient, who had received bilateral intravitreal injection of putative adipose tissue-derived stem cells at a private clinic in India with the promise of treatment of NAION. During an observation period of 8, respectively, 18 months, the intravitreally injected cells remained silent in the vitreous bodies without either therapeutic effects or complications. The cells cleared with vitrectomy without evidence of integration in the optic nerve or retina. Contrary to recent reports on patients receiving intravitreal injections of similar putative stem cells with the aim of treating AMD, our patient suffered no devastating ocular consequences. Summary. Contrary to recent reports, this case demonstrated no devastating consequences of intravitreal injection of adipose tissue-derived stem cells during an observation period of up to 18 months. After vitrectomy, the cells cleared without evidence of either harm or integration.
Pheochromocytoma, "the Great Masquerader," Presenting as Severe Acute Decompensated Heart Failure in a Young Patient
Authors: Hans A Reyes, Jason J Paquin, David M Harris
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

A 22-year-old man presented to the hospital with progressive shortness of breath, chest discomfort, sinus tachycardia, and emesis. The echocardiogram demonstrated global hypokinesis with a left ventricle ejection fraction of 15-20%. The patient was treated for acute systolic heart failure decompensation with diuresis and afterload reduction. Unexpectedly, an abdominal computed tomography showed a left adrenal mass and subsequent serum/urine metanephrine tests suggested pheochromocytoma. Once the patient had stabilized, he underwent an uneventful adrenalectomy with histology results confirming the diagnosis of pheochromocytoma. After six months follow-up, he is currently doing well with close outpatient follow-up by cardiology.
Case Report: Psychoacoustic Analysis of a Clarinet Performance With a Custom-Made Soft Lip Shield Worn to Prevent Mucosal Erosion of Lower Lip
Authors: Gen Tanabe, Mariko Hattori, Satoshi Obata, Yuumi Takahashi, Hiroshi Churei, Akira Nishiyama, Toshiaki Ueno, Yuka I Sumita
Journal: Front Psychol (2022)
Keywords: clarinet, lip shield, mucosal erosion, performing arts, wind instrument
MeSH terms: Case Reports

Introduction:
Wind instrument players sometimes suffer from erosion of the mucous membrane of the lip. This is caused by the action and pressure of the mouthpiece of the wind instrument against teeth. To address this problem, a lip shield is fitted over the dental arch to prevent direct contact between the lips and teeth. However, there are a few studies on the influence of the lip shield on the acoustics of wind instruments. The purpose of this study was to analyze the psychoacoustics of a clarinet performance with the player wearing a custom-made soft lip shield to prevent mucosal erosion of the lower lip.
Case description:
A lip shield was custom-made with a soft thermoplastic material for a female clarinetist who complained of mucosal erosion and pain of the lower lip. The psychoacoustics of her musical performance played in different dynamics, fortissimo, mezzo forte and pianissimo were analyzed, including loudness and sharpness. A self-evaluation questionnaire with items rated on a 10-point scale was administered. After wearing the lip shield, the patient reported that the mucosal erosion and pain of her lower lip when playing clarinet resolved. The lip shield had little effect on the loudness. There was a slight decrease in sharpness when the lip shield was worn compared to when it was not, describing the reduction of high frequencies. Furthermore, fewer variations in sharpness between the tones were observed.
Conclusion:
The results suggest that lip shields made of soft materials can eliminate mucosal erosion and pain of the lower lip while having little effect on performance, although, a slight change in timbre is possible.
Case Report: Pulmonary Conidiobolomycosis in a Vietnamese Pot-Bellied Pig
Authors: Brittany L Rasche, Samuel M Tucker, Keith Linder, Tara M Harrison, Tatiane Terumi Negrão Watanabe
Journal: Front Vet Sci (2021)
Keywords: conidiobolus spp, domestic animal, entomophthoromycosis, pig, pneumonia
MeSH terms: Case Reports

