OpenMed/multicare-articles huggingface dataset:
Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Pediatric Sedation Complications
Authors: Amanda Dupont, Daisy Ciener, Cecilia Monteilh, Anita Bharath, Anita Thomas, Katherine Wolpert, Jean Pearce
Journal: MedEdPORTAL (2024)
Keywords: apnea, bag valve mask ventilation, consent and assent, emergency medicine, hypotension, ketamine, laryngospasm, pediatric emergency medicine, propofol, sedation, simulation
MeSH terms: Emergency Medicine / education, Ketamine, Pediatric Emergency Medicine / education, Propofol / adverse effects, Simulation Training, Case Reports, Child, Humans, Male, Propofol, Ketamine

Introduction:
Ketamine and propofol are commonly used agents for sedation in the pediatric emergency department (PED). While these medications routinely provide safe sedations, there are side effects providers should be able to recognize and manage. Currently, no pediatric sedation simulations exist in the literature.
Methods:
We created two sedation simulation cases for learners, including pediatric emergency medicine (PEM) fellows, working in the PED: case 1, a 12-year-old male with a shoulder dislocation requiring reduction under propofol sedation, and case 2, a forearm fracture requiring reduction under ketamine sedation. Learner actions included setting up equipment for sedations, dosing medications correctly, and managing complications. Additionally, in case 2, learners assigned an American Society of Anesthesiologists classification and selected the appropriate candidate for PED sedation from amongst three patients. A debrief followed the cases. Next, a didactic presentation reinforced concepts discussed in the debrief. Participants then completed an evaluation of the simulation.
Results:
Fifty-eight emergency medicine residents and PEM fellows across four sites at three institutions participated. Participants scored the simulations and the debriefing session on a 5-point Likert scale. Learners rated the scenario as clinically relevant (M = 4.37) and effective at improving their comfort level in caring for critically ill patients (M = 4.36). Learners felt the debrief provided valuable learning (M = 4.40) and was a safe learning environment (M = 4.50).
Discussion:
These cases can be utilized as resources for learners in any emergency department and can be tailored to any training background of learner providing sedation.
Case report: A compound heterozygous mutations in ASNS broadens the spectrum of asparagine synthetase deficiency in the prenatal diagnosis
Authors: Linyan Zhu, Yixi Sun, Yuqing Xu, Pengzhen Jin, Huiqing Ding, Minyue Dong
Journal: Front Pediatr (2023)
Keywords: asns, asparagine synthetase deficiency, case report, prenatal diagnosis, whole-exome sequencing
MeSH terms: Case Reports

Asparagine synthetase deficiency (ASNSD) is a rare congenital disorder characterized by severe progressive microcephaly, global developmental delay, spastic quadriplegia, and refractory seizures. ASNSD is caused by variations of the ASNS gene. The present study showed a Chinese family with a fetus suffering microcephaly. Whole-exome sequencing and Sanger sequencing were used to identify the disease-associated genetic variants. Compound heterozygous variants c.97C>T p. (R33C) and c.1031-2_1033del were identified in the ASNS gene and the variants were inherited from the parents. The mutation site c.97C>T was highly conserved across a wide range of species and predicted to alter the local electrostatic potential. The variant c.1031-2_1033del was classified pathogenic. However, there is no case report of prenatal diagnosis of ASNSD. This is the first description of fetal compound mutations in the ASNS gene leading to ASNSD, which expanded the spectrum of ASNSD.
Hypopituitarism due to a Large Osteoclastoma Arising from the Sphenoid Bone Invading the Pituitary Fossa in a Patient with Parathyroid Carcinoma
Authors: Leonardo Bandeira, Lucian Batista de Oliveira, Maria Vitória Silva de Lima, Daniella Rêgo, Luiz Griz, Francisco Bandeira
Journal: Case Rep Endocrinol (2023)
MeSH terms: Case Reports

