OpenMed/multicare-articles huggingface dataset:
Case Report: C-reactive protein apheresis in non-ST-elevation ACS-case series from the C-reactive protein apheresis in Acute Myocardial Infarction Registry
Authors: J Torzewski, S Mattecka, F Esposito, F Heigl, J Fiedler, A Sheriff
Journal: Front Cardiovasc Med (2024)
Keywords: c-reactive protein apheresis, acute coronary syndrome, anti-inflammatory therapy, inflammation, non-st-elevation acs
MeSH terms: Case Reports

C-reactive protein (CRP) apheresis has been introduced in ST-elevation myocardial infarction and cardiogenic shock. Here, we describe a first-in-man application in non-ST-elevation acute coronary syndrome (NSTE-ACS). Seven NSTE-ACS patients with high CRP levels (range 14.2-154 mg/L) were treated with CRP apheresis. Treatment was well-tolerated. Patients were discharged in good clinical condition.
Hypothyroidism and sinus dysfunction associated with lithium-paliperidone combination therapy for bipolar disorder with psychotic symptoms: a case report
Authors: Wenjian Wei, Yonglan Yang, Haifeng Wang, Yunbin Yang, Jizhou Liu, Jinfeng Li
Journal: Front Psychiatry (2024)
Keywords: bipolar disorder, bradycardia, hypothyroidism, lithium, paliperidone, sinus arrest
MeSH terms: Case Reports

Background and aim:
Lithium is considered to be the first-line treatment for bipolar disorder, and paliperidone was approved for the treatment of schizophrenia and acute bipolar manic/mixed episodes. However, both agents have been associated with thyroid dysfunction and cardiovascular adverse effects like subclinical hypothyroidism, bradycardia, and sinus arrest, even at therapeutic doses.
Case presentation:
Here, we reported a case of a 17-year-old Han Chinese female who developed symptomatic hypothyroidism, sinus bradycardia, and sinus arrest while being treated with lithium and paliperidone for bipolar disorder with psychotic features including auditory hallucinations. Her workup suggested that these adverse effects might be related to the combined lithium and paliperidone treatment, although other causes could not be ruled out. After discontinuing both medications, her thyroid function and heart rhythm normalized over 20 days.
Conclusion:
To our knowledge, hypothyroidism, sinus bradycardia, and sinus arrest associated with the combined use of lithium and paliperidone had not been reported previously. Further research is warranted to elucidate the potential risks and benefits of this combination therapy for bipolar disorder with psychotic symptoms.
Case report: Successful treatment of refractory immune thrombocytopenia in chronic lymphocytic leukaemia with venetoclax monotherapy
Authors: Timothy Woo, Matthew Carter, George Follows, Piers Em Patten
Journal: Front Oncol (2023)
Keywords: chronic lymphocytic leukaemia, immune thrombocytopenia, monotherapy, refractory, venetoclax
MeSH terms: Case Reports

In chronic lymphocytic leukaemia (CLL), immune dysregulation is common and can manifest as immune thrombocytopenia (ITP). Corticosteroids are the mainstay for front-line management of CLL-associated ITP. Therapy refractoriness represents a clinical challenge and is an indication to commence CLL-directed treatment, historically with anti-CD20 antibody-based chemoimmunotherapy. There is a small but growing body of evidence supporting the use of Bruton's tyrosine kinase (BTK) inhibitors in this setting, but not the B-cell lymphoma-2 inhibitor, venetoclax. Here, we describe two cases of refractory ITP in patients with CLL who successfully achieved and sustained complete remission with fixed-duration venetoclax monotherapy. Responses were rapid and durable and not explained by the concomitant use of an anti-CD20 antibody. This supports a dual role for single-agent venetoclax in managing active CLL and associated ITP as an alternative to BTK inhibitors and anti-CD20 monoclonals.
IGF-2-mediated hypoglycemia: a case series and review of the medical therapies for refractory hypoglycemia
Authors: Albert Vu, Constance Chik, Sarah Kwong
Journal: Endocrinol Diabetes Metab Case Rep (2024)

Summary:
Non-islet cell tumour hypoglycemia (NICTH), typically mediated by insulin-like growth factor 2 (IGF-2), is a rare but highly morbid paraneoplastic syndrome associated with tumours of mesenchymal or epithelial origin. Outside of dextrose administration and dietary modification which provide transient relief of hypoglycemia, resection of the underlying tumour is the only known cure for NICTH. Available medical therapies to manage hypoglycemia include glucocorticoids, recombinant growth hormone, and pasireotide. We report two cases of IGF-2 mediated hypoglycemia. The first was managed surgically to good effect, highlighting the importance of a timely diagnosis to maximise the likelihood of a surgical cure. The second patient had unresectable disease and was managed medically, adding to a growing number of cases supporting the efficacy of glucocorticoids and recombinant growth hormone in NICTH.
Learning points:
Recurrent fasting hypoglycemia in the setting of a malignancy should raise suspicion of non-islet cell tumour hypoglycemia (NICTH), which is typically mediated by IGF-2. The initial workup for NICTH should include a serum glucose, C-peptide, insulin, insulin antibodies, beta-hydroxybutyrate, IGF-2, IGF-1, and sulphonylurea screen during a spontaneous or induced hypoglycemic episode. An IGF-2/IGF-1 ratio above 10 is highly suggestive of IGF-2-mediated hypoglycemia if the IGF-2 level is normal or elevated. False positives may be seen with sepsis and cachexia as both IGF-2 and IGF-1 are subnormal in these cases. A low IGF binding protein 3 (IGFBP3), such as in renal failure, may also result in a falsely normal or low IGF-2/IGF-1 ratio. Surgical resection of the associated tumour is curative in most NICTH cases. When the tumour is unresectable, moderate-dose glucocorticoids, low-dose glucocorticoids in combination with recombinant growth hormone, and pasireotide are medical therapies with promising results in controlling NICTH.
Severe murine typhus complicated by multiple organ dysfunctions: A case report
Authors: Ermira Muco, Arta Karruli, Anjeza Dajlani, Arjana Zerja, Artan Bego
Journal: Caspian J Intern Med (2024)
Keywords: multi-organ failure, murine typhus, rickettsial diseases
MeSH terms: Case Reports

Background:
Rickettsioses are infectious diseases which are caused by intracellular bacteria which belong to the family Rickettsiaceae. This zoonosis endemically prefers tropical and subtropical regions of which the Mediterranean is included. Murine typhus is a type of rickettsial disease that commonly presents with undulating fever, headache rash, chills, malaise, and myalgias. It can lead to complications such as multi-organ failure and has a lethality rate of <5% in such cases.
Case presentation:
A 70-year-old male was hospitalized at the Unit of Infectious Diseases, Mother Teresa Hospital, Tirana, Albania in a comatose condition. He had a seven-day history of fever up to 39-40°C, headache, fatigue, anorexia, vomiting, cough, and myalgia. He was a farmer and had contact with animals. Upon admission, he had scleral hemorrhages, hepatosplenomegaly, jaundice, maculopapular rash over the trunk, abdomen, and palms of his hands as well as severe acidosis, depressed bicarbonate levels, alteration in liver, kidney, and pancreas function tests. He was urgently transferred to the Intensive care unit of the Infectious Diseases Department. He was hemodynamically unstable and was put immediately on vasoactive agents and mechanical ventilation. ELISA Rickettsia typhi IgM resulted positive. Supportive treatment along with antibiotics Levofloxacin and Ceftriaxone was initiated. However, the patient died on the 4th day of hospitalization and the 11th of the disease onset.
Conclusion:
Murine typhus should be included in the investigation of possible causes when dealing with patients presenting with fever and maculopapular rash complicated by multi-organ failure and coming from a typhus-endemic area, especially in the summer season.
A case of extracapsular silicone gel implant rupture with contralateral gel migration
Authors: Rebecca Patrick, Sydney Bormann, Heather Karu
Journal: Case Reports Plast Surg Hand Surg (2024)
Keywords: implant rupture, implant tunneling, symmastia
MeSH terms: Case Reports

Symmastia is a rare complication of augmentation mammaplasty that occurs when a breast implant crosses the midline and connects with the contralateral implant pocket. We present a case of implant rupture, migration to the contralateral breast, and ultimate symmastia following a traumatic fall in a patient with prior breast augmentation.
The impact of detailed history taking: a case report of pediatric pulmonary and hepatic hydatid disease from Ecuador
Authors: Camila Gallegos, Ariel Vargas, David Estrella, Alejandra Torres, Carlos Andrade, Yazmina Del Carmen Lascano, Daniel Garzon-Chavez, Ana Cristina Aguilar
Journal: Front Pediatr (2024)
Keywords: echinococcosis, hydatid disease, pediatric infection, pulmonary and hepatic infection, zoonotic transmission
MeSH terms: Case Reports

Background:
Echinococcosis is a uncommon condition in pediatric patients, and encompasses alveolar and cystic forms, predominantly affecting the lungs and liver. Transmission occurs primarily through zoonotic means, such as the contamination of water and food by infected dog and other canid feces. Diagnosis can be challenging due to nonspecific symptoms that often mimic pneumonia.
The case:
A 6-year-old female patient from a rural area in Ecuador who initially presented with nonspecific symptoms indicative of pneumonia. However, further investigation into socio-environmental factors led to a diagnosis of pulmonary and hepatic hydatid disease.
Conclusion:
The timely and accurate diagnosis of this infectious disease enabled the patient to receive appropriate treatment and surgical intervention, leading to her complete recovery.
Case Report: The application of novel imaging technologies in lower extremity peripheral artery disease: NIR-II imaging, OCTA, and LSFG
Authors: Yijie Ning, Jie Hu, Haifeng Li, Chuanlong Lu, Zeyu Zhang, Sheng Yan, Peilu Shi, Tingting Gao, Heng Wang, Ruijing Zhang, Honglin Dong
Journal: Front Cardiovasc Med (2024)
Keywords: nir-ii imaging, imaging technology, laser speckle flowgraphy, optical coherence tomography, peripheral artery disease
MeSH terms: Case Reports

Lower extremity peripheral artery disease (PAD) is a growing global health problem. New methods to diagnose PAD have been explored in recent years. At present, the majority of imaging methods for PAD focus on the macrovascular blood flow, and the exploration of microcirculation and tissue perfusion of PAD remains largely insufficient. In this report, we applied three new imaging technologies, i.e., second near-infrared region (NIR-II, 900-1,880 nm wavelengths) imaging, optical coherence tomography angiography (OCTA), and laser speckle flowgraphy (LSFG), in a PAD patient with a healthy human subject as control. Our results showed that the PAD patient had poorer tissue perfusion than the control without observed adverse effects. Moreover, compared with the first near-infrared region (NIR-I, 700-900 nm wavelengths) imaging results, NIR-II imaging had a higher signal-to-background ratio and resolution than NIR-I imaging and detected microvessels that were not detected by NIR-I imaging. These observations suggested that NIR-II imaging, OCTA, and LSFG are potentially safe and effective methods for diagnosing PAD.
Cystic intracranial solitary fibrous tumor: a case report
Authors: Yongzhe Li, Dongxue Li, Li Yang, Jiaren Zhang, Xiaoyu Gu, Linfeng Song, Binlin Tian, Tingchao Li, Lin Jiang
Journal: Front Oncol (2024)
Keywords: case report, cystic, intracranial tumor, magnetic resonance imaging, solitary fibrous tumor, tumor
MeSH terms: Case Reports

Solitary fibrous tumor (SFT) is a rare spindle cell tumor originating from mesenchymal tissue, and even rarer when it occurs intracranially. This case report described a 42-year-old man who presented with headache and limb weakness for more than 10 days. Magnetic resonance imaging (MRI) showed a well-defined multicompartmental cystic space-occupying lesion in the left occipital region, with surrounding edema and a compressed left lateral ventricle, the mass growing across the cerebellar vermis, which was initially diagnosed as hemangioblastoma. Neurosurgery was utilized to successfully remove the mass, and intracranial solitary fibrous tumor (ISFT) was identified by postoperative pathological analysis. Here, this article describes the imaging manifestations and pathologic features of a case of cystic intracranial solitary fibrous tumor, aiming to improve the understanding and diagnosis of this disease in order to provide an accurate therapy plan.
False positive elevation in serum creatinine: a case report
Authors: Laia Oliveras, Ana Coloma, Teresa Escartín, Maria José Castro, Natalia Vicente, Montse Gomà, Josep Maria Cruzado
Journal: Front Med (Lausanne) (2024)
Keywords: igm, case report, falsely elevated creatinine, monoclonal gammopathy, spurious creatinine
MeSH terms: Case Reports

Background:
Paraproteins can interfere with several substances, producing erroneous laboratory measurements. The diagnosis of kidney disease in patients with hematological disorders has important prognosis implications. An elevated creatinine with no other signs of kidney disease should prompt the idea of a spurious creatinine. Communication between the clinical team and the laboratory is key.
Case presentation:
In this case, we present a 68-year-old woman with an elevated creatinine and an IgM lambda paraprotein. Interestingly, there were no other signs of chronic kidney disease besides the creatinine value, with no albuminuria or microhematuria. A kidney biopsy showed normal parenchyma and ruled out the possibility of paraprotein-related damage. The monoclonal component and creatinine levels raised parallelly during follow-up while maintaining normal urea levels. This prompted the hypothesis of a falsely elevated creatinine. It was confirmed with a normal glomerular filtration rate determined by a radioisotope, a cystatin C measurement and a reduction in creatinine when diluting the sample.
Conclusion:
It is important to consider the possibility of a falsely elevated creatinine in patients with paraproteinemia and no other signs of kidney disease to avoid unnecessary diagnostic tests and for the prognostic implications.
Changes in sleep quality of children with epilepsy and anxiety of their caregivers after COVID-19 infection: a case-series report
Authors: Dan Li, Yongjing Shi, Bo Wang, Jing Zhou, Xueying Wang, Shaoping Huang, Lin Yang
Journal: Front Pediatr (2023)
Keywords: covid-19, anxiety, epilepsy, questionnaire survey, sleep habits

Objective:
To study the changes in epileptic seizures and sleep quality in children with epilepsy (CWE) and the changes in anxiety of their caregivers after infection with COVID-19.
Methods:
Outpatients and inpatients of CWEs were selected as subjects and a questionnaire survey was used to carry out this case-series study. The demographic information of the CWEs and their caregivers, information about epilepsy, and information about the vaccination, infection, and treatment of COVID-19 were collected. The changes in sleep quality of CWEs and the changes in anxiety of their caregivers were assessed by the Child Sleep Habits Questionnaire (CSHQ) and Caregiver Anxiety Scale (CAS). Risk factors affecting sleep habits in CWEs and caregiver anxiety were further analyzed by one-way analysis of variance.
Results:
A total of 312 children were included in the study. Among them, 134 patients (42.9%) were female. The average age of the children was 9.30 ± 3.88 years, and the duration of epilepsy was 4.59 ± 3.36 years. A total of 221 of the 312 children were infected with COVID-19, and all the infected children developed fever, which lasted for 1.71 ± 1.13 days. 10 children were satisfied with controlled seizures for more than 1 year and relapsed after COVID-19 infection (4.2%), 4 cases (3.6%) with increased seizures, and 8 children with reduced seizures (7.7%), 17 children (7.7%) had no change in seizures, and 182 children (82.3%) remained seizure-free after the COVID-19 infection. The average sleep time of the CWEs was 9.25 ± 1.04 h and the average total score of the CSHQ was 37.25 ± 5.19, among which 44 cases (14.1%) had more than 41 points. As the result of the CAS, 16 of them (5.13%) scored above 50 and the average total score was 31.49 ± 8.09. The control of seizures, age of onset, types of anti-seizure medicines (ASMs), and seizure duration were risk factors affecting sleep quality. Accordingly, the score of CAS was significantly lower when there was more than one caregiver who cared for the CWE.
Conclusions:
COVID-19 infection did not cause an increase in seizures in CWEs, nor did it worsen their sleep quality of them or aggravate the anxiety of their caregivers.
Atraumatic Bilateral Patella Fracture in Middle-Aged Female: A Rare Case Report
Authors: Ishwor Ghimire Padhya, Saral Lamichhane, Pramod Devkota, Praful Gurung, Pragya Aryal
Journal: Case Rep Orthop (2024)
MeSH terms: Case Reports

The patella is the largest sesamoid bone in the body and an important structure of the extensor apparatus which is under undue stress during flexion and extension of the knee. Bilateral fracture of the patella without trauma is a very rare event and may be multifactorial without a single cause. A repetitive stress reaction in a previously predisposed bone can be an important cause. We report a case of a 45-year-old female with a nontraumatic bilateral transverse patella fracture with loss of extensor mechanism. A stable surgical fixation for such a displaced fracture with a good rehabilitation program can lead to a good functional outcome.
Implementing competing risks in discrete event simulation: the event-specific probabilities and distributions approach
Authors: Fanny Franchini, Victor Fedyashov, Maarten J IJzerman, Koen Degeling
Journal: Front Pharmacol (2023)
Keywords: bayesian framework, censored data, competing risks modelling, discrete event simulation, frequentist implementation

Background: Although several strategies for modelling competing events in discrete event simulation (DES) exist, a methodological gap for the event-specific probabilities and distributions (ESPD) approach when dealing with censored data remains. This study defines and illustrates the ESPD strategy for censored data. Methods: The ESPD approach assumes that events are generated through a two-step process. First, the type of event is selected according to some (unknown) mixture proportions. Next, the times of occurrence of the events are sampled from a corresponding survival distribution. Both of these steps can be modelled based on covariates. Performance was evaluated through a simulation study, considering sample size and levels of censoring. Additionally, an oncology-related case study was conducted to assess the ability to produce realistic results, and to demonstrate its implementation using both frequentist and Bayesian frameworks in R. Results: The simulation study showed good performance of the ESPD approach, with accuracy decreasing as sample sizes decreased and censoring levels increased. The average relative absolute error of the event probability (95%-confidence interval) ranged from 0.04 (0.00; 0.10) to 0.23 (0.01; 0.66) for 60% censoring and sample size 50, showing that increased censoring and decreased sample size resulted in lower accuracy. The approach yielded realistic results in the case study. Discussion: The ESPD approach can be used to model competing events in DES based on censored data. Further research is warranted to compare the approach to other modelling approaches for DES, and to evaluate its usefulness in estimating cumulative event incidences in a broader context.
Recurrence of Primary Aldosteronism After Surgery in Aldosterone-producing Adenoma With KCNJ5 Gene Mutation
Authors: Ko Aiga, Mitsuhiro Kometani, Daisuke Aono, Takashi Yoneda
Journal: JCEM Case Rep (2023)
Keywords: kcnj5, adrenal venous sampling, aldosterone-producing adenoma, aldosterone-producing cell cluster, primary aldosteronism
MeSH terms: Case Reports

Primary aldosteronism (PA) is a major cause of secondary hypertension. Aldosterone-producing adenoma (APA) is a subtype of PA, and adrenalectomy is the gold-standard treatment. Recently, a high prevalence of the KCNJ5 gene mutation has been reported in APA, particularly in Japan. Herein, we present 2 extremely rare cases of PA recurrence more than 10 years after adrenalectomy for APA. In the first case, a 52-year-old woman was examined for hypertension 22 years after total adrenalectomy of the right adrenal gland. Recurrent PA was diagnosed based on high aldosterone-renin-ratio (ARR), identification of left adrenal gland tumor by computed tomography (CT), and a confirmatory test. In the second case, a 65-year-old man was examined for hypertension 17 years after total adrenalectomy of the left adrenal gland. He had maintained his blood pressure using medication since the onset of hypertension 4 years after the surgery. A year later, a high ARR was observed. PA recurrence was determined by a right adrenal gland tumor noted on CT and a confirmatory test. Somatic mutations in KCNJ5 were detected in the resected tissues in both cases. We recommend careful follow-ups after adrenalectomy in APA cases, especially in those with a KCNJ5 gene mutation.
Case report: Immunotherapy-based combination therapy achieving complete remission and prolonged survival in nasopharyngeal carcinoma with extensive bone marrow metastasis
Authors: Xingran Wang, Ying Yuan, Yan Zhang, Guanglei Qiao, Shihong Chen, Wentao Huang, Jianjun Zhang
Journal: Front Immunol (2024)
Keywords: bone marrow, chemotherapy, immunotherapy, nasopharyngeal carcinoma, recurrence and metastasis
MeSH terms: Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Bone Marrow Neoplasms / secondary, Bone Marrow Neoplasms / therapy, Nasopharyngeal Carcinoma / pathology, Nasopharyngeal Carcinoma / therapy, Nasopharyngeal Neoplasms / pathology, Nasopharyngeal Neoplasms / therapy, Case Reports, Albumins, Antibodies, Monoclonal, Humanized / administration & dosage, Antibodies, Monoclonal, Humanized / therapeutic use, Cisplatin / administration & dosage, Cisplatin / therapeutic use, Humans, Immunotherapy / methods, Male, Middle Aged, Paclitaxel / administration & dosage, Paclitaxel / therapeutic use, Remission Induction, Treatment Outcome, Cisplatin, Paclitaxel, pembrolizumab, Antibodies, Monoclonal, Humanized, 130-nm albumin-bound paclitaxel, Albumins

Nasopharyngeal carcinoma with bone marrow metastasis presents a rare and challenging clinical scenario associated with exceedingly poor prognosis. While standard treatment regimens offer limited efficacy and tolerability in such cases, individualized approaches are increasingly necessary. We present the case of a 64-year-old male diagnosed with recurrent nonkeratinizing undifferentiated nasopharyngeal carcinoma with extensive bone marrow metastasis (rTxN0M1). Treatment was initiated with immunotherapy-based combination therapy, consisting of pembrolizumab and low-dose cisplatin, which resulted in an initial response. Subsequently, there was a transition to standard-dose nab-paclitaxel-cisplatin chemotherapy in combination with pembrolizumab, followed by maintenance therapy with pembrolizumab plus fruquintinib. The patient achieved a sustained response with renormalization of tumor markers, imaging findings, and bone biopsies, resulting in complete remission. This case highlights the successful management of nasopharyngeal carcinoma with extensive bone marrow metastasis through an individualized treatment approach incorporating immunotherapy.