An adult castrated male Vietnamese pot-bellied pig had a 1-week history of acute dyspnea and lethargy. Minimal diagnostic testing was authorized by the owner, resulting in treatment with a third-generation cephalosporin and a non-steroidal anti-inflammatory drug. Partial improvement was observed after a week; however, the pig died 2 weeks after the initial onset of clinical signs. Macroscopically, ~90% of the left lung was effaced by large masses with a caseonecrotic center. Histologic examination revealed eosinophilic granulomas with myriad, intralesional, negatively staining hyphae highlighted by "sleeves" of hypereosinophilic material (Splendore-Hoeppli material). Infection with an oomycete or "zygomycete" (i.e., organisms of the order Entomophthorales or Mucorales) was initially considered. Pan-fungal PCR and sequencing performed on formalin-fixed, paraffin-embedded lung tissue identified Conidiobolus spp., consistent with a diagnosis of primary pulmonary conidiobolomycosis. There are only a few reports of infections with Conidiobolus spp. (and other members of the order Entomophthorales) in swine. Unlike humans and other animal species, conidiobolomycosis in pigs presents more commonly as a primary pulmonary disease rather than rhinofacial or nasopharyngeal disease.
Legionnaires' disease with facial nerve palsy
Authors: Shailesh R Basani, Salwa Mohamed Ahmed, Eyassu Habte-Gabr
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Legionnaires' disease is primarily a pneumonic process caused by Legionella pneumophilia, a gram-negative aerobic bacillus but also has multiple system involvement. The most common manifestation is encephalopathy suggesting a generalized brain dysfunction but focal neurological manifestations have been reported. We report a patient with Legionella pneumonia associated with cerebellar dysfunction and unilateral facial nerve weakness. 51-year-old previously healthy male presented with shortness of breath, cough, slurred speech, and unsteadiness on feet associated with malaise, fevers and myalgias. Patient's family reported facial asymmetry for 2 days. Patient had no significant medical history and was not on any medication. He denied smoking, alcohol or illicit drug use. Chest X-ray showed bilateral lower lobe infiltrates. Urinary antigen assay for Legionella pneumophilia serogroup 1 was positive. Patient was started on intravenous moxifloxacin. On day 5 the patient was discharged home and continued oral moxifloxacin for two weeks. After the two weeks, his respiratory symptoms, gait ataxia and dysarthria resolved. We report the first case of Legionnaires' disease with cerebellar dysfunction and seventh nerve palsy. Legionnaires' disease should be considered in patients with any neurological symptoms in the setting of pneumonia. Failure to recognize and treat the infection may lead to poor outcomes.
CASE REPORT How to Repair the Lower Eyelid Retraction, Resulting From the Primary Surgery for Epiblepharon?
Authors: Shinichi Asamura, Hirohiko Kakizaki, Seika Matsushima, Tadaaki Morotomi, Noritaka Isogai
Journal: Eplasty (2013)
Keywords: auricular cartilage, epiblepharon, lower eyelid retraction, the posterior layer of the lower eyelid retractors, the transcutaneous approach

Objective:
Among the surgical procedures used to correct the positions of the eyelids or improve their cosmetic appearance, procedures for treating eyelid retraction are some of the most challenging. Lower eyelid retraction can occur iatrogenically after various surgical procedures. We performed a successful corrective procedure for lower eyelid retraction, which had occurred at some point in the 2 decades after primary surgery for epiblepharon.
Method:
A 23-year-old woman underwent primary surgery for bilateral epiblepharon at the age of 5 years. However, at the age of 17, she noticed that an abnormally large proportion of her right sclera was visible when her eyes were in their natural position. In the primary position of gaze, the distance from the lower limbus of the right cornea to the upper margin of the lower eyelid was approximately 2 mm. An incision was made in the lower eyelid along the scar caused by the previous operation. Subsequently, the connections between the tarsus and the lower eyelid retractors were broken, and harvested auricular cartilage was placed between the lower edge of the tarsus and the lower eyelid retractors.
Results:
One year after the operation, there was no gross difference in the distance between the lower margin of the corneal limbus and the lower eyelid on either side, and the patient was extremely happy with the results.
Conclusion:
Using a novel surgical technique, we successfully lengthened the posterior layer of the lower eyelid retractors with a small amount auricular cartilage, resulting in good functional and cosmetic outcomes.
Homozygous deep intronic variant in SNX14 cause autosomal recessive Spinocerebellar ataxia 20: a case report
Authors: Olga Levchenko, Alexandra Filatova, Irina Mishina, Aleksey Antonenko, Mikhail Skoblov
Journal: Front Genet (2023)
Keywords: scar20, snx14 gene, ataxia, deep intronic variants, intellectual and developmental disabilities, whole genome sequencing
MeSH terms: Case Reports

