OpenMed/multicare-articles huggingface dataset:
Spontaneous Ovarian Hyperstimulation Syndrome Associated With Primary Hypothyroidism
Authors: Jawharah A Alzebidi, Khairiah Almushri, Rehab Elmoheen
Journal: Cureus (2023)
Keywords: hypothyrodism, primary hypothyroidism, spontaneous ovarian hyperstimulation syndrome, thyroid-stimulating hormone, thyroxine
MeSH terms: Case Reports

Ovarian hyperstimulation syndrome is a rare condition in pregnant women. Most cases are associated with the use of ovulation induction and stimulation medications. Some studies have reported cases of this condition in non-pregnant women or women undergoing ovulation therapy. In this case report, we report the case of a 27-year-old pregnant Saudi woman presenting with a picture of severe spontaneous ovarian hyperstimulation syndrome secondary to severe undiagnosed hypothyroidism. Treatment with Eltroxin (thyroxine) led to complete improvement and regression of ovarian enlargement after empirical titrating thyroxin replacement therapy, which proved the presence of this causation. The diagnosis was confirmed by laboratory and imaging findings, which helped prompt management and prevented complications of unneeded surgical intervention.
Allyship in Residency: An Introductory Module on Medical Allyship for Graduate Medical Trainees
Authors: Sarah Martinez, Joseph Araj, Symone Reid, Jeslyn Rodriguez, Mytien Nguyen, Dorcas Boahema Pinto, Pamela Y Young, Anicia Ivey, Alexis Webber, Hyacinth Mason
Journal: MedEdPORTAL (2021)
Keywords: allyship, anti-racism, diversity, health equity, inclusion, lgbtq+ ally, urm, underrepresented in medicine
MeSH terms: Health Equity, Internship and Residency, Child, Curriculum, Humans, Learning, Surveys and Questionnaires

Introduction:
Lack of diversity impacts research, medical curricula, and medical trainees' ability to provide equitable patient care. The concept of allyship, defined as a supportive association between identities with power and privilege and marginalized identities, provides an optimal framework for enhancing education about health equity. Currently, there are no established curricula focused on allyship and limited mention within current medical training literature. We propose use of allyship to increase graduate medical trainee understanding of diversity and focus on health equity.
Methods:
We developed a 1-hour workshop aimed at helping residents understand the definition of allyship, effective allyship to patients and colleagues, and allyship differences across communities. The workshop consisted of pre- and postassessment surveys, a didactic presentation module, and facilitated case study discussions. It was conducted locally on four occasions across pediatrics, family medicine, surgery, and emergency medicine residency programs.
Results:
An analysis of the 101 preassessment and 58 postassessment survey responses revealed an increased level of knowledge regarding allyship (p < .001) and increased comprehension of allyship competencies (p < .001). All workshop learning objectives demonstrated positive change postmodule.
Discussion:
With an increasing need for curricula to address health equity in medical trainees, this workshop serves as a unique and effective approach to expanding cultural responsiveness skills under the lens of allyship. Specifically, the workshop functions as a constructive introduction to allyship principles and practices and can serve as a foundation on which residents can build more robust skills as a part of their allyship journey.
Mycosis Fungoides: Analysis of Ophthalmologic Findings in a Series of Cases
Authors: Carina G Colossi, Juliano Mondadori, Pedro K M Barreto, Felipe M Valença, Rodrigo Duquia, Manuel A P Vilela
Journal: Case Rep Dermatol Med (2019)
MeSH terms: Case Reports

Background:
Ophthalmic findings in mycosis fungoides (MF) can be highly variable. It seems that the prevalence of ophthalmic findings could be much more common than previously assumed.
Objective:
To present case series examined in the last 12 months, together with a literature review.
Methods:
Symptomatic patients with biopsy-proven mycosis fungoides were examined ophthalmologically in a 12-month period. The medical records of affected patients were reviewed.
Results:
Eight patients were examined. Of these, 75% were male, all were Caucasian, and average age was 58.2 years. Blepharitis (50.0%), thickened eyelids (37.5%), and flaking (25.0%) were the most prevalent findings.
Conclusion:
Incidence of MF affecting the eyes and surrounding structures may be greater than estimated. Early case management offers means to reduce difficulties experienced with later diagnosis. Regular monitoring by an ophthalmologist is justified, including that of asymptomatic cases.
Primary pilocytic astrocytoma of the cerebellopontine angle in pediatric patient with neurofibromatosis type 1: a case report
Authors: Zaitun Zakaria, Raja Zubaidah Raja Mohd Rasi, Noor Azman A Rahman
Journal: Egypt J Neurosurg (2022)
Keywords: cerebellopontine angle, neurofibromas, neurofibromatosis, pilocytic astrocytoma, schwannoma
MeSH terms: Case Reports

Background:
Cerebellopontine angle tumor (CPA) in pediatrics is rare as compared to adults. We describe a case of pediatric pilocytic astrocytoma presented as a right CPA mass with a concurrent clinical diagnosis of neurofibromatosis type 1 (NF1).
Case presentation:
A 14-year-old boy with a newly diagnosed hypertension presented with a short history of headache and blurring vision. Neurological examination revealed bilateral papilloedema, partial right third nerve palsy and mild sensorineuronal hearing deficits. Skin examination identified multiple café au lait spots with cutaneous neurofibromas. Preoperative neuroimaging suggested the diagnosis of an extraaxial CPA mass consistent with meningioma, with obstructive hydrocephalus. A left ventriculoperitoneal shunt was inserted and the child was subjected for a suboccipital retrosigmoid approach for tumor resection. The histopathological features, however, were typical for pilocytic astrocytoma.
Conclusions:
A careful evaluation of the clinical presentation and radiological images of CPA lesions is necessary prior to surgical embarkment. To the best of our knowledge, this case is the first report of pilocytic astrocytoma in the CPA in pediatric with NF1.
Vestibular Derangement and Motion Intolerance in VATER Association
Authors: Orit Samuel, Avi Shupak, Ayelet Eran, Dror Tal
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

VATER association is a nonrandom occurrence of congenital malformations: vertebral defects, anal atresia, tracheoesophageal fistula, renal defects, and radial bone anomalies. We report the case of a 19-year-old man with a childhood diagnosis of VATER association, who presented to the motion sickness clinic with severe seasickness. We discuss the clinical and laboratory diagnosis of vestibular pathophysiology, which was confirmed by MRI of lateral semicircular canal and vestibule dysplasia. We suggest the possibility of vestibular involvement as part of the developmental field defect associated with VATER syndrome, which hitherto has rarely been reported.
Protective effect of unilateral vasospasm in the setting of HHH-associated posterior reversible encephalopathy syndrome: case report, review of the literature, and treatment considerations
Authors: Alankrita Raghavan, Jordan Xu, James M Wright, Christina Huang Wright, Benjamin Miller, Yin Hu
Journal: Chin Neurosurg J (2018)
Keywords: hyperdynamic therapy, posterior reversible encephalopathy syndrome, subarachnoid hemorrhage
MeSH terms: Case Reports

Background:
Hyperdynamic therapy, also called triple-H therapy, is the standard treatment and prophylaxis for aneurysmal-associated vasospasm. In patients who are able to tolerate cardiopulmonary stressors induced by this therapy, it is of benefit as a modality for prevention and treatment of delayed ischemic neurologic deficit. However, it can be a cause of significant cardiopulmonary or neurologic sequelae. In rare cases, it can be associated with posterior reversible encephalopathy syndrome (PRES), secondary to prolonged vasopressor and hypertensive therapies.
Case presentation:
We present the case of a patient with right-sided aneurysmal-associated vasospasm who, after 10 days of triple-H therapy, experienced a seizure and was found to have left-sided PRES. Right-sided vasospasm served as a protective mechanism from triple-H therapy-associated PRES. It presented a treatment conundrum due to contradictory perfusion requirements. Hypertensive therapy was curtailed and in efforts to preserve local cerebral perfusion and vasodilation, local therapy with intrathecal nicardipine was initiated. We present our case, a review of the literature, and management considerations.
Conclusions:
Therapies that have conventionally functioned as second line treatments for aneurysmal subarachnoid hemorrhage (intra-arterial vasodilators and intrathecal vasodilators) may be beneficial as earlier treatments in the setting of vasospasm given the systemic difficulties and complications associated with HHH therapy in patients with PRES.
Extensive Recontouring of the Femoral Head with Osteochondral Allografting: A Case Report with Histological and MicroCT Analysis
Authors: Amir A Jamali, Douglas Rowland, Kristen N Vandewalker
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Morphological abnormalities such as cam deformity or growth disturbances can have a detrimental effect on the smooth function of the hip joint. This case reports an attempt to salvage the hip joint of a young patient with a posttraumatic growth disturbance of the femoral head using a fresh osteochondral allograft. This treatment has been used very rarely in the femoral head due to the presumed tenuous blood supply of the head and the perceived risk of nonunion or progressive avascular necrosis. The patient in this case had persistent pain and mechanical symptoms leading to hip replacement. A detailed analysis of the retrieved femoral head demonstrated durability and healing of the grafts based on gross inspection, histology of bone and cartilage, and microCT analysis. This case is the first report to our knowledge of a detailed histological and radiographic analysis of the fate of osteochondral allografts of the femoral head. We hope that this case provides justification for the use of osteochondral allografts of the femoral head for other indications such as femoral head fractures, avascular necrosis, and benign epiphyseal tumors of the femoral head in an effort to avoid arthroplasty in young patients. The authors have obtained the patient's informed written consent for print and electronic publication of the case report.
Simultaneous Ipsilateral Quadriceps and Triceps Tendon Rupture in a Patient with End-Stage Renal Failure
Authors: Kevin Moerenhout, Georgios Gkagkalis, Benoit Benoit, Georges Yves Laflamme
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Introduction:
Quadriceps tendon ruptures (QTR) frequently occur in patients with end-stage renal failure, while triceps brachii tendon ruptures (TTR) are less common. This is the first properly documented report of a simultaneous ipsilateral traumatic rupture of both of these tendons.
Case report:
A 50-year-old patient, on hemodialysis for end-stage renal failure, fell on his right side. He presented with sudden right knee and elbow pain, with functional impairment of both joints. X-rays showed avulsion-like osseous lesions on the olecranon and patella with a low-riding patella. Ultrasound confirmed complete quadriceps and triceps avulsion ruptures. Both lesions were treated surgically. Fixation was performed with anchors using the Krackow suture technique for both tendons. Postoperative clinical and radiological results were satisfactory, and follow-up was uneventful. The patient regained his preinjury functional level with a complete range of motion of both his knee and elbow.
Discussion:
Isolated QTR and TTR are frequent lesions in chronic renal failure patients treated with hemodialysis. Simultaneous ipsilateral rupture of both tendons however is extremely rare and should therefore not be overlooked. Surgical treatment is recommended for complete ruptures.
Arteriolar vs. valvular thrombosis: Pick your evil!
Authors: Abeer Berry, George Degheim, Souheil Saba
Journal: Thromb J (2018)
MeSH terms: Case Reports

Background:
Anticoagulation therapy for mechanical prosthetic valves is limited to vitamin K antagonists, unfractionated heparin and low-molecular-weight-heparin. Other forms of anticoagulation are either contraindicated or have not been well studied. Hence, anticoagulation for preexisting mechanical valves is controversial if vitamin K antagonists are contraindicated. We present a case involving an end-stage-renal disease patient with both mitral and aortic mechanical valves who developed warfarin-induced calciphylaxis.
Case presentation:
A 72-year-old male with history of end-stage renal disease, chronic atrial fibrillation and rheumatic heart disease status post mitral and aortic valve replacements presented with complaints of left thigh erythema with skin induration. Despite multiple antibiotic regimens for presumed cellulitis, the skin lesions progressed to necrotic ulcers. A biopsy revealed evidence of calciphylaxis; a lethal condition typically associated with renal disease. The patient was on warfarin for anticoagulation of his mechanical heart valves as well as prophylactically for atrial fibrillation. Warfarin contributes to the development of calciphylaxis and needed to be exchanged to avoid progression of the ulceration. The only other acceptable option for long-term anticoagulation was subcutaneous unfractionated heparin but this approach was not taken. The patient suffered from further sequelae of calciphylaxis and eventually expired.
Conclusion:
Calciphylaxis is a rare, serious disorder that presents with skin ischemia and necrosis mainly in end-stage renal disease patients. The pathogenesis and treatment are poorly understