OpenMed/multicare-articles huggingface dataset:
First case report of Schistosoma japonicum in Nepal
Authors: Dipendra Bajracharya, Sanjeet Pandit, Durga Bhandari
Journal: Access Microbiol (2020)
Keywords: ciwec hospital, nepal, schistosoma japonicum, schistosomiasis, first case report
MeSH terms: Case Reports

Background:
Schistosomiasis, globally, is significant public as well as veterinary health problem as it is associated with a wide range of clinical conditions in humans and animals. Schistosomiasis is mostly caused by the following species of genus Schistosoma: Schistosoma japonicum, Schistosoma haematobium, Schistosoma mekongi, Schistosoma intercalatum Schistosoma guineensis, Schistosoma malayensis and Schistosoma mansoni. S. japonicum might be considered as the most pathogenic among these species as the clinical disease caused by this parasite ranges from mild diarrhea, nausea, Katayama fever, portal hypertension, splenomegaly and ascites to liver cirrhosis and fibrosis. S. japonicum has been commonly encountered in China, the Philippines and Indonesia. According to WHO, at least 220.8 million people required preventive treatment for schistosomiasis in 2017 but only 102.3 million people were reported to have been treated. To our knowledge, there are no cases reported from Nepal. Hence, this is the first reported case of S. japonicum in Nepal.
Case presentation:
A case of acute schistosomiasis due to S. japonicum was identified in CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal. The patient arrived with gastrointestinal symptoms without any pre-existing chronic illness with no evidence of travel outside of Spain since last August, but had travelled to many other countries 2 years ago. Timely diagnosis by stool routine and microscopic examination and formal-ether concentration technique led to successful treatment of the disease.
Conclusion:
As the parasite has not been reported to date in Nepal, many people are unaware of its mode of infection and pathogenesis. Many laboratory workers are heedless with the egg of the parasite due to which this parasite might be misdiagnosed or undiagnosed. This case report might help laboratory workers to be sentient about the parasite and further diagnosis in future.
Challenges of diagnosing and managing bronchiectasis in resource-limited settings: a case study
Authors: Adebola Adetiloye, Gregory Erhabor, Olayemi Awopeju, Olufemi Adewole, Ebimobowei Onini, Oladapo Adewuya
Journal: Pan Afr Med J (2019)
Keywords: bronchiectasis, morbidity, pathogenetic mechanisms
MeSH terms: Bronchi / pathology, Bronchiectasis / diagnosis, Case Reports, Adult, Bronchiectasis / therapy, Delayed Diagnosis, Female, Humans, Nigeria

Bronchiectasis, once an orphan disease is now gaining renewed attention as a significant cause of morbidity and mortality. It is a morphologic term used to describe abnormal, irreversibly dilated and thick-walled bronchi, with many etiologies. The management of bronchiectasis can be challenging because its pathogenetic mechanisms is still evolving. Its diagnosis and management is particularly more demanding especially in resource-limited settings like Nigeria because of delayed diagnosis and improper management with devastating consequences, hence this case study.
Road to Tokyo 2020 Olympic Games: Training Characteristics of a World Class Male Triathlete
Authors: Roberto Cejuela, Sergio Sellés-Pérez
Journal: Front Physiol (2022)
Keywords: ecos, endurance training, training load, training periodization, triathlon

There is a growing interest in the scientific literature for reporting top-class endurance athletes training programs. This case study reports on the training program of a world-class male triathlete preparing to compete in the Tokyo 2020 Olympic Games. A macrocycle of 43 weeks is presented. The triathlete performed 14.74 ± 3.01 h of weekly endurance training volume. Training intensity distribution (TID) was 81.93% ± 6.74%/7.16% ± 2.03%/10.91% ± 6.90% for zones 1 (low intensity, <VT1), 2 (moderate intensity, VT1-VT2) and 3 (high intensity, >VT2) respectively. Pyramidal TID model is observed during the initial stages of the periodization and Polarized TID model is observed at the end of the macrocycle. The triathlete's peak ⩒O2 was increased by 20% on cycling and by 14% on running. Peak power was increased by 3.13% on cycling test and peak speed by 9.71% on running test. Finally, the triathlete placed 12th in Olympic distance and 10th in Mixed Relay in Tokyo 2020 Olympic games.
Case Report: Whole-Genome Sequencing of Serially Collected Haemophilus influenzae From a Patient With Common Variable Immunodeficiency Reveals Within-Host Evolution of Resistance to Trimethoprim-Sulfamethoxazole and Azithromycin After Prolonged Treatment With These Antibiotics
Authors: Paul Christoffer Lindemann, Haima Mylvaganam, Oddvar Oppegaard, Inger Lill Anthonisen, Nermin Zecic, Dagfinn Skaare
Journal: Front Cell Infect Microbiol (2022)
Keywords: cvid, haemophilus influenzae, case report, multidrug resistance, persistence
MeSH terms: Common Variable Immunodeficiency, Haemophilus Infections / drug therapy, Haemophilus Infections / microbiology, Case Reports, Research Support, Non-U.S. Gov't, Anti-Bacterial Agents / metabolism, Anti-Bacterial Agents / pharmacology, Anti-Bacterial Agents / therapeutic use, Azithromycin / pharmacology, Azithromycin / therapeutic use, Dihydropteroate Synthase / genetics, Dihydropteroate Synthase / metabolism, Haemophilus influenzae, Humans, Microbial Sensitivity Tests, Trimethoprim, Sulfamethoxazole Drug Combination / pharmacology, Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use, Anti-Bacterial Agents, Trimethoprim, Sulfamethoxazole Drug Combination, Azithromycin, Dihydropteroate Synthase

We report within-host evolution of antibiotic resistance to trimethoprim-sulfamethoxazole and azithromycin in a nontypeable Haemophilus influenzae strain from a patient with common variable immunodeficiency (CVID), who received repeated or prolonged treatment with these antibiotics for recurrent respiratory tract infections. Whole-genome sequencing of three longitudinally collected sputum isolates during the period April 2016 to January 2018 revealed persistence of a strain of sequence type 2386. Reduced susceptibility to trimethoprim-sulfamethoxazole in the first two isolates was associated with mutations in genes encoding dihydrofolate reductase (folA) and its promotor region, dihydropteroate synthase (folP), and thymidylate synthase (thyA), while subsequent substitution of a single amino acid in dihydropteroate synthase (G225A) rendered high-level resistance in the third isolate from 2018. Azithromycin co-resistance in this isolate was associated with amino acid substitutions in 50S ribosomal proteins L4 (W59R) and L22 (G91D), possibly aided by a substitution in AcrB (A604E) of the AcrAB efflux pump. All three isolates were resistant to aminopenicillins and cefotaxime due to TEM-1B beta-lactamase and identical alterations in penicillin-binding protein 3. Further resistance development to trimethoprim-sulfamethoxazole and azithromycin resulted in a multidrug-resistant phenotype. Evolution of multidrug resistance due to horizontal gene transfer and/or spontaneous mutations, along with selection of resistant subpopulations is a particular risk in CVID and other patients requiring repeated and prolonged antibiotic treatment or prophylaxis. Such challenging situations call for careful antibiotic stewardship together with supportive and supplementary treatment. We describe the clinical and microbiological course of events in this case report and address the challenges encountered.
Initial clinical experience with magnetic resonance-guided radiotherapy in pediatric patients: Lessons learned from a single institution with proton therapy
Authors: Matthew D Hall, Kathryn E Mittauer, Roberto Herrera, Katherine Von Werne, Rupesh Kotecha, Noah S Kalman, James McCulloch, Diane Alvarez, Nicole C McAllister, Delia G Doty, Amy E Rzepczynski, Will Deere, Alonso N Gutierrez, Michael D Chuong
Journal: Front Oncol (2023)
Keywords: mr linac, sabr, sbrt, adaptive replanning, anesthesia, motion management, proton therapy, stereotactic body radiation therapy

Purpose/objectives:
Magnetic resonance-guided radiotherapy (MRgRT) is increasingly used in a variety of adult cancers. To date, published experience regarding the use of MRgRT in pediatric patients is limited to two case reports. We report on the use of MRgRT for pediatric patients at our institution during a four-year period and describe important considerations in the selection and application of this technology in children.
Materials/methods:
All patients treated with MRgRT since inception at our institution between 4/2018 and 4/2022 were retrospectively reviewed. We also evaluated all pediatric patients treated at our institution during the same period who received either imaging or treatment using our magnetic resonance-guided linear accelerator (MR Linac). We summarize four clinical cases where MRgRT was selected for treatment in our clinic, including disease outcomes and toxicities and describe our experience using the MR Linac for imaging before and during treatment for image fusion and tumor assessments.
Results:
Between 4/2018 and 4/2022, 535 patients received MRgRT at our center, including 405 (75.7%) with stereotactic ablative radiotherapy (SABR). During this period, 347 distinct radiotherapy courses were delivered to pediatric patients, including 217 (62.5%) with proton therapy. Four pediatric patients received MRgRT. One received SABR for lung metastasis with daily adaptive replanning and a second was treated for liver metastasis using a non-adaptive workflow. Two patients received fractionated MRgRT for an ALK-rearranged non-small cell lung cancer and neuroblastoma. No Grade 2 or higher toxicities were observed or reported during MRgRT or subsequent follow-up. Twelve patients underwent MR imaging without contrast during treatment for brain tumors to assess for tumor/cystic changes. Two patients treated with other modalities underwent MR simulation for target volume delineation and organ at risk sparing due to anatomic changes during treatment or unexpected delays in obtaining diagnostic MR appointments.
Conclusions:
In four pediatric patients treated with MRgRT, treatment was well tolerated with no severe acute effects. At our center, most pediatric patients are treated with proton therapy, but the cases selected for MRgRT demonstrated significant organ at risk sparing compared to alternative modalities. In particular, MRgRT may provide advantages for thoracic/abdominal/pelvic targets using gated delivery and adaptive replanning, but selected patients treated with fractionated radiotherapy may also benefit MRgRT through superior organ at risk sparing.
Should Serum Protein Electrophoresis Be a Surrogate for Liver Biopsy in Some Cases of Alpha1 Antitrypsin Deficiency?
Authors: Newton Key Hokama, Marcelo Padovani de Toledo Moraes, Paula de Oliveira Montandon Hokama, Fernando Gomes Romeiro
Journal: Case Reports Hepatol (2017)
MeSH terms: Case Reports

Most patients with alpha1 antitrypsin deficiency do not receive this diagnosis until developing severe complications, in particular when respiratory symptoms are absent. This is a reason for making alpha1 antitrypsin deficiency a possible diagnosis among patients with cryptogenic cirrhosis or other conditions of liver disease without a clear etiology. In this report, a case of cryptogenic cirrhosis is presented, showing the role of serum protein electrophoresis in the diagnosis, which was made before liver biopsy. Therefore, the possibility of using a typical pattern of serum protein electrophoresis as a surrogate for liver biopsy in alpha1 antitrypsin deficiency is discussed.
Acute Vision Loss Following Endoscopic Sinus Surgery
Authors: Serena Byrd, Adnan S Hussaini, Jastin Antisdel
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

A 41-year-old female with a history of uterine cancer and Celiac and Raynaud's Disease presented to our institution with frequent migraines and nasal congestion. She underwent functional endoscopic sinus surgery (FESS) and experienced acute unilateral vision loss postoperatively. Rapid recognition of the etiology and effective treatment are paramount given the permanent and irreversible vision loss that can result. Arterial vasospasm following FESS is rare. Patients with autoimmune diseases have perhaps an increased risk for vasospasm secondary to an increased vasoreactive profile. We present the first documented case of nitroglycerin sublingual therapy to successfully treat ophthalmic artery vasospasm following FESS. Nitroglycerin sublingual therapy is a promising treatment for ophthalmic vasospasm secondary to its ability to cross the blood-ocular barrier, its rapid onset of action, and its ability to promote relaxation of vascular smooth muscle.
Preoperative diagnosis and surgical treatment for giant retroperitoneal liposarcoma: A case report
Authors: Anna Pisapia, Enrico Crolla, Rosario A Saglioccolo, Alessandro Perrella, Carlo Molino
Journal: Int J Surg Case Rep (2019)
Keywords: case report, compartmental surgery, liposarcoma, preoperative diagnosis, retroperitoneum

Introduction:
The purpose of this article is to present the diagnostic and surgical approach for a giant retroperitoneal sarcoma and to highlight the difficulty of a precise preoperative diagnosis and the extention of surgical resection.
Presentation of case:
A 63-year-old female patient was admitted at our department with light diffuse abdominal pain, fever and gradual increase of abdominal girth. A CT scan showed a giant fatty tumor occupying left hemiabdomen and indirect findings of renal damage, probably sustained by ureter stretching and urine stasis. At surgical exploration, no cleavage plane was discovered between the mass and the surrounding organs. The severe pielonephritis and the apparent intraoperatively involvement of surrounding tumour structures lead to an aggressive surgery. An "en-bloc" resection of tumor mass, left colon, spleen, pancreatic tail, left annex, left kidney and adrenal gland was performed. Histology revealed a well differentiated liposarcoma with large areas of high grade of dedifferentiation.
Discussion:
Liposarcoma is an histologic subtype of soft tissue sarcoma and the most common type of sarcoma arising in retroperitoneum. It is difficult to make an accurate preoperative diagnosis through a percutaneous biopsy. Although it is required to obtain negative resection margins, literature shows that surgical radicality is not a primary endpoint if noble structures are strictly close. In some cases surgery must be more aggressive because of the apparent organ involvement or damage.
Conclusion:
This is a rare case of a giant liposarcoma involging many organs. Surgery should be tailored according to intraoperative findings and organ damage.
Rheumatoid arthritis and Swine influenza vaccine: a case report
Authors: Gurjot Basra, Praveen Jajoria, Emilio Gonzalez
Journal: Case Rep Rheumatol (2012)

Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease. Multiple scientific articles have documented that vaccinations for influenza, MMR, and HBV, to name a few, could be triggers of RA in genetically predisposed individuals. However, there is limited data regarding the association of swine flu vaccine (H1N1) and RA. We report the case of a Mexican American female who developed RA right after vaccination with H1N1 vaccine. Genetically, RA has consistently been associated with an epitope in the third hypervariable region of the HLA-DR β chains, known as the "shared epitope", which is found primarily in DR4 and DR1 regions. The presence of HLA-DRB1 alleles is associated with susceptibility to RA in Mexican Americans. Hence, certain individuals with the presence of the "shared epitope" may develop RA following specific vaccinations. To our knowledge, this is the first reported case of RA following vaccination with the swine flu vaccine.
Excellent Response to Atezolizumab After Clinically Defined Hyperprogression Upon Previous Treatment With Pembrolizumab in Metastatic Triple-Negative Breast Cancer: A Case Report and Review of the Literature
Authors: Dongfeng Feng, Yaping Guan, Mingguo Liu, Shuqian He, Weipeng Zhao, Beibei Yin, Jing Liang, Yan Li, Jun Wang
Journal: Front Immunol (2021)
Keywords: atezolizumab, hyperprogressive disease, immune checkpoint inhibitor, pembrolizumab, triple-negative breast cancer
MeSH terms: Antibodies, Monoclonal, Humanized / therapeutic use, Antineoplastic Agents, Immunological / therapeutic use, Carcinoma, Ductal / drug therapy, Immune Checkpoint Inhibitors / therapeutic use, Immunotherapy / methods, Triple Negative Breast Neoplasms / drug therapy, Case Reports, Research Support, Non-U.S. Gov't, Review, Aged, Disease Progression, Female, Humans, Neoplasm Metastasis, Neoplasm Staging, Remission Induction, Treatment Outcome, Antibodies, Monoclonal, Humanized, Antineoplastic Agents, Immunological, Immune Checkpoint Inhibitors, atezolizumab, pembrolizumab

Immunotherapy with immune checkpoint inhibitors (ICIs), including programmed cell death protein-1 (PD-1) and programmed cell death ligand-1 (PD-L1) inhibitors, has revolutionized the systematic treatment of advanced and metastatic solid tumors. However, the response rate to ICIs is unsatisfactory, and unexpected hyperprogressive disease (HPD) is even observed in a small subgroup of patients. Patients with HPD usually have worsening clinical symptoms and poorer survival, and therapeutic strategies are extremely limited. Here, we presented a patient with HPD who had used a PD-L1 inhibitor and was highly responsive to the sequential use of a PD-1 inhibitor. A 67-year-old woman with metastatic triple-negative breast cancer was treated with pembrolizumab plus chemotherapy after progression on previous multiple-line chemotherapy treatments. After 2 cycles of treatments, she rapidly developed HPD, as confirmed by radiological evaluation and worsening symptoms. At that time, pembrolizumab was discontinued, and she switched to the PD-L1 inhibitor atezolizumab plus chemotherapy. This patient partially responded to atezolizumab plus chemotherapy without experiencing severe drug-related adverse effects. This is the first reported case of metastatic breast cancer in a patient with radiologically confirmed HPD after pembrolizumab therapy in which successful rechallenge with atezolizumab relieved clinical symptoms. Further studies with larger sample sizes involving a deeper translational investigation of HPD are needed to confirm the efficacy and mechanism of sequential application of different ICIs for the clinical management of HPD.
CT findings and clinical features of pancreatic hemolymphangioma: a case report and review of the literature
Authors: Liang Pan, Gao Jian-Bo, Pullas Tapia Gonzalo Javier
Journal: Medicine (Baltimore) (2015)
MeSH terms: Lymphangioma / diagnosis, Lymphangioma / diagnostic imaging, Pancreatic Neoplasms / diagnosis, Pancreatic Neoplasms / diagnostic imaging, Case Reports, Review, Age Factors, Female, Humans, Lymphangioma / surgery, Middle Aged, Pancreatic Neoplasms / surgery, Pancreaticoduodenectomy, Sex Factors, Tomography, X-Ray Computed, Treatment Outcome

Pancreatic hemolymphangioma is a very rare benign tumor. There were only 10 reports of this disease until June 2014.The aim of the present study was to describe a hemolymphangioma in the neck and body of the pancreas in a 57-year-old woman.The method used in the present study consists of description of the clinical history, image lab features, and pathological result.The patient complained of a 10-day history of epigastric discomfort. Abdominal computed tomography (CT) showed a cystic-solid tumor with an irregular shape, in the neck and body of the pancreas. The tumoral cystic wall and its internal division could be seen intensified on contrast-enhanced CT images compared with those on precontrast images. The pathological examination confirmed the diagnosis.The clinical feature of pancreatic hemolymphangioma includes a lack of specificity. The CT appearance combined with age and sex may be useful in making an early diagnosis.
Hemoperitoneum during Pregnancy: A Rare Case of Spontaneous Rupture of the Uterine Artery
Authors: Catarina Marçal da Silva, Rita Luz, Manuela Almeida, Daniel Pedro, Bárbara Paredes, Rui Branco, Alcides Pereira
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Spontaneous rupture of the uterine artery is a rare cause of hemoperitoneum during pregnancy. This is a life-threatening condition associated with maternal and fetal mortality. We describe a case of spontaneous rupture of the left uterine artery in a 32-year-old healthy pregnant woman with an uneventful pregnancy.
Case Report: Immune-Related Toxicity During Adjuvant Treatment With BRAF Plus MEK Inhibitors in a Melanoma Patient
Authors: Andrea Boutros, Chiara Schiavi, Federica Cecchi, Francesco Spagnolo, Antonio Guadagno, Enrica Teresa Tanda, Francesca Giusti, Giuseppe Murdaca, Paola Queirolo
Journal: Front Immunol (2020)
Keywords: braf and mek targeted therapy, dabrafenib and trametinib, immune-related adverse event irae, immunotherapy, melanoma, sarcoidosis, tattoo, uveitis
MeSH terms: Antineoplastic Combined Chemotherapy Protocols / adverse effects, Imidazoles / adverse effects, Melanoma / drug therapy, Oximes / adverse effects, Pyridones / adverse effects, Pyrimidinones / adverse effects, Sarcoidosis / diagnosis, Skin Neoplasms / drug therapy, Case Reports, Adrenal Cortex Hormones / administration & dosage, Adult, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Drug-Related Side Effects and Adverse Reactions, Female, Humans, Imidazoles / therapeutic use, MAP Kinase Kinase Kinases / genetics, Melanoma / complications, Mutation / genetics, Neoplasm Staging, Oximes / therapeutic use, Proto-Oncogene Proteins B-raf / genetics, Proto-Oncogene Proteins B-raf / metabolism, Pyridones / therapeutic use, Pyrimidinones / therapeutic use, Sarcoidosis / etiology, Sarcoidosis / prevention & control, Skin Neoplasms / complications, Adrenal Cortex Hormones, Imidazoles, Oximes, Pyridones, Pyrimidinones, trametinib, Proto-Oncogene Proteins B-raf, MAP Kinase Kinase Kinases, dabrafenib

Adjuvant treatment of operated melanoma has deeply changed in the last few years with the introduction of immune-checkpoint inhibitors and BRAF/MEK inhibitors. Sarcoidosis is a systemic inflammatory disease causing non-caseous granulomatous reactions. Sarcoid-like granulomatous reactions have been reported in patients with advanced melanoma, mostly related to immunotherapy with immune-checkpoint inhibitors. We report a case of a 38-year-old woman with stage III operated melanoma treated with adjuvant BRAF plus MEK inhibitors, who developed sarcoidosis-like syndrome with systemic involvement, resolved after discontinuation of treatment. The occurrence of immune-related toxicity with the use of MAPK inhibitors supports the hypothesis that this class of drugs may also have an immunological effect, and that the long-term efficacy of adjuvant MAPK inhibitors may be due to their immunological function.