Autosomal recessive spinocerebellar ataxia type 20, SCAR20 (MIM: 616354) is a rare syndromic form of hereditary ataxias. It characterized by the presence of progressive ataxia, intellectual developmental disorder, autism and dysmorphic features. The disease caused by biallelic variants in SNX14 gene that lead to loss of protein function. Typically, these variants result in the formation of a premature stop codon, a shift in the reading frame or a variant in canonical splicing sites, as well as gross rearrangements. Here we present the first case of a deep intronic variant c.462-589A>G in SNX14 identified in two sisters with SCAR20 from a consanguineous family. This variant resulted in the inclusion of a pseudo-exon 82 nucleotides long and the formation of a premature stop codon, leading to the production of a truncated protein (NP_722523.1:p.Asp155Valfs*8). Following an extensive diagnostic search, the diagnosis was confirmed using trio whole genome sequencing. This case contributes to expanding the spectrum of potential genetic variants associated with SCAR20.
Alterations in bone mineral density and lower extremity lean mass after hip arthroscopy in a professional female Ironman triathlete: a case study
Authors: Sandro Manuel Mueller, Simone Braendli, Marco Toigo
Journal: Springerplus (2015)
Keywords: dual-energy x-ray absorptiometry (dxa), femoroacetabular impingement (fai), peripheral quantitative computed tomography (pqct)

Introduction:
Femoroacetabular impingement is a pathomechanical condition of the hip, which is often treated through arthroscopic techniques. The ensuing immobilization period is associated with decreases in muscle mass and bone mass. To date, minimal knowledge is present about the development of tissue mass during the considerably short rehabilitation period before returning to competition in elite endurance athletes.
Case description:
Before and after surgery, a professional female Ironman triathlete underwent dual-energy X-ray absorptiometry and peripheral quantitative computed tomography measurements.
Discussion and evaluation:
Areal bone mineral density (aBMD) of the proximal femur and lower extremity lean mass decreased in the surgically treated lower extremity during the two-month period of immobilization after the hip arthroscopy. These losses were compensated for after only six weeks of rehabilitation. A similar progression of aBMD values was observed in the lumbar spine. The adaptational pattern in volumetric BMD (vBMD) and volumetric bone mineral content (vBMC) of the tibiae were more complex, but attained pre-immobilization values for most variables also after six weeks of rehabilitation. All other variables attained pre-immobilization values no later than nine months after the surgical intervention.
Conclusions:
The athlete showed a high plasticity of bone and lean tissue with an optimal short- and midterm outcome. Following a two months immobilization period after a hip arthroscopy, aBMD, vBMD and vBMC achieved pre-surgical levels after four months of rehabilitation in a female Ironman triathlete. A nine-month follow-up measurement confirmed the safety of the fast return to sport.
Rapid response in relapsed follicular lymphoma with massive chylous ascites to anti-CD19 CAR T therapy using Piggy Bac: A case report
Authors: Yan Zhang, Zhicai Lin, Faliang Zhang, Xiuxiu Chen, Yaping Yang, Xin Fu, Zhong Li, Yan Sun, Qijun Qian
Journal: Front Immunol (2022)
Keywords: cd-19 directed, piggy bac, chimeric antigen receptor t cells, follicular lymphoma, non-viral gene transfer, relapsed
MeSH terms: Chylous Ascites / chemically induced, Chylous Ascites / drug therapy, Lymphoma, Follicular / complications, Lymphoma, Follicular / therapy, Receptors, Chimeric Antigen / therapeutic use, Case Reports, Research Support, Non-U.S. Gov't, Antigens, CD19, Cytokine Release Syndrome / drug therapy, Humans, Immunotherapy, Adoptive / adverse effects, Immunotherapy, Adoptive / methods, Receptors, Chimeric Antigen, Antigens, CD19

CD19-directed chimeric antigen receptor (CAR) T cell therapy has been shown to achieve a considerably durable response in patients with refractory or relapsed B cell non-Hodgkin lymphomas, as seen from the results of Zuma-1, Zuma-5, and other clinical trials. Most of these CARs were generated by lentivirus or reverse adenovirus. It is rare to see CARs using non-viral vectors, such as Piggy Bac (pb), in treating lymphoma patients with active diseases. Generally, patients with a high tumor burden tend to have a higher rate of severe cytokine release syndrome (CRS) or neurological events as reported in the literature. Patients with symptomatic pleural effusions are excluded from the Zuma-1 trial because of the risk of severe CRS. We report here that a patient with relapsed follicular lymphoma with bulky disease and massive chylous ascites failed several lines of chemotherapy. After infusion of the CD19-directed pbCAR-T cells at 6 × 106 cells/kg, the patient had a rapid response and achieved a nearly complete metabolic remission on day 28. There was only grade 1 CRS, and no neurotoxicity occurred. The CAR-T cells reached a peak level on day 14 and spread into the ascites and expanded for 3 months. This might be the first case reported for pbCAR-T cells to treat relapsed follicular lymphoma directly. The long-term efficacy will be observed, and more patients be tested in the future.
Clinical trial registration:
https://ClinicalTrials.gov, identifier NCT05472610.
Tea Party Health Narratives and Belief Polarization: the Journey to Killing Grandma
Authors: Kristin Haltinner, Dilshani Sarathchandra
Journal: AIMS Public Health (2017)
Keywords: affordable care act, obamacare, political polarization, right-wing populism

