OpenMed/multicare-articles huggingface dataset:
Utilization of dapsone and hemoglobin in the epithelial skin regeneration therapy of cutaneous loxoscelism: A case report and integrative literature review
Authors: Omar Azuara-Antonio, Mario Isidoro Ortiz, Karla Daniela Jiménez-Oliver, Marco Castillo-Cabrera, Ana Karen Méndez-Salinas, Luz Hernández-Ramírez
Journal: Sao Paulo Med J (2024)
MeSH terms: Dapsone / therapeutic use, Spider Bites / drug therapy, Systematic Review, Case Reports, Adrenal Cortex Hormones, Female, Hemoglobins, Heparin, Humans, Male, Middle Aged, Regeneration, Dapsone, Hemoglobins, Heparin, Adrenal Cortex Hormones

Background:
Loxosceles spp are arthropods found worldwide. Its bite may produce cutaneous loxoscelism (necrotic or edematous) or cutaneous-visceral loxoscelism. Depending on their severity and location, cutaneous forms are managed with local cold application and systemic administration of antihistamines, corticosteroids, antibiotics, polymorphonuclear inhibitors, and analgesics.
Objective:
This study aimed to report a case of cutaneous loxoscelism and to identify the main dermatological manifestations associated with the Loxosceles spp bite.
Design and setting:
This case report and literature review was conducted in a Mexican university.
Methods:
A detailed report on the medical management of a patient with cutaneous loxoscelism treated at the emergency department of a public hospital was published. Scopus, PubMed, Web of Science, and Google Scholar databases were searched to identify articles reporting cutaneous loxoscelism. The following keywords were used during the database search: "loxoscelism" OR "spider bite," OR "loxosceles" OR "loxosceles species" OR "loxosceles venom" OR "loxoscelism case report" AND "cutaneous" OR "dermonecrotic arachnidism."
Results:
A 62-year-old female patient with cutaneous loxoscelism was treated with systemic dapsone and local heparin spray. Eighteen studies with 22 clinical cases were included in this systematic review. Of the 22 patients, 12 (54.5%) were men. L. rufescens was the predominant spider species.
Conclusions:
The administration of dapsone and heparin for the management of cutaneous loxoscelism demonstrated success in this case, with no sequelae observed. In general, the literature review indicated favorable outcomes in patients treated with antimicrobials and corticosteroids, with continuous healing of skin lesions.
Systematic review registration:
PROSPERO ID CRD42023422424 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023422424).
A Case Report and Literature Review of a Rare Jejunal Solitary Peutz-Jeghers-Type Polyp Resected Endoscopically in an Elderly Patient Presenting with Subacute Gastrointestinal Bleeding
Authors: Talal Alenezi, Victoria Marcus, Talat Bessissow
Journal: Case Rep Gastrointest Med (2023)
MeSH terms: Case Reports

Solitary Peutz-Jeghers-type polyp (SPJP) is a rare hamartomatous lesion. It is considered a different entity from Peutz-Jeghers syndrome despite similar histopathological findings. It can be found in the GI tract but rarely in the jejunum. Jejunal SPJP is susceptible to necrosis, ulceration, and intussusception, resulting in GI bleeding or small bowel obstruction. We describe a case of subacute gastrointestinal bleeding secondary to jejunal SPJP to share our approach to this challenging case using therapeutic endoscopy. An 81-year-old male patient with a history of atrial fibrillation on warfarin with stable therapeutic INR levels presented with a 1-week history of melena, generalized fatigue, and shortness of breath on exertion and was found to have profound iron deficiency anemia. Esophageal gastroduodenoscopy and colonoscopy failed to identify the source of bleeding; however, single-balloon enteroscopy detected a 4 cm polyp with a stalk in the proximal jejunum. Endoscopic polypectomy was performed, and the whole polyp was removed. Histopathological examination was consistent with Peutz-Jeghers polyp. The genetic analysis was negative for STK11 mutation. Follow-up magnetic resonance enterography and video capsule endoscopy did not reveal any other polypoid lesion in the GI tract. The patient's symptoms resolved gradually, and his hemoglobin level returned back to normal levels within 6 months. To our knowledge, this is the first case of endoscopic polypectomy during balloon-assisted enteroscopy for jejunal SPJP.
Primary renal malignant epithelioid angiomyolipoma with distant metastasis: a case report and literature review
Authors: Jun Zhang, Wen-Juan Wang, Li-Hong Chen, Ning Wang, Ming-Wen Wang, Hao Liu, Li-Juan Pang, Han-Guo Jiang, Yan Qi
Journal: Front Oncol (2023)
Keywords: differential diagnosis, histopathology, immunohistochemistry, liver metastasis, renal epithelioid angiomyolipoma
MeSH terms: Case Reports

Epithelioid angiomyolipoma (EAML) is a rare type of mesenchymal angiomyolipoma with potential malignancy in the kidney that can cause lymph node metastases, local recurrence, and distant metastases. Herein, we describe a case of EAML in the right kidney of a 51-year-old man who was admitted to the hospital with a right abdominal mass. Computed tomography revealed a heterogeneously enhanced mass with blurred margins, which was considered a malignant tumor. A radical nephrectomy was then performed. Two years later, the patient developed liver metastases from EAML and was administered sintilimab combined with bevacizumab. The patient survived after 6 months of follow-up. Histologically, the tumors showed clear boundaries and no obvious capsules. The tumor tissue mainly consisted of epithelioid tumor cells, thick-walled blood vessels, and a small amount of adipose tissue. Tumor cells with lipid vacuoles and acinar areas were large, round, polygonal, eosinophilic, or transparent in the cytoplasm. The enlarged and hyperchromatic nuclei were accompanied by distinct nucleoli and pathological mitosis. These histopathological findings resembled those of renal cell carcinoma, and immunohistochemical analysis was performed. The tumor cells were diffusely positive for HMB45, Melan-A, CK20, vimentin antibodies, and TFE3, suggesting that the tumor originated from perivascular epithelioid cells, excluding renal cell carcinoma. The Ki-67 index was 10%. These histopathological features were observed in liver mass puncture tissues. We also summarized 46 cases of EAML with distant metastasis and explored the clinicopathological features of EAML to improve the treatment of the disease. EAML is often ignored in the clinical setting, leading to metastasis and recurrence. Therefore, EAMLs require long-term follow-up, and timely detection of recurrent disease can improve the prognosis.
Coinheritance of the c.-19 G > C and c.315 + 1 G > A Variants in the β-Globin Gene Leads to Thalassemia Disease: A Report from the North of Iran
Authors: Hossein Jalali, Mahan Mahdavi, Mohammad Eslamijouybari, Mohammad Reza Mahdavi
Journal: Case Rep Genet (2023)
MeSH terms: Case Reports

Up to now, more than 300 pathogenic variants have been identified in the β-globin gene, some of which are categorized as silent mutations that do not change the hematological indices. In the present study, our aim is to introduce the first report of a case with thalassemia intermedia with coinheritance of the c.315 + 1 G > A pathogenic variant and a silent variant (HBB: c.-19 G > C) that was missed during the screening program. Multiplex-Gap-PCR and Sanger sequencing methods were applied to identify α- and β-globin gene mutations in a 26-year-old male subject with diagnosis of thalassemia. The identified mutations were also checked on the parent's sample. The CBC and capillary electrophoresis tests were performed on the parent's blood samples. The case was compound heterozygote for the c.315 + 1 G > A and c.-19 G > C (rs1239893012) variants. The subject's mother carried the c.-19 G > C variant in the β-globin gene while her CBC and electrophoresis test results showed a normal pattern. Silent mutations are susceptible to being missed during premarital screening of β-thalassemia carriers, and the c.-19 G > C variant is recommended to be classified as a pathogenic variant in the β-globin gene.
Are teachers "butter lamps"? Teacher stress in Chinese Minzu "ethnic" schools
Authors: Bilige Sude, Fred Dervin, Mei Yuan, Ning Chen
Journal: Front Psychol (2023)
Keywords: inner mongolia, minzu education, case study, intercultural, teacher stress
MeSH terms: Review

China is a unified multi-ethnic country. Although research on teacher stress is plentiful in this context, the specific case of Minzu ("ethnic") teachers is under-researched. Using Minzu schools located in a diverse county of the Inner Mongolia Autonomous Region (North China), as a case study, the authors examine factors behind Minzu teacher stress. Using mixed methods, three main results were identified by analyzing interviews and questionnaires with both the software NVivo and dialogical discourse analysis: societal, school and Self factors. In general, the teachers confirmed that their job was extremely stressful. While some of these aspects derived directly from the specific context of Minzu education (e.g., rural and pastoralist families send their children to towns leading to teachers taking over parents' responsibilities), some elements were also found in other contexts of Chinese education and/or internationally. The article ends with some recommendations specifically about Minzu aspects in the treatment of teacher stress, which will also be of interest for international audiences.
Case Report: Temporary pacing using active fixation lead and invasive electrophysiology studies for immune checkpoint inhibitor associated reversible advanced atrioventricular block
Authors: Yifan Wang, Min Qian, Xiaofeng Jin, Jiaqi Wang, Taibo Chen, Peng Gao, Zhongwei Cheng, Jinzhi Lai, Yongtai Liu, Jingbo Fan, Lihua Zhang, Kangan Cheng, Hua Deng, Quan Fang, Deyan Yang
Journal: Front Cardiovasc Med (2024)
Keywords: advanced atrioventricular block, case report, immune checkpoint inhibitors, invasive electrophysiology studies, temporary pacing
MeSH terms: Case Reports

A case of immune checkpoint inhibitors (ICIs)-associated myocarditis with reversible advanced atrioventricular block (AVB) was reported. We innovatively used active fixation lead connected to an external device for prolonged temporary pacing until atrioventricular conduction recovered. Invasive electrophysiology studies were performed to evaluate atrioventricular conduction in detail. Long-term follow-up for nearly 120-days and repeated long-term electrocardiography was conducted to ensure the conduction system was truly recovered.
First case report of Candida guilliermondii native left-sided valve endocarditis
Authors: Zilong Zheng, Xiaokang Tu, Chuanhao Jiang, Feng Liu, Chengming Fan
Journal: Front Cardiovasc Med (2023)
Keywords: candida guilliermondii, aortic valve, cardiac surgery, fungal endocarditis, infective endocarditis, mitral valve
MeSH terms: Case Reports

Endocarditis, a life-threatening inflammation of the endocardium, is incited by bacteria, fungi, or other pathogenic microorganisms. Fungal endocarditis closely mirrors bacterial endocarditis in clinical signs and symptoms, leading to potential misdiagnoses. Here, we unveil the inaugural confirmed instance of native left-sided valve endocarditis attributed to Candida guilliermondii. Diagnosis was substantiated through valvular biopsies, blood and vegetative cultures. Treatment encompassed surgical excision of vegetations along with a six-week regimen of fluconazole administration (12 mg/kg/day), followed by 4 years of meticulous monitoring, resulting in sustained patient recovery.
A Novel SPAST Variant Associated with Isolated Spastic Paraplegia
Authors: Helle Høyer, Ola Nakken, Trygve Holmøy
Journal: Case Rep Genet (2023)
MeSH terms: Case Reports

Genetic variants in SPAST are the most common cause of hereditary spastic paraplegia (HSP), entitled spastic paraplegia type 4 (SPG4). Inheritance is autosomal dominant, and age of onset can vary from childhood to adulthood. Pathogenic SPAST variants are often observed in isolated cases, likely due to reduced penetrance and clinical variability. We report an isolated case of SPG4 associated with a novel likely pathogenic variant in SPAST. A 38-year-old woman presented with an eight-year history of progressive difficulty walking. Neurological examination revealed spastic paraparesis in the absence of upper motor neuron dysfunction, sensory deficits, or intellectual disability. Magnetic resonance imaging (MRI) of the brain and spinal cord was normal. No family members had similar complaints. Genetic analysis revealed a novel heterozygous sequence variant in SPAST, c.1751A > G p.(Asp584Gly) (NM_014946.4). The affected amino acid is highly conserved among orthologue and paralogue species. Four other nucleotide substitutions predicted to affect the same amino acid, a "hot spot", have been reported previously in adult-onset HSP. This report describes a novel SPAST variant in a female with HSP without a known family history of the disorder.
Case report: Therapeutic drug monitoring and CYP2D6 phenoconversion in a protracted paroxetine intoxication
Authors: Alena Damborská, Lenka Hanáková, Eva Pindurová, Kateřina Horská
Journal: Front Pharmacol (2024)
Keywords: cyp2d6, case report, overdose, paroxetine, phenoconversion, poor and intermediate metabolizer
MeSH terms: Case Reports