Background:
Parathyroid carcinoma accounts for <1% of cases of primary hyperparathyroidism (PHPT). This rare condition may present with severe hypercalcemia and bone complications such as osteoclastomas and pathologic fractures. Here, we present a rare condition of panhypopituitarism resulting from an osteoclastoma in the sphenoid bone that invaded the pituitary fossa due to parathyroid carcinoma. Case Report. A 47-year-old woman previously diagnosed with PHPT underwent a parathyroidectomy 6 years earlier, with histological examination indicating a parathyroid adenoma. After surgery, she continued to exhibit high serum parathyroid hormone (PTH) and calcium levels, with the development of bone pain and spontaneous fractures. Imaging exams showed a large osteoclastoma of the sphenoid bone, invading the pituitary fossa, causing hypopituitarism. A new parathyroidectomy was performed, with histological confirmation of parathyroid carcinoma and regression of the osteoclastoma.
Conclusion:
This case illustrates an unusual presentation of parathyroid carcinoma, in which an osteoclastoma of the sphenoid bone caused hypopituitarism.
Very low monomethyl fumarate exposure via human milk: a case report-a contribution from the ConcePTION project
Authors: Martje Van Neste, Nina Nauwelaerts, Michael Ceulemans, Benedikte Cuppers, Pieter Annaert, Anne Smits, Karel Allegaert
Journal: Front Public Health (2024)
Keywords: breastfeeding, case report, dimethyl fumarate, human milk, lactation, monomethyl fumarate, multiple sclerosis, pharmacokinetics
MeSH terms: Fumarates, Milk, Human / chemistry, Case Reports, Adult, Breast Feeding, Female, Humans, Immunosuppressive Agents, Infant, Infant, Newborn, Maleates, Multiple Sclerosis / drug therapy, Fumarates, citraconic acid, Immunosuppressive Agents, Maleates

Introduction:
While breastfeeding is recommended, knowledge regarding medicine transfer to human milk and its safety for nursing infants is limited. Only one paper has previously described dimethyl fumarate (DMF) transfer during breastfeeding in two patients at 5 and 6 months postpartum, respectively. The current case report describes maternal pharmacokinetic data of monomethyl fumarate (MMF), the active metabolite of DMF, and infant exposure estimations of MMF at 3 months postpartum.
Methods:
A 32-year-old Caucasian woman started DMF therapy (120 mg, 2x/day) for multiple sclerosis at 3 months postpartum, after weaning her infant from breastfeeding. On day 99 after birth, the patient collected four milk samples over 24 h after 6 days of treatment at the initial dose. Additionally, a single maternal blood sample was collected to calculate the milk-to-plasma (M/P) ratio. The samples were analyzed using liquid chromatography coupled with the mass spectrometry method.
Results:
A wide range of measured steady-state concentrations of MMF (5.5-83.5 ng/mL) was observed in human milk samples. Estimated daily infant dosage values for MMF, calculated with 150 and 200 mL/kg/day human milk intake, were 5.76 and 7.68 μg/kg/day, and the relative infant doses were 0.16 and 0.22%. The observed mean M/P ratio was 0.059, similar to the M/P ratio predicted using the empirical Koshimichi model (0.06).
Discussion:
Combining this case report with the two previously described cases, the estimated infant exposure is low, albeit with relevant intra- and inter-patient variabilities. Research should further focus on infant exposure and safety.
Requirements for essential micronutrients during caloric restriction and fasting
Authors: Weiguo Zhang, Peng Chen, Shaofeng Huo, Xiaomin Huang, Youyou Zhao
Journal: Front Nutr (2024)
Keywords: aging, caloric restriction, metabolism, micronutrients (vitamins and minerals), non-human primates, obesity
MeSH terms: Review