In the past decade the U.S. public has expressed varying degrees of skepticism about certain factual claims, and of "expertise" more broadly. Ideological and partisan belief polarization seems to have elevated public anxiety about topics ranging from climate change and vaccines to immigration and healthcare policy. Furthermore, polarized narratives about scientific, medical, and political topics have encouraged "directionally motivated cognition", leading to a decline in institutional trust among some fractions of the U.S. political spectrum. Our case study of the Tea Party Patriots (TPP) (i.e. a political organization that promotes the Tea Party goals) uses data from 45 interviews, 80 hours of participant observation, and content analysis of movement literature, to examine the nature and nuance of health narratives employed by the Tea Party. Specifically, we explain a central narrative in TPP organizing that features "a villainous Left covertly seeking to harm U.S. citizens" as the root of three key TPP health care narratives: (1) Democratic health initiatives enslaving youth; (2) the political left profiting from covertly making Americans dependent on state's health care programs; and (3) the left clandestinely seeking to violate the constitution as represented by their efforts to "kill grandma". These narratives reflect the increased polarization of attitudes towards healthcare, as well as a broader distrust of the political left who, activists believe, are advancing a political agenda of social control. Ultimately, we argue that culturally driven healthcare narratives of the Tea Party have had a significant impact on right-wing public opinion and Republican politics regarding U.S. healthcare policy. Many Tea Party concerns are reflected in the Republican policy positions, including those related to the Affordable Care Act of 2010.
Immune Thrombocytopenia Induced by Immune Checkpoint Inhibitrs in Lung Cancer: Case Report and Literature Review
Authors: Wang Xie, NaNa Hu, LeJie Cao
Journal: Front Immunol (2021)
Keywords: atezolizumab, immune checkpoint inhibitor, immune thrombocytopenia, immune-related adverse event (irae), programmed cell death 1 inhibitor
MeSH terms: Adenocarcinoma of Lung / drug therapy, Antibodies, Monoclonal, Humanized / adverse effects, Blood Platelets / drug effects, Immune Checkpoint Inhibitors / adverse effects, Lung Neoplasms / drug therapy, Purpura, Thrombocytopenic, Idiopathic / chemically induced, Case Reports, Research Support, Non-U.S. Gov't, Review, Adenocarcinoma of Lung / immunology, Adenocarcinoma of Lung / pathology, Aged, Blood Platelets / immunology, Humans, Lung Neoplasms / immunology, Lung Neoplasms / pathology, Male, Purpura, Thrombocytopenic, Idiopathic / diagnosis, Purpura, Thrombocytopenic, Idiopathic / immunology, Purpura, Thrombocytopenic, Idiopathic / therapy, Risk Factors, Treatment Outcome, Antibodies, Monoclonal, Humanized, Immune Checkpoint Inhibitors, atezolizumab

Immune checkpoint inhibitors (ICIs), including antibodies targeting programmed cell death protein-1 (PD-1) and programmed cell death ligand-1 (PD-L1), are being extensively used on advanced human malignancies therapy. The treatment with ICIs have acquired durable tumor inhibition and changed the treatment landscape in lung cancer. Immune-related adverse events including pneumonitis and thyroiditis have been well described, but less frequent events, such as ICIs-induced thrombocytopenia, are now emerging and may sometimes be severe or fatal. Since early detection and prompt intervention are crucial to prevent fatal consequences, it is of outmost importance that medical staff is aware of these potential toxicities and learn to recognize and treat them adequately. This review focuses on the epidemiology, clinical presentation, mechanisms, and clinical management of ICIs-induced thrombocytopenia in patients with lung cancer. We also present a patient with advanced lung adenocarcinoma who received the PD-L1 inhibitor atezolizumab and eventually developed severe thrombocytopenia. The case indirectly suggests that cytokine changes might contribute to immune dysregulation in ICIs-induced thrombocytopenia.