OpenMed/multicare-articles huggingface dataset:
Ecological urbanism as a condition underpinning urban life for internally displaced peoples in Colombia
Authors: Paula Andrea Valencia Londoño, Diana Valencia Londoño, Phoenix Storm Paz
Journal: PLoS One (2023)
MeSH terms: Bignoniaceae, Quality of Life, Research Support, Non-U.S. Gov't, Colombia, Electricity, Humans, Rivers

This paper employs the concepts of sustainability and habitability to define and measure ecological urbanism in informal settlements founded by people who have been forcibly displaced by violence. The objective is to identify the obstacles in meeting the tenets of ecological urbanism in informal settlements. We offer primary research from La Primavera, an informal settlement founded by internally displaced people in the late 1970s, located in the corregimiento El Hatillo of Barbosa, Antioquia in northwestern Colombia. Primary research includes qualitative and quantitative data gathered through 72 surveys and 45 technical assessments of properties and houses in the settlement. Situated between the Aburrá River and the northbound highway, above a gas pipeline and under an electricity pylon, La Primavera exists in a state of extreme risk, exacerbated by increasing migration which threatens to exceed the carrying capacity of the territory. Moreover, in Article 35 of Law 388 of 1997, the territory was declared a protected or restricted area and earmarked for the development of the regional commuter train, called the Tren de Cercanías, in 2017. The case study highlights the contradictions in the development agenda in Colombia by showing how development projects designed for the economic betterment and environmental conservation of the region negatively impact the quality of life for the most vulnerable inhabitants and expose them to greater environmental, economic, and social risk.
Challenges in Extubation: A Case of a Non-removable Tracheal Tube Following Surgery
Authors: Rita Silva, Tania Carvalho, Maria João Tarroso, Helder Cardoso
Journal: Cureus (2024)
Keywords: airway extubation, difficult airway management, endotracheal tube cuff, lodged tube, tracheal cuff rupture
MeSH terms: Case Reports

This report details a challenging case of difficult extubation due to a lodged tracheal tube following surgery, presenting an unexpected and complex clinical situation. An inspection of the airway using videolaryngoscopy revealed an over-inflated cuff beneath the vocal cords. Initial efforts to deflate the cuff with various methods were unsuccessful. The situation was ultimately resolved through the intervention of an otolaryngology surgeon. This case not only reviews various mechanisms of difficult endotracheal tube removal reported in the literature, but also underscores the potential for serious complications and highlights the critical role of multidisciplinary collaboration in managing extubation challenges. Additionally, our manuscript discusses alternative strategies that can be employed in scenarios where an otolaryngology surgeon is not available, offering practical guidance for anesthesiologists confronted with similar situations.
Embolization of multiple splenic artery aneurysms in a patient with hypersplenism due to portal hypertension: a case report
Authors: Lucas Victoy Guimarães Zengo, Maria Vitoria Bandeira Liebich, Larissa Rossi, Giuliana Rossato Biezus, Jeferson Freitas Toregeani, Jong Hun Park
Journal: J Vasc Bras (2024)
Keywords: aneurysms, cirrhosis, embolization, hypersplenism, portal hypertension, splenic artery
MeSH terms: Case Reports

Aneurysms of the splenic artery are the third most common type of intra-abdominal aneurysms and the most common type of visceral aneurysms. Portal hypertension is a significant risk factor for development of these aneurysms. We report the case of a white, female, 52-year-old patient with multiple splenic artery aneurysms and hypersplenism secondary to portal hypertension and cirrhosis. Abdominal angiotomography identified six splenic aneurysms. In this scenario, an endovascular intervention was scheduled to conduct embolization using controlled release coils and Onyx™ embolization agent. The three largest aneurysms were treated. Control angiographs showed good exclusion of the aneurysms. The endovascular technique therefore proved to be a good choice considering the patient's comorbidities and blood disorders. In this case, the procedure was successful. There were no immediate or long-term complications. The patient recovered well and is in clinical follow-up.
Small Cell/Neuroendocrine Prostate Cancer: A Rare Treatment-Resistant Variant Presenting as Acute Onset Severe Back Pain
Authors: Su T Khine, Sania Ajmal, Qazi Azher, Adiraj Singh
Journal: Cureus (2024)
Keywords: adt (androgen deprivation therapy), bony metastases, intractable back pain, neuroendocrine prostate cancer, oncology, psa negative prostate cancer
MeSH terms: Case Reports

Adenocarcinoma of the prostate is the most frequent subtype of prostate cancer. Being an androgen-driven disease, androgen deprivation therapy (ADT) is one of the mainstay treatments for prostatic adenocarcinoma. ADT however can induce androgen resistance and can cause neuroendocrine differentiation of the cells and subsequently can lead to the emergence of neuroendocrine prostate cancer (NEPC). NEPC, despite being rare, is very aggressive with a very low survival period. The majority of the NEPC cases are treatment-emergent. There is no definite guideline on screening for the development of NEPC for patients who are on ADT. Our case highlights the lethality and aggressiveness of NEPC and the relationship between ADT and NEPC. More research is needed to compare different imaging techniques for early detection and identification of NEPC and to establish screening protocols for patients at risk of developing NEPC while on ADT.
From Nonfunctioning Adrenocortical Cancer to Biochemically Silent Paraganglioma Associated with SDHB Mutation: An Uncommon Presentation of a Patient with a Retroperitoneal Mass
Authors: Izabella Freitas, Anna Albuquerque, Luiz de Marco, Eduardo Jr, José Renan Melo, Juliana Drummond, Beatriz Rocha
Journal: Case Rep Endocrinol (2024)
MeSH terms: Case Reports

The combination of clinical characteristics and diagnostic exams including imaging, laboratory, and molecular tests help in the differential diagnosis of retroperitoneal lesions. We report a 41-year-old male with a metastatic retroperitoneal lesion with atypical characteristics, displaying pathological findings consistent with both nonsecretory pheochromocytomas/paragangliomas and adrenal cortex carcinoma. The patient was examined for abdominal pain, weight loss, and hypertension. Abdominal computed tomography showed a 21 × 8 × 10-cm right retroperitoneal mass. He was initially diagnosed as pheochromocytoma/paraganglioma (PHEO/PGL). However, the diagnosis was later changed to adrenocortical carcinoma based on histopathological features of the metastatic lesions and the findings of normal urinary levels of catecholamines/metanephrines. Systemic chemotherapy and abdominal radiotherapy were performed, in addition to multiple surgical resections, with no satisfactory response. The indolent course of the disease and minimal impact on the patient's performance status led to a genetic evaluation which resulted in the identification of a germline mutation in the succinate dehydrogenase complex subunit B (SDHB). An immunohistology review of previous slides was consistent with the hypothesis of a neuroendocrine tumor. Forty percent of the patients with PHEO/PGL have an underlying germline mutation. SDHB mutation is frequently associated with metastatic disease and dominant secretion of noradrenaline and/or dopamine. In addition to the metastatic disease, few cases with the mutations can be a biochemically silent PHEO/PGL. We concluded that the patient presented a metastatic abdominal paraganglioma associated with an SDHB mutation and we reinforced the need to perform genetic screening for all adrenal/extra-adrenal lesions characteristic of PHEO/PGL.
Case report: Rapid improvements of anorexia nervosa and probable myalgic encephalomyelitis/chronic fatigue syndrome upon metreleptin treatment during two dosing episodes
Authors: Johannes Hebebrand, Jochen Antel, Linda von Piechowski, Cordula Kiewert, Burkhard Stüve, Gertraud Gradl-Dietsch
Journal: Front Psychiatry (2023)
Keywords: depression, exhaustion, fatigue, leptin, muscle, sleep quality
MeSH terms: Case Reports

A comorbidity of anorexia nervosa (AN) and myalgic encephalomyelitis (ME/CSF) is uncommon. A 17 years-old male adolescent with possible onset of ME/CFS after an Epstein Barr Virus infection (EBV) and later onset of AN during a second period of weight loss was twice treated off-label with metreleptin for 15 and 11 days, respectively. As in previous cases, eating disorder specific cognitions and mood improved. Interestingly, fatigue and post-exertional muscle pain (P-EMP) improved, too. We discuss potential mechanisms. Treatment with metreleptin may prove beneficial in AN and in ME/CSF associated with substantial weight loss.
Case report: An ultrasound-based approach as an easy tool to evaluate hormone receptor-positive HER-2-negative breast cancer in advanced/metastatic settings: preliminary data of the Plus-ENDO study
Authors: Liliana Montella, Luigi Di Marino, Maria Adele Marino, Vittorio Riccio, Nunzio Del Gaudio, Lucia Altucci, Massimiliano Berretta, Gaetano Facchini
Journal: Front Oncol (2024)
Keywords: cdk4/6 inhibitors, breast cancer, hormone-responsive, radiology, ultrasound
MeSH terms: Case Reports

Background:
Hormone receptor-positive tumors are unlikely to exhibit a complete pathological tumor response. The association of CDK 4/6 inhibitor plus hormone therapy has changed this perspective.
Case presentation:
In this study, we retrospectively reviewed the charts of patients with a diagnosis of luminal A/B advanced/metastatic tumors treated with a CDK 4/6 inhibitor-based therapy. In this part of the study, we present clinical and ultrasound evaluation. Eight female patients were considered eligible for the study aims. Three complete and five partial responses were reported, including a clinical tumor response of 50% or more in five out of nine assessed lesions (55%). All patients showed a response on ultrasound. The mean lesion size measured by ultrasound was 27.1 ± 15.02 mm (range, 6-47 mm) at the baseline; 16.08 ± 14.6 mm (range, 0-40 mm) after 4 months (T1); and 11.7 ± 12.9 mm (range, 0-30 mm) at the 6 months follow-up (T2). Two patients underwent surgery. The radiological complete response found confirmation in a pathological complete response, while the partial response matched a moderate residual disease.
Conclusion:
The evaluation of breast cancer by ultrasound is basically informative of response and may be an easy and practical tool to monitor advanced tumors, especially in advanced/unfit patients who are reluctant to invasive exams.
Poorly cohesive duodenal carcinoma mixed with signet ring cell carcinoma with systemic metastasis: a case report and literature review
Authors: Song Tang, Xinjun Li, Aiguo Wu
Journal: Front Oncol (2023)
Keywords: case report, duodenal carcinoma, poorly cohesive carcinoma, signet ring cell carcinoma, systemic metastasis
MeSH terms: Case Reports

Poorly cohesive duodenal carcinoma mixed with signet ring cell carcinoma is very rare, and no cases have been reported. When distant metastasis occurs, it is very easy to be misdiagnosed. We report the first case of a 52-year-old man with poorly cohesive carcinoma of the duodenum mixed with signet ring cell carcinoma with systemic metastasis. The process of its diagnosis and differential diagnosis is highlighted.
A Case of Reverse McConnell's Sign Associated With Acute Respiratory Distress Syndrome and Septic Shock
Authors: Brett Curtis, Albert Ha, Jeffrey Xie, Robert Hyzy, Adam S Helms
Journal: Cureus (2024)
Keywords: acute respiratory distress syndrome (ards), acute right heart failure, mcconnell’s sign, right ventricular cardiomyopathy, shock
MeSH terms: Case Reports

We present a case of reverse McConnell's sign, a rare echocardiographic finding of right ventricular apical hypokinesis and basal hyperkinesis, in a patient with acute respiratory distress syndrome and septic shock. Although multiple etiologies were hypothesized, providers attributed this cardiomyopathy to increased right heart afterload from hypoxic pulmonary vasoconstriction. Cardiac function normalized as the patient's respiratory failure and sepsis resolved. This study highlights the value of early echocardiography to help guide management in critical illness. In our case, this finding helped initiate diuresis and establish a baseline for monitoring cardiac function as this patient's critical illness resolved. Literature has most commonly associated reverse McConnell's sign with massive pulmonary embolism and, more rarely, takotsubo cardiomyopathy. Given the absence of PE, takotsubo, or other identifiable cause, this case suggests that reverse McConnell's sign may more generally indicate acutely increased right ventricular afterload rather than a specific diagnosis. When reverse McConnell's sign is detected, treatment should focus on reversible causes of elevated right heart pressure (e.g., volume overload, PE) and increased pulmonary resistance.
Dysphagia as an Initial Presentation of Acute Myeloid Leukemia: A Rare Presentation of Myeloid Sarcoma
Authors: Rajaa Mohamed Salih, Rahman Olusoji, Chizoba Nwankwo, Noah Osei, Ifeoma P Kwentoh, Obinna T Nwankwo
Journal: Cureus (2024)
Keywords: acute myeloid leukemia (aml), acute myeloid sarcoma, bone marrow biopsy, dysphagia, lymphadenopathy
MeSH terms: Case Reports

Myeloid sarcoma (MS) represents a unique clinical presentation of acute myeloid leukemia (AML). This report describes a case of MS in a 66-year-old man who presented with dysphagia, nausea, vomiting, anorexia, and fatigue. Generalized lymphadenopathy was noted on physical exam and confirmed by CT scans which also showed diffuse esophageal wall thickening. Axillary lymph node biopsy was positive for MS. Bone marrow biopsy confirmed AML with 88% blasts. The patient received induction chemotherapy with decitabine and venetoclax and was planned for four cycles of treatment over three months while monitoring the response.
Seizures, Psychosis, and Cerebral Vascular Malformation: A Rare Chain of Events
Authors: Ismail Hanine, Khadija Benallel, Roukaya Benjelloun, Mohamed Kadiri
Journal: Case Rep Psychiatry (2024)
MeSH terms: Case Reports

Background:
In psychiatry, anatomical abnormalities are sometimes forgotten, and this can mislead doctors into thinking that the diagnosis is purely psychiatric. A physical examination is important whenever it is possible. Even though cerebral arteriovenous malformations (cAVMs) are rare and can go unnoticed, in some cases they can cause clinical symptoms, which is a complication. Case Presentation. In this case, we describe a patient with no prior medical or psychiatric history having a cAVM diagnosed after showing psychotic symptoms (delusion and disorganized thoughts and behavior). The deep 4 × 5 cm cAVM was discovered after admitting the patient to psychiatric ward, the neurological cause has been considered after a recorded seizure, which brings the following question: Is the clinical presentation a direct result of the cAVM or is it postictal?
Conclusions:
An abnormality leading to another, here is how we could describe our patient's psychopathology leading to psychotic symptoms. The two hypotheses explaining this case report have a low rate of occurring making this a rare case. Either way, neurological cause cannot be overlooked even if the clinical presentation is typical.
Nitrous oxide abuse in a 21-year-old female: a case report and review of literature
Authors: Qi Dai, Shutong Chen, Xiaodan Zhang, Kuixin Fan, Jingfeng Zhang, Jianjun Zheng
Journal: Front Neurol (2024)
Keywords: n2o abuse, laughing gas, neurological disorders, subacute combined degeneration, vitamin b12
MeSH terms: Review

The abuse of nitrous oxide (N2O) poses a substantial public health challenge. In many countries, including China, regulations governing the utilization and accessibility to N2O remain ambiguous, particularly within the food industry. Here, we report a case of a 21-year-old female who presented with symptoms of subacute combined degeneration (SCD) of the spinal cord due to N2O abuse. The patient exhibited bilateral lower limb numbness and weakness, low serum vitamin B12 levels with elevated homocysteine levels, and lumbar spine magnetic resonance imaging (MRI) revealed abnormal signals of the spinal cord. Following cessation of N2O and comprehensive therapy including methylcobalamin and nerve growth factor, the symptoms significantly improved. A follow-up examination 3 months later showed good progress in gait stability. At a 5-year follow-up, the patient's previous clinical symptoms had completely disappeared, and her quality of life had returned to normal. This case underscores the urgency of raising awareness and prevention of N2O abuse, emphasizing the importance of timely diagnosis and comprehensive treatment for patient recovery. Clear formulation and enforcement of relevant regulatory measures are equally crucial in reducing instances of abuse.
Severe Atelectasis due to Aspirated Valproic Acid Tablet
Authors: Tomomi Tanigaki, Takunori Ogawa, Sakika Nomura, Koki Ito, Yuhei Kurata, Akira Matsukida, Morio Ishihara, Aihide Yoshino, Akihiko Kawana, Yoshifumi Kimizuka
Journal: Case Rep Pulmonol (2024)
MeSH terms: Case Reports

A 60-year-old man treated with valproic acid (VPA) for epilepsy developed atelectasis and respiratory failure after an accidentally aspirated VPA tablet-induced mucus hypersecretion. Following bronchoscopic removal of the aspirated tablet, his respiratory status improved and massive sputum production did not recur. We hypothesized that the aspirated VPA tablet increased the expression of mucin-related genes, thereby increasing mucus production. Our in vitro experiments using a human respiratory epithelial cell line revealed that VPA directly upregulates the airway mucin-related genes. We believe that this is the first case report of aspirated VPA-induced severe atelectasis and respiratory failure, which were successfully treated with the bronchoscopic removal of the VPA tablet.
A case report of secondary B-cell acute lymphoblastic leukemia treated with a combination of FLT3 inhibitor and decitabine
Authors: Mengci Hu, Wenzhe Li, Pan Li, Jie Tan, Ya Wang
Journal: Front Oncol (2024)
Keywords: flt3, acute lymphoblastic leukemia, diffuse large b-cell lymphoma, myelodysplastic syndrome, secondary acute lymphoblastic leukemia
MeSH terms: Case Reports

Secondary acute lymphoblastic leukemia (s-ALL) refers to acute lymphoblastic leukemia that occurs after a previous malignant tumor, including therapy-related acute lymphoblastic leukemia (t-ALL) and prior malignant tumor acute lymphoblastic leukemia (pm-ALL). We report a case of a 51-year-old female patient who developed acute lymphoblastic leukemia 14 years after being diagnosed with diffuse large B-cell lymphoma (DLBCL). The patient was unresponsive to conventional chemotherapy for acute lymphoblastic leukemia (ALL) and achieved remission with a combination of sorafenib and decitabine based on the molecular biology characteristics of her B-ALL.
A tree-based approach to identify indispensable foods in minimum-cost food baskets
Authors: Melissa F Koenen, Romée Geelen, Marleen Balvert, Hein Fleuren
Journal: Front Nutr (2024)
Keywords: cost resilience, diet optimization, food and nutrition security, food baskets, linear programming

Introduction:
Optimization techniques, such as linear programming, can be used to estimate the minimum cost of a nutrient-adequate food basket, to determine if individuals or households can afford nutritious diets. These cost estimates typically account for seasonal fluctuations but often overlook significant disruptions in the availability of affordable nutritious food that can severely impact food and nutrition security.
Methods:
This paper proposes a tree-based method, the binary search tree, to assess the resilience of the cost estimate of the minimum-cost food basket. In particular, this method aims to identify indispensable foods in these baskets - those whose unavailability would lead to a substantial cost increase. The binary search tree operates by iteratively excluding essential food items while ensuring the construction of minimum-cost nutritious baskets. It considers all relevant combinations of foods up to a specified size and avoids unnecessary optimizations, thereby saving computation time. We describe how the resulting tree can be evaluated and condensed to capture only the necessary information for decision makers. The construction and evaluation of the binary search tree are independent of the (dietary) restrictions or type of optimization model (i.e., linear, non-linear or integer) included.
Results:
In general, the binary search tree can identify all (combinations of) foods whose exclusion leads to a significant cost increase of a nutritious food basket. Furthermore, it can detect possible substitute effects between foods and identify key limiting nutrients. A case study is presented in which the binary search tree is applied to data from Ebonyi, Nigeria, modeled using linear programming. We report all combinations of up to five foods that, when unavailable, can impact food and nutrition security in Ebonyi.
Conclusion:
The BST can provide insights into local food and nutrition security when facing drastic disruptions in access to nutritious foods by identifying indispensable foods. Its results can be used to inform and design interventions in the context of humanitarian operations.
Successful Percutaneous Coronary Intervention in Chronic Total Occlusion after Coronary Perforation
Authors: Luis A Areiza, Juan F Rodriguez
Journal: Case Rep Cardiol (2023)
MeSH terms: Case Reports

Coronary chronic total occlusions are challenging lesions with high rates of complications related to percutaneous intervention. We describe a successful angioplasty in a patient with a recent coronary perforation, using multiple techniques, such as stick and swap with Stingray, subintimal transcatheter withdrawal, and investment.
"You can't really have a relationship with them because they just ask you questions": understanding adolescent dropout - an empirical single case study
Authors: Antonella Cirasola, Dora Szegedi, Peter Fonagy, Nick Midgley
Journal: Front Psychol (2024)
Keywords: short-term psychoanalytic psychotherapy, adolescent depression, alliance, dropout, single case, unsuccessful treatments, youth psychotherapy

Introduction:
High dropout rates are common in youth psychotherapy, including psychoanalytic psychotherapy, yet the reasons behind this trend remain obscure. A critical focus to enhance adolescent engagement could be the therapeutic alliance, particularly in resolving alliance ruptures. This study sought to clarify the complex relationships between the therapeutic alliance, encompassing alliance ruptures and resolutions, and dropout within the context of poor outcome. It investigated a single case of an adolescent with depression who dropped-out of Short-Term Psychoanalytic Psychotherapy, without showing clinical improvement.
Method:
Data was garnered from diverse sources, including questionnaires, interviews, and session recordings, and analyzed through a mixed-method longitudinal framework. This encompassed views from the adolescent, therapist, parents, and external evaluators.
Results:
The study identifies several factors impacting the decision to drop out, including initial profound distrust toward the therapist, a complex and difficult therapeutic relationship characterized by unresolved alliance ruptures, and sporadic attendance. External factors including minimal parental engagement with therapy were also seen as detrimental to the adolescent's involvement and progress.
Discussion:
The research underscores the challenges in engaging adolescents, especially when there may be distrust of professionals, and in the absence of parental involvement with treatment.