OpenMed/multicare-articles huggingface dataset:
Physician tobacco screening and advice to quit among U.S. adolescents - National Survey on Drug Use and Health, 2013
Authors: Lauren Collins, Sabrina L Smiley, Rakiya A Moore, Amanda L Graham, Andrea C Villanti
Journal: Tob Induc Dis (2017)
Keywords: adolescent, physicians, smoking, smoking cessation, united states
MeSH terms: Case Reports

Background:
Initiating tobacco use in adolescence increases the risk of nicotine dependence and continued smoking. Physician screening for tobacco use increases the odds of physicians intervening with patients who smoke; However, without appropriate follow-through by the physician, screening for tobacco use is not enough to significantly increase cessation rates. Given the critical phase of development adolescence poses in tobacco use and evidence that physician intervention improves adult cessation efforts, we sought to examine physician tobacco use screening and advice to quit among adolescents (12-17 years).
Methods:
Using data from the 2013 National Survey on Drug Use and Health (NSDUH), we examined the prevalence and correlates of tobacco use screening in adolescent respondents who reported visiting their physician within the past year (N = 12,798). Multivariable logistic regression analyses explored the relationship between tobacco use screening and physician advice to quit in a sub-set of the sample who reported on physician advice to quit (n = 1,868), controlling for sociodemographics, cigarette use, and substance use and screening.
Results:
Only 49% of adolescents who visited a physician within the past year reported being screened for tobacco use. Adolescents who were screened by their physician were predominantly female (56.6%), White (60.1%), in late adolescence (83.0%), and covered by private health insurance (63.8%). Screening for tobacco use was highly correlated with physician advice to quit smoking, controlling for sociodemographic characteristics and cigarette use; this relationship was attenuated, but remained significant, after screening for alcohol and marijuana were added to the model. Hispanic adolescents were significantly less likely to receive physician advice to quit in all multivariable models.
Conclusions:
Our findings suggest missed opportunities for youth tobacco use prevention and cessation efforts in the clinical setting. Further research is needed to better facilitate an open dialogue on tobacco use between physicians and their adolescent patients.
Bradycardia during Transradial Cardiac Catheterization due to Catheter Manipulation: Resolved by Catheter Removal
Authors: Maheedhar Gedela, Vishesh Kumar, Kashif Abbas Shaikh, Adam Stys, Tomasz Stys
Journal: Case Rep Vasc Med (2017)
MeSH terms: Case Reports

Purpose. To report the resolution of bradycardia encountered during transradial cardiac catheterization through the catheter pullback technique in two cases. Case Report. A 62-year-old male and an 81-year-old male underwent coronary angiogram to evaluate for coronary artery disease and as a result of positive stress test, respectively. Upon engagement of the FL 3.5 catheter into the ascending aorta through the transradial approach, the first case developed bradycardia with a heart rate of 39 beats per minute. The second case developed profound bradycardia with a heart rate of 25 beats per minute upon insertion of the 5 Fr FL 3.5 catheter near the right brachiocephalic trunk through the right radial access. Conclusion. Bradycardia can be subsided by removal of the catheter during catheter manipulation in patients undergoing transradial coronary angiogram if there is a suspicion of excessive stretching of aortic arch receptors and/or carotid sinus receptors.
Gastrointestinal tract metastasis presenting as intussusception in invasive lobular carcinoma of the breast: A case report
Authors: Joanne Aisha Mosiun, Muhammad Syafiq Bin Idris, Li Ying Teoh, Mei Sze Teh, Patricia Ann Chandran, Mee Hoong See
Journal: Int J Surg Case Rep (2019)
Keywords: breast cancer, case report, gastrointestinal metastasis, intussusception, invasive lobular carcinoma

Introduction:
Breast cancer metastasis to the gastrointestinal (GI) tract is rare and occurs more frequently in invasive lobular carcinoma. Patients may be asymptomatic or present with variable vague symptoms that may be mistakenly attributed to side effects of chemotherapy or other benign GI diseases. Treatment follows the principles of systemic disease and includes hormonal therapy, chemotherapy and signal transduction inhibitors, with surgical intervention indicated for complications such as obstruction, perforation and hemorrhage.
Presentation of case:
We present the case of a female patient with a history of invasive lobular breast carcinoma who had undergone mastectomy and axillary dissection, followed by chemoradiotherapy. Over the next nine years, she developed ovarian and bone metastases for which appropriate treatment was provided. A right iliac fossa mass was discovered during routine clinic review, though she remained asymptomatic. Computed tomography scan showed ileocecal intussusception. Histopathological examination of the right hemicolectomy specimen following emergency surgery confirmed metastatic invasive lobular carcinoma to the GI tract.
Discussion:
GI tract metastasis may present 30 years after the primary breast cancer. Up to 20% of patients may be asymptomatic as shown by Montagna et al. When present, symptoms are commonly non-specific and vague. Histological diagnosis is challenging. GI metastasis typically appears as intramural infiltration of the bowel wall by small cells arranged in cords.
Conclusion:
It is important to maintain a suspicion for GI tract metastasis in breast cancer patients who present with abdominal mass or GI symptoms, as this aids in prompt institution of accurate and appropriate management.
Sequential CD38 monoclonal antibody retreatment leads to deep remission in a patient with relapsed/refractory multiple myeloma
Authors: Maximilian Johannes Steinhardt, Xiang Zhou, Franziska Krummenast, Katharina Meckel, Katharina Nickel, David Böckle, Janin Messerschmidt, Sebastian Knorz, Alexander Dierks, Anke Heidemeier, Constantin Lapa, Hermann Einsele, Leo Rasche, Klaus Martin Kortüm
Journal: Int J Immunopathol Pharmacol (2020)
Keywords: cd38, mor202, daratumumab, multiple myeloma, refractory, relapse
MeSH terms: ADP-ribosyl Cyclase 1 / antagonists & inhibitors, Antibodies, Monoclonal / administration & dosage, Antibodies, Monoclonal, Humanized / administration & dosage, Antineoplastic Agents, Immunological / administration & dosage, Antineoplastic Combined Chemotherapy Protocols / administration & dosage, Membrane Glycoproteins / antagonists & inhibitors, Multiple Myeloma / drug therapy, Case Reports, ADP-ribosyl Cyclase 1 / immunology, Aged, Drug Administration Schedule, Drug Resistance, Neoplasm, Female, Humans, Membrane Glycoproteins / immunology, Multiple Myeloma / diagnosis, Multiple Myeloma / immunology, Progression-Free Survival, Remission Induction, Salvage Therapy, Time Factors, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Antineoplastic Agents, Immunological, Membrane Glycoproteins, felzartamab, daratumumab, CD38 protein, human, ADP-ribosyl Cyclase 1

We report on a currently 76-year-old female patient with relapsed/refractory (RR) multiple myeloma (MM) treated at our institution. This patient had received six lines of therapy including tandem autologous stem cell transplant, proteasome inhibitor, immunomodulatory drugs and CD38 antibody MOR202. At the last relapse, she progressed during treatment with pomalidomide and MOR202. In an individualized therapy concept, we started a multi-agent salvage therapy with pomalidomide, bortezomib, doxorubicin, dexamethasone, and CD38 antibody daratumumab ("Pom-PAD-Dara"), which resulted in a stringent complete remission with minimal residual disease (MRD) negativity after nine cycles. So far, our patient shows a progression free survival of more than 12 months. Our case demonstrates the feasibility of successful CD38 antibody retreatment in a patient with heavily pretreated CD38 antibody resistant MM.
A Case of Mucoepidermoid Carcinoma of the Larynx
Authors: James Philip Skliris, Katerina Marini, Alexandros Poutoglidis, Ioannis Matzarakis, Paraskevi Karamitsou
Journal: Cureus (2023)
Keywords: cancer, larynx, mucoepidermoid carcinoma, oncology, otolaryngology, tumor
MeSH terms: Case Reports

Mucoepidermoid carcinoma is a common malignant neoplasm of the salivary glands. While quite common in the oral cavity, it is rare in the larynx. A middle-aged male patient presented to the otolaryngology clinic of our institution with the chief complaint of hoarseness. A supraglottic subepithelial mass was detected on the left laryngeal ventricle after a comprehensive clinical examination. Eventually, the diagnosis was established with a biopsy after a direct laryngoscopy. The multidisciplinary team of our institution suggested total laryngectomy without adjuvant modalities. An uneventful procedure followed and the patient remains free of disease and up to date. Mucoepidermoid tumors of the larynx are rare and surgical treatment is strongly indicated as the treatment of choice.
Case Report: Two Cases of Pediatric Thrombotic Thrombocytopenic Purpura Treated With Combined Therapy
Authors: Costanza Tripiciano, Paola Zangari, Mauro Montanari, Giovanna Leone, Laura Massella, Lucia Garaboldi, Michela Massoud, Stefano Lancellotti, Luisa Strocchio, Emma Concetta Manno, Paolo Palma, Tiziana Corsetti, Matteo Luciani
Journal: Front Pediatr (2021)
Keywords: ttp (thrombotic thrombocytopenic purpura), caplacizumab, immunosuppressive therapy, pediatrics, plasma exchange (pex)
MeSH terms: Case Reports

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by a severely reduced activity of the von Willebrand factor-cleaving protease ADAMTS13. Over 95% of TTPs are acquired, due to autoantibody inhibitors. In children, acquired TTP is a very rare, life-threatening disease. To date, no consensus exists on the treatment strategy of pediatric TTP. We report the cases of two pediatric patients with a diagnosis of TTP, successfully treated with a combination of various therapeutic approaches. Although the patients complained of different sets of symptoms, laboratory data showed Coombs negative hemolytic anemia, renal impairment, and low platelet count in both cases. The diagnosis of acquired TTP was supported by the PLASMIC score and confirmed by the reduction of the ADAMTS13 activity and the presence of anti-ADAMTS13 antibodies. Intravenous immunoglobulin, corticosteroids, and plasma exchange (PEX) were performed without delay. As soon as available, caplacizumab was added to the therapy, with a prompt normalization of platelet count. Nevertheless, ADAMTS13 activity was persistently low, and anti-ADAMTS13 antibodies level was high; thus, a course of rituximab was administered, with persistent normalization of laboratory findings. No adverse events were observed during the treatment. In our experience, the combined use of PEX, caplacizumab, and immunosuppressive therapy during the acute phase of the disease is safe and may have a significant impact on the prognosis with successful clinical outcome and decrease in life-threatening events.
Clozapine prescribing in COVID-19 positive medical inpatients: a case series
Authors: Matthew Butler, Felicity Bano, Marilia Calcia, Isabel McMullen, Chun Chiang Sin Fai Lam, Laura Jane Smith, David Taylor, Siobhan Gee
Journal: Ther Adv Psychopharmacol (2020)
Keywords: covid-19, sars-cov-2, clozapine, psychosis, schizophrenia

There is both uncertainty regarding the safety of clozapine in COVID-19 patients owing to limited published data and a lack of consensus on continuing clozapine in patients with severe respiratory infections. COVID-19 is known to induce an acute immune response which can affect haematological parameters associated with clozapine monitoring, and systemic infection may reduce clozapine clearance. Clozapine, which has been associated with worse outcomes in some pneumonias, may in theory worsen outcomes in COVID-19. Despite these concerns, there are some data to indicate it is safe to continue clozapine in COVID-19 infection. In this retrospective case series, we describe our experiences of clozapine prescribing and disease progression of eight SARS-CoV-2 positive patients on medical wards in a major London teaching hospital. In four cases clozapine was stopped during the hospital admission. A COVID-19 pneumonia developed in four patients: three of these required intensive care unit admission for an average of 34 days. At the time of writing, three patients had died (two directly from COVID-19 pneumonia), two remained in general hospital wards, two were recovering in the community and one had been transferred to an inpatient psychiatric hospital. Follow-up length varied but in each case was not more than 104 days. Delirium was the most common adverse neuropsychiatric event, and in one case a relapse of psychosis occurred after cessation of clozapine. This retrospective case series illustrates the safe use of clozapine during COVID-19 infection. Our experiences suggest that consideration should be made to continuing clozapine even in those most unwell with COVID-19. We also identify areas which require larger scale hypothesis-testing research.
Rituximab as Rescue Therapy for Aggressive Pediatric Multiple Sclerosis
Authors: George Vartzelis, Despoina Maritsi, Maria Nikolaidou, Anastasia Garoufi, Constantinos Kilidireas
Journal: Case Rep Pediatr (2019)
MeSH terms: Case Reports

Multiple sclerosis is a chronic, debilitating disease. Almost one in ten patients with MS has a history of disease onset during childhood. Although numerous therapeutic options exist for adult MS, the available treatments for pediatric patients are still limited. One of the emerging therapies is rituximab, a monoclonal anti-CD20 chimeric antibody that can deplete the CD20+ lymphocyte populations. A 12-year-old boy presented with ataxia, paresthesias, and headache while his brain MRI showed numerous T2 contrast-enhancing lesions. Gamma globulin, steroids, and cyclophosphamide failed to intercept his disease, and he progressed to a rapid clinical and radiological deterioration. Treatment with rituximab reversed the disease course in a dramatic fashion, leading to complete remission.
Successful implantation and live birth of a healthy boy after triple biopsy and double vitrification of oocyte-embryo-blastocyst
Authors: Ermanno Greco, Anil Biricik, Rocio P Cotarelo, Elisabetta Iammarone, Patrizia Rubino, Jan Tesarik, Francesco Fiorentino, Maria Giulia Minasi
Journal: Springerplus (2015)
Keywords: blastocyst biopsy, embryo biopsy, polar body biopsy, vitrification

Introduction:
Preimplantation genetic diagnosis and/or screening (PGD/PGS) allow the assessment of the genetic health of an embryo before transferring it into the uterus. These techniques require the removal of cellular material (polar bodies, blastomere(s) or trophectoderm cells) in order to perform the proper genetic analysis. We report the implantation and live birth outcome of a vitrified-warmed blastocyst developed after triple biopsy and double vitrification procedures at oocyte, cleavage embryo and blastocyst stage.
Case description:
An infertile couple, with family history of β-thalassemia, searched for IVF procedure and PGD. First polar bodies biopsy with subsequent vitrification was uninformative due to meiotic crossing-over, so oocytes were inseminated after warming. Two embryos were obtained and blastomere biopsy was performed on day 3 with inconclusive results on their genetic status. Their culture resulted in one expanded blastocyst stage on day 7 that underwent trophectoderm biopsy and vitrification. This embryo showed to be normal. It was then warmed and transferred in an artificial cycle.
Discussion and evaluation:
Preconception genetic analysis by removal and analysis of the first polar body is technically possible, but the genetic information that we can obtain at this stage may be limited and the oocytes to be inseminated is not predictable. Compared to blastomere biopsy, trophectoderm biopsy has more diagnostic efficiency with respect to both chromosomal mosaicism and PCR accuracy, reducing the problems of amplification failure and allele drop out. Moreover, embryos biopsied at the cleavage stage seem to have lower implantation rate than biopsied blastocyst.
Conclusions:
This is the first case report of a live birth obtained from a three step biopsy and double vitrification procedures of a blastocyst. This case report seems also to suggest the harmlessness of all these procedures if carefully performed by a skilled biologist in an IVF lab with quality management system. Finally, our study highlight that blastocyst cryopreserved on day 7 have clinically important potential and embryos that not reach blastocyst stage on day 6 should not to be discharged because they may result in an ongoing pregnancy.
Two immigrants with tuberculosis of the ear, nose, and throat region with skull base and cranial nerve involvement
Authors: Renate A Richardus, Jeroen C Jansen, Stefan C A Steens, Sandra M Arend
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

We report two immigrants with tuberculosis of the skull base and a review of the literature. A Somalian man presented with bilateral otitis media, hearing loss, and facial and abducens palsy. Imaging showed involvement of both mastoid and petrous bones, extending via the skull base to the nasopharynx, suggesting tuberculosis which was confirmed by characteristic histology and positive auramine staining, while Ziehl-Neelsen staining and PCR were negative. A Sudanese man presented with torticollis and deviation of the uvula due to paresis of N. IX and XI. Imaging showed a retropharyngeal abscess and lysis of the clivus. Histology, acid-fast staining, and PCR were negative. Both patients had a positive Quantiferon TB Gold in-tube result and improved rapidly after empiric treatment for tuberculosis. Cultures eventually yielded M. tuberculosis. These unusual cases exemplify the many faces of tuberculosis and the importance to include tuberculosis in the differential diagnosis of unexplained problems.
Benign Scrotal Tumor in a Pediatric Patient: Epididymal Cyst
Authors: María Fernández-Ibieta, Flor Villalon-Ferrero, Jose Luis Ramos-García
Journal: Case Rep Urol (2018)
MeSH terms: Case Reports

A pediatric patient of 12 years consulted for a left scrotal mass of 2 months of evolution. After suspecting a cystic content due to positive transillumination, on ultrasonography a scrotal cyst separated from the testis, of 5 cm in its maximum length, was confirmed. Due to size, parental anxiety, and the referred short evolution, excision was decided. Given the clinical radiological findings, a scrotal incision was chosen, obtaining complete excision. Biopsy confirmed the diagnosis of simple epididymal cyst (EC). ECs usually present as painless, scrotal swelling in adolescents as a result of dilatation of the efferent epididymal tubules. Many cases (up to 60%) regress spontaneously. In these, average time to involute ranges from 4 to 50 months. Although cases of cyst torsion have been described (with pain derived from ischemia and inflammation), conservative management has been suggested in the majority, both in pediatric and in adult series. Surgery is recommended in some patients, due to testicular pain or increased paratesticular mass, as was our case.
Perioperative Management of a Patient with Cold Urticaria
Authors: Priscilla Agbenyefia, Lance A Shilliam, Nicoleta Stoicea, Andrew Roth, Kenneth R Moran
Journal: Front Med (Lausanne) (2017)
Keywords: anesthesiology, cold allergy, cold urticaria, hypersensitivity reactions, immune reactions, perioperative anaphylaxis, perioperative hypothermia, perioperative normothermia
MeSH terms: Case Reports

Cold urticaria consists of an allergic immune response to cold temperatures with symptoms ranging from pruritic wheals to life-threatening angioedema, bronchospasm, or anaphylactic shock. Adequate planning to maintain normothermia perioperatively is vital due to impaired hypothalamic thermoregulation and overall depression of sympathetic outflow during deep sedation and general anesthesia. This case report describes the successful perioperative management of a 45-year-old female with a history of cold urticaria undergoing a laparoscopic Nissen fundoplication for refractory gastroesophageal reflux disease and discusses how to appropriately optimize the care of these patients.
Unforeseen cytomegalovirus retinopathy following high dose thiotepa and proton irradiation in a pediatric patient with high-risk medulloblastoma: A case report
Authors: Elisabetta Bigagli, Sara Agostiniani, Alessandra Pugi, Barbara Rombi, Elena Eve Tornaboni, Maria Luigia Censullo, Carlotta Gemma Gori, Rossana Pavone, Iacopo Sardi
Journal: Front Pediatr (2023)
Keywords: cytomegalovirus, drug safety—clinical pharmacology, leukoencephalopathy, medulloblastoma, pediatric, proton irradiation, retinopathy, thiotepa
MeSH terms: Case Reports

In immunocompetent individuals, cytomegalovirus (CMV) infection is usually mild but may cause severe complications such as retinitis, pneumonitis, and encephalitis in immunocompromised individuals. So far, cases of CMV retinitis in patients with medulloblastoma undergoing chemotherapy and radiotherapy, have not been reported. We herein report the case of a pediatric patient with high-risk medulloblastoma who experienced an unexpected CMV retinopathy and leukoencephalopathy following high dose thiotepa and proton irradiation. The patient underwent a four-course induction therapy (1st cycle: methotrexate and vinorelbine; 2nd cycle: etoposide and hematopoietic stem cells apheresis; 3rd cycle: cyclophosphamide and vinorelbine; 4th cycle: carboplatin and vinorelbine) and then a consolidation phase consisting in high dose thiotepa followed by autologous HSC transplant and proton cranio-spinal irradiation plus boost to the primary tumor site and pituitary site with concomitant vinorelbine. After two months of maintenance treatment with lomustine and vinorelbine, the patient showed complete blindness and leukoencephalopathy. A diagnosis of CMV retinopathy was made and oral valganciclovir was administered. CMV retinopathy was judged to be possibly related to the use of high dose thiotepa worsened by radiotherapy. This case report suggests that in pediatric patients undergoing immunosuppressive chemo-radiotherapy, CMV reactivation should be carefully monitored to prevent serious complications such as retinopathy and visual loss.
Marked Improvement in Refractory TTP Directly after H. pylori Eradication Therapy
Authors: Irina Gringauz, Narin Nard Carmel-Neiderman, Tobin Mangel, Orith Portnoy, Gad Segal, Idan Goren
Journal: Case Rep Hematol (2016)

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder involving thrombotic microangiopathy and is characterized by increased platelet aggregation throughout the body. Acquired TTP can be triggered by a variety of conditions including infections. We hereby describe a case report of an 81-year-old female presenting to the internal medicine department with TTP and active chronic gastritis, positive for Helicobacter pylori (H. pylori) on biopsy. The TTP was highly resistant to medical therapy; however the patient underwent complete resolution of her TTP following H. pylori eradication. We conclude that acquired TTP may be triggered by H. pylori infection and that treating the underlying infection may play a role in improving TTP's outcome in some patients, especially when disease is refractory to medical therapy.