Objective:
The cytochrome P450 2D6 (CYP2D6) is an enzyme involved in the oxidative biotransformation of various widely used drugs, including paroxetine, a substrate and strong inhibitor of the enzyme. The aim is to report on a case of protracted intoxication with paroxetine after a single overdose in a genotype-predicted intermediate CYP2D6 metabolizer.
Observation:
A 49-year-old man was receiving chronic treatment for more than 6 years with paroxetine 60 mg/day for an indication of agoraphobia. The patient ingested fifty 20 mg tablets of paroxetine in a suicide attempt. The toxic plasma level, accompanied by delirium, persisted for approximately 1 month after the overdose. According to the genotype profile, the patient was evaluated as an intermediate metabolizer with reduced CYP2D6 enzyme activity.
Conclusion:
As a consequence of the suicide attempt with overdose and the chronic paroxetine treatment that preceded it, phenoconversion to a poor metabolizer with very low CYP2D6 enzyme activity is suggested as contributing to an extremely long intoxication accompanied by delirium. Prolonged monitoring over a standard 24 h of both physical symptoms and drug plasma levels, together with a genetic profile assessment and phenoconversion consideration, is recommended after a single overdose in patients chronically treated with paroxetine.
Partial hand replantation using free microsurgical replantation with staged heterotopic banking of amputated parts: towards improving long term outcomes
Authors: Arthur R Celestin, Valeria P Bustos, Amer H Nassar, Kaimana Chow, Alex Neusner, Swapnil Kachare, Joseph Upton 3rd, Arriyan S Dowlatshahi
Journal: Case Reports Plast Surg Hand Surg (2024)
Keywords: hand replantation, digit replantation, microsurgery
MeSH terms: Case Reports

In hand trauma, the uninjured forearm has been touted as the ideal site for ectopic banking in digit/hand amputations. Here, we describe the temporary ectopic implantation and subsequent replantation of a partially amputated hand and highlight the "Three R's" - Recovery, Rehabilitation, and Revision over the first year of recovery.
Case Report: Solid variant of papillary thyroid carcinoma in a young adult with Turner syndrome with chronic thyroiditis
Authors: Daichi Murakami, Masayoshi Hijiya, Takuro Iyo, Sachiko Hayata, Takashi Ozaki, Keisuke Enomoto, Masamitsu Kono, Shunji Tamagawa, Muneki Hotomi
Journal: Front Oncol (2023)
Keywords: turner syndrome, chronic thyroiditis, gene mutation, gene panel test, solid variant of papillary thyroid carcinoma
MeSH terms: Case Reports

Turner syndrome is associated with an increased risk of developing several neoplasms. In particular, a clinical feature of Turner syndrome with chronic thyroiditis implies a relationship with thyroid malignancies. We report a very rare case of a solid variant of papillary thyroid carcinoma that was identified during a follow-up of chronic thyroiditis in a 22-year-old woman with Turner syndrome. The patient had no notable history of radiation exposure. No genetic mutations relating to the occurrence of the solid variant of papillary thyroid carcinoma, including RET/PTC rearrangements and mutations in the BRAF or RAS, were detected by a gene panel test, namely, the Oncomine™ Dx Target test. To the best of our knowledge, this is the first report of a solid variant of papillary thyroid carcinoma in a young adult with Turner syndrome with chronic thyroiditis. Our case suggests that in patients with Turner syndrome, there may be different pathogeneses from those previously reported, including exposure to radiation or known genetic mutations for the development of a solid variant of papillary thyroid carcinoma.
A Case of Right-Sided Infective Endocarditis Requiring AngioVac Debulking
Authors: Danielle Pawlichuk, Micah Pippin
Journal: Cureus (2024)
Keywords: angiovac and infective endocarditis, iv drug, persistent bacteremia, septic pulmonary emboli, septic shock in endocarditis, staph aureus endocarditis
MeSH terms: Case Reports

Infective endocarditis is an uncommon but consequential disease process that occurs after damage to the cardiac endothelium. Management depends on location and infection severity, but it can typically be treated with intravenous antibiotics. Still, in more complex presentations, surgical intervention may be warranted. Here, we examine a case of right-sided infective endocarditis affecting the tricuspid valve in a patient with a history of intravenous drug use. The purpose of this paper is to examine a case of right-sided endocarditis refractory to intravenous antibiotics, resulting in the need for an alternative treatment modality using AngioVAC debulking.
Contrast media-induced nephropathy in Tunisia: prospective case-control study with cardio-nephrological monitoring
Authors: Meriam Hajji, Hela Jebali, Emna Chaabouni, Khadija Mzoughi, Ihssen Zairi, Sondos Kraiem, Lamia Raies, Fethi Ben Hamida, Lilia Ben Fatma, Mohammed Karim Zouaghi, Taieb Ben Abdallah
Journal: Pan Afr Med J (2023)
Keywords: acute renal failure, iodinated contrast media, prevention, risk factors
MeSH terms: Angioplasty, Balloon, Coronary, Kidney Diseases / chemically induced, Kidney Diseases / epidemiology, Renal Insufficiency / etiology, Case Reports, Adult, Aged, Aged, 80 and over, Case-Control Studies, Contrast Media / adverse effects, Coronary Angiography / adverse effects, Creatinine, Female, Humans, Iohexol / adverse effects, Male, Middle Aged, Prospective Studies, Risk Factors, Tunisia / epidemiology, Contrast Media, iopromide, Iohexol, Creatinine

Introduction:
vascular opacification using iodinated contrast media (ICM) is often the primary diagnostic and therapeutic approach. However, the risk of post-injection nephrotoxicity of ICM is significantly higher in patients with underlying nephropathy. This study aimed to determine the incidence of Contrast Media Induced Nephropathy (CMIN) and identify predictive factors for its occurrence in patients from a cardiology department.
Methods:
our prospective study involved 158 patients who underwent coronary angiography or angioplasty at the cardiology department between December 2017 and May 2018. Two types of ICM were used in our study: Iopromide and Iohexol. All patients received either physiological serum (9‰) or bicarbonate serum (14‰) intravenously for hydration. We defined impaired renal function as an increase in creatinine ranging from 10 to 26 µmol/L, while CMIN was defined as an increase in serum creatinine exceeding 26.5 µmol/L. We investigated the factors associated with CMIN using logistic regression analysis.
Results:
the mean age of our patients was 60 ± 11 years (range: 29-82), with a predominance of men 63.9% (n=101). The most common cardiovascular risk factors were tobacco (36.1%, n = 57), diabetes (48.1%, n =76), hypertension (55%, n = 87). Pre-procedural creatinine averaged 81.1 ± 47.3 µmol / L with extremes ranging from 39 to 600 µmol / L. The median Mehran risk score was 3.2 (range: 0- 15). The interventional cardiology act consisted of coronary angiography in 86.2% (n=136) of cases, coronary angioplasty in 2.5% (n=4) of cases. We used iohexol and iopromide in 57.6% (n=91) and 42.4% (n=67) of cases, respectively. The overall incidence of CMIN was 9.5% (n=9). The multivariable regression analysis identified 4 risk factors independently linked to the occurrence of CMIN which were Pre-existing renal failure (OR: 6.05, 95%CI [1.23-29.62], p = 0.026), anemia (OR: 0.043, CI [1.03-8.96], p = 0.043), the toxic dose of PC (OR: 4.7, CI [1.28-17.7], p=0.02), and at a Mehran score = 11 (OR: 3.7, CI [0.88-15.6], p=0.036).
Conclusion:
the most effective approach for CMIN is prevention, which focuses on addressing modifiable risk factors to minimize the risk especially in patients with pre-existing renal failure.
Effect of bihemispheric transcranial direct current stimulation on distal upper limb function and corticospinal tract excitability in a patient with subacute stroke: a case study
Authors: Takahiro Shiba, Naomichi Mizuta, Naruhito Hasui, Yohei Kominami, Tomoki Nakatani, Junji Taguchi, Shu Morioka
Journal: Front Rehabil Sci (2023)
Keywords: fugl-meyer assessment, intermuscular coherence, stroke rehabilitation, subacute stroke, transcranial direct current stimulation
MeSH terms: Case Reports

Introduction:
Activation of the unaffected hemisphere contributes to motor function recovery post stroke in patients with severe upper limb motor paralysis. Transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation to increase the excitability of motor-related areas. tDCS has been reported to improve upper limb motor function; nonetheless, its effects on corticospinal tract excitability and muscle activity patterns during upper limb exercise remain unclear. Additionally, it is unclear whether simultaneously applied bihemispheric tDCS is more effective than anodal tDCS, which stimulates only one hemisphere. This study examined the effects of bihemispheric tDCS training on corticospinal tract excitability and muscle activity patterns during upper limb movements in a patient with subacute stroke.
Methods:
In this single-case retrospective study, the Fugl-Meyer Assessment, Box and Block Test, electromyography, and intermuscular coherence measurement were performed. Intermuscular coherence was calculated at 15-30 Hz, which reflects corticospinal tract excitability.
Results:
The results indicated that bihemispheric tDCS improved the Fugl-Meyer Assessment, Box and Block Test, co-contraction, and intermuscular coherence results, as compared with anodal tDCS. Discussion: These results reveal that upper limb training with bihemispheric tDCS improves corticospinal tract excitability and muscle activity patterns in patients with subacute stroke.