Caloric restriction (CR) or energy restriction, when carefully designed, monitored, and implemented in self-motivated and compliant individuals, proves to be a viable non-pharmacologic strategy for human weight control and obesity management. Beyond its role in weight management, CR has the potential to impede responses involved not only in the pathogenesis of various diseases but also in the aging process in adults, thereby being proposed to promote a healthier and longer life. The core objective of implementing caloric restriction is to establish a balance between energy intake and expenditure, typically involving a reduction in intake and an increase in expenditure-a negative balance at least initially. It may transition toward and maintain a more desired equilibrium over time. However, it is essential to note that CR may lead to a proportional reduction in micronutrient intake unless corresponding supplementation is provided. Historical human case reports on CR have consistently maintained adequate intakes (AI) or recommended dietary allowances (RDA) for essential micronutrients, including vitamins and minerals. Similarly, longevity studies involving non-human primates have upheld micronutrient consumption levels comparable to control groups or baseline measures. Recent randomized controlled trials (RCTs) have also endorsed daily supplementation of multivitamins and minerals to meet micronutrient needs. However, aside from these human case reports, limited human trials, and primate experiments, there remains a notable gap in human research specifically addressing precise micronutrient requirements during CR. While adhering to AI or RDA for minerals and vitamins appears sensible in the current practice, it's important to recognize that these guidelines are formulated for generally healthy populations under standard circumstances. The adequacy of these guidelines in the setting of prolonged and profound negative energy balance remains unclear. From perspectives of evidence-based medicine and precision nutrition, this field necessitates comprehensive exploration to uncover the intricacies of absorption, utilization, and metabolism and the requirement of each hydrophilic and lipophilic vitamin and mineral during these special periods. Such investigations are crucial to determine whether existing daily dietary recommendations for micronutrients are quantitatively inadequate, excessive, or appropriate when energy balance remains negative over extended durations.
Non-functional alpha-cell hyperplasia with glucagon-producing NET: a case report
Authors: Catarina Cidade-Rodrigues, Ana Paula Santos, Raquel Calheiros, Sara Santos, Catarina Matos, Ana Paula Moreira, Isabel Inácio, Pedro Souteiro, Joana Oliveira, Manuel Jácome, Sofia S Pereira, Rui Henrique, Isabel Torres, Mariana P Monteiro
Journal: Front Endocrinol (Lausanne) (2024)
Keywords: alpha-cell, glucagon-producing net, hyperplasia, neuroendocrine tumors, pancreas
MeSH terms: Glucagon / metabolism, Glucagon-Secreting Cells / metabolism, Glucagon-Secreting Cells / pathology, Hyperplasia / metabolism, Hyperplasia / pathology, Neuroendocrine Tumors / diagnosis, Neuroendocrine Tumors / metabolism, Neuroendocrine Tumors / pathology, Pancreatic Neoplasms / diagnosis, Pancreatic Neoplasms / metabolism, Pancreatic Neoplasms / pathology, Case Reports, Aged, Diabetes Mellitus, Type 2 / complications, Diabetes Mellitus, Type 2 / metabolism, Humans, Male, Glucagon

Introduction:
Alpha-cell hyperplasia (ACH) is a rare pancreatic endocrine condition. Three types of ACH have been described: functional or nonglucagonoma hyperglucagonemic glucagonoma syndrome, reactive or secondary to defective glucagon signaling, and non-functional. Few cases of ACH with concomitant pancreatic neuroendocrine tumors (pNETs) have been reported and its etiology remains poorly understood. A case report of non-functional ACH with glucagon-producing NET is herein presented.
Case report:
A 72-year-old male was referred to our institution for a 2 cm single pNET incidentally found during imaging for acute cholecystitis. The patient's past medical history included type 2 diabetes (T2D) diagnosed 12 years earlier, for which he was prescribed metformin, dapagliflozin, and semaglutide. The pNET was clinically and biochemically non-functioning, apart from mildly elevated glucagon 217 pg/ml (<209), and 68Ga-SSTR PET/CT positive uptake was only found at the pancreatic tail (SUVmax 11.45). The patient underwent a caudal pancreatectomy and the post-operative 68Ga-SSTR PET/CT was negative. A multifocal well-differentiated NET G1, pT1N0M0R0 (mf) strongly staining for glucagon on a background neuroendocrine alpha-cell hyperplasia with some degree of acinar fibrosis was identified on pathology analysis.
Discussion and conclusion:
This case reports the incidental finding of a clinically non-functioning pNET in a patient with T2D and elevated glucagon levels, unexpectedly diagnosed as glucagon-producing NET and ACH. A high level of suspicion was required to conduct the glucagon immunostaining, which is not part of the pathology routine for a clinically non-functioning pNET, and was key for the diagnosis that otherwise would have been missed. This case highlights the need to consider the diagnosis of glucagon-producing pNET on an ACH background even in the absence of glucagonoma syndrome.
Exceptional improvement in chronic stroke through Guided Self-rehabilitation Contract: a case report study
Authors: Caroline Gault-Colas, Maud Pradines, Marjolaine Baude, Jean-Michel Gracies
Journal: Front Rehabil Sci (2024)
Keywords: case report, chronic, guided self-rehabilitation contracts, hemiparesis, self-rehabilitation, spastic paresis, stroke, upper limb
MeSH terms: Case Reports

A 44-year-old woman suffered a carotid dissection causing a deep and superficial right middle cerebral artery stroke in October 2013, despite undergoing thrombolysis and thrombectomy. Sixteen months later, massive left upper extremity impairment persisted. She then agreed to embark upon a guided self-rehabilitation contract (GSC). This GSC is a moral contract where the physician or therapist identifies specific muscles, particularly hypo-extensible and disabling that act as antagonists to functional activities. The physician or therapist then teaches and prescribes quantified daily high-load self-stretch postures for these muscles, alternating with repeated maximal amplitude movement exercises against their resistance. In turn, the patient commits to practicing the prescribed program and to delivering a diary of the stretch postures and alternating movement exercises performed each day. Over 4 years of GSC, the patient practiced upon prescription against a total of seven upper limb antagonists to common functional movements: shoulder extensors, shoulder internal rotators, elbow flexors, elbow pronators, wrist and finger flexors, and interossei muscles. She manually filled up her diary 99% of the days. Each day, she practiced an average of 20 min of high-load static self-stretch per muscle, alternating with about 50 maximal active efforts against the resistance of each targeted muscle's resistance. Overall, her mean static self-stretch time was 81 ± 2 (mean ± SEM) min/day, and her mean number of active maximal efforts was 285 ± 78/day, for a total daily self-rehabilitation time of over 2 h a day. Five years after her stroke, she had recovered all left upper extremity use in daily activities and resumed her previous job as a nurse's aide. She now spontaneously uses her left hand in most tasks. Functional MRI (March 2020) demonstrated bilateral primary motor and motor supplementary area activation upon left-hand exercise. Prolonged static self-stretch increased muscle extensibility (muscle plasticity) while maximal amplitude, alternating movement training reduced co-contraction in these muscles (neural plasticity). The Modified Frenchay Scale assessment was video-recorded by the clinician at each visit, allowing qualitative and quantitative evaluation of the functional capacities. The two videos of the first and last clinic visits have been uploaded and are available.
Retrieval of a Missing Translocated Intrauterine Contraceptive Device Using Combined Laparoscopic and Cystoscopic Techniques
Authors: Shahd T Natsheh, Mahmoud R Manasra, Ahmad G Hammouri, Nour K Fakhorui, Yazan M Abugharbieh, Alaa M I Alazzeh
Journal: Case Rep Obstet Gynecol (2024)
MeSH terms: Case Reports

Background:
Intrauterine contraceptive devices (IUCDs) are considered to be an effective way of preventing unwanted pregnancies. However, one significant complication associated with IUCDs is uterine perforation especially at the time of insertion and could reach the peritoneal cavity and the viscus of the adjacent organs. Intravesical migration is extremely rare. Case Presentation. We report a 41-year-old woman who was diagnosed with IUCD intravesical migration after she presented to our hospital complaining of persistent lower urinary tract symptoms. Laparoscopic removal was done after the failure of cystoscopic extraction.
Conclusion:
The IUCD must be monitored continuously by the gynaecologist, and suspicions of intravesical migration must be considered in those presenting with persistent, unexplained lower urinary tract symptoms.
Choriocarcinoma complicated with intra-abdominal and intrapleural hemorrhage in pregnancy - case report
Authors: Kamila Jaz, Cezary Miedziarek, Ewa Piasek, Artur Florek, Ewa Nowak-Markwitz, Mikołaj Piotr Zaborowski
Journal: Front Oncol (2023)
Keywords: chemotherapy, choriocarcinoma, hemorrhage, metastases, pregnancy
MeSH terms: Case Reports

Background:
Choriocarcinoma is a rare neoplasm, exceptionally uncommon during an ongoing pregnancy. The disease often has a metastatic character, causing severe symptoms from various anatomic sites like the lungs, central nervous system, vagina, pelvis, or liver. Due to the condition's rarity, evidence on how to treat the choriocarcinoma originating during pregnancy remains scarce.
Case presentation:
Here, we present a case of a patient who developed choriocarcinoma before the 29th week of gestation. The neoplasm had a metastatic character, resulting in hemorrhage complicated by a hypovolemic shock. The patient underwent an emergency cesarean section and several surgeries to stop the massive hemorrhage. The treatment of the choriocarcinoma included chemotherapy with methotrexate followed by an EMA-CO regimen. The patient had a complete response to the therapy. The neonate suffered from complications related to prematurity.
Conclusion:
Metastatic choriocarcinoma can be a diagnostic and therapeutic challenge during ongoing pregnancy. Treatment of the disease can be associated with severe complications, but a complete response to chemotherapy is possible with a favorable long-term prognosis.
Pericarditis and Cardiac Tamponade in Patients Treated with First and Second Generation Bruton Tyrosine Kinase Inhibitors: An Underappreciated Risk
Authors: Thomas Erblich, Charlotte Manisty, John Gribben
Journal: Case Rep Hematol (2024)
MeSH terms: Case Reports

Introduction:
The introduction of Bruton's tyrosine kinase (BTK) inhibitors significantly improved the management of chronic lymphocytic leukemia (CLL). However, BTK carry the risk of cardiotoxicity, which is not only limited to atrial fibrillation. Case Reports. We report three cases of patients on BTK inhibitors who developed acute pericarditis and cardiac tamponade. We report the first patient who developed this complication on treatment with zanubrutinib. This patient's treatment was changed to zanubrutinib due to atrial fibrillation. Shortly after cardioversion, he developed cardiac tamponade and shock. He underwent pericardiocentesis, received treatment for acute pericarditis with steroids and colchicine, and made a full recovery. We also report two further cases, both involving patients treated with ibrutinib. These patients also developed acute pericarditis and cardiac tamponade and required pericardiocentesis. All three patients discontinued BTK therapy following the events.
Conclusions:
These three cases highlight the rare but potentially life-threatening risk of cardiac tamponade which can occur even with newer generations of BTK inhibitors. Haemato-oncologists should remain vigilant in patients who report dyspnea or who show sinus tachycardia on routine electrocardiography. Even in the absence of classical clinical signs of tamponade, patients require urgent evaluation with echocardiography and potentially emergency pericardiocentesis.
Primary Cervical Extraosseous Ewing's Sarcoma Originated from the Sternocleidomastoid Muscle: A Case Report and Review of the Literature
Authors: Sasa Jakovljevic, Nenad Arsovic, Zoran Dudvarski, Nemanja Radivojevic, Katarina Jovanovic, Neda Mladenovic, Snezana Babac
Journal: Case Rep Otolaryngol (2024)
MeSH terms: Case Reports

Extraosseous Ewing's sarcoma is extremely rare in the soft tissues of the neck, especially in the sternocleidomastoid muscle. It usually manifests clinically as a rapidly growing mass that shows great potential for local spread. The aim of this paper is to present a rare case of еxtraosseous Ewing's sarcoma in the sternocleidomastoid muscle. To the best of our knowledge, this is the first case of extraskeletal Ewing's sarcoma at this location. The patient was admitted to our clinic because of a neck tumefaction. The computerized tomography finding showed a tumor mass, most of which was in the V region of the neck, measuring 40 × 27 × 35 mm. Pathohistological and immunohistochemical findings showed that it was Ewing's sarcoma. Unfortunately, the patient passed away nine months after the initial diagnosis. Extraosseous Ewing sarcoma is a rare, fast-growing malignant tumor manifesting histomorphological similarities to bone Ewing's sarcoma. Most reports state that extraosseous Ewing sarcoma has a worse prognosis than skeletal. Extraosseous Ewing sarcoma should be borne in mind in the differential diagnosis of soft tissue tumors of the neck.
Transcranial Direct Current Stimulation Is Safe and Reduces Chronic Fatigue in Patients With Stable Systemic Lupus Erythematosus and Rheumatoid Arthritis
Authors: Vanessa P De Andrade, Alexandre M Dos Santos, Samuel K Shinjo
Journal: Cureus (2024)
Keywords: aerobic exercise, fatigue disorder, neuromodulation, rheumatoid arthritis, systemic lupus erythematosus
MeSH terms: Case Reports

To the best of our knowledge, this is the first case series to assess a combined technique of transcranial direct current stimulation (tDCS - a non-pharmacological and non-invasive brain stimulation) and aerobic exercise in one patient with systemic lupus erythematosus (SLE) and another with rheumatoid arthritis (RA) and significant chronic fatigue. We conducted five sessions of tDCS combined with low-intensity treadmill exercise. Fatigue levels were assessed using the Fatigue Severity Scale and the Visual Analog Scale for fatigue before (pre), immediately after five tDCS sessions (post-zero), and after six months (post-6-mo). The level of fatigue decreased, and functionality improved significantly post-zero and remained sustainable post-6-mo in both SLE and RA cases. There was only one mild and transient side effect (headache) specifically in the patient with RA, and no disease reactivation occurred in any of the cases. Our data showed that tDCS combined with aerobic exercise appears to be safe and promising for reducing fatigue and improving functionality in patients with SLE and RA. Randomized studies with larger sample sizes are required to corroborate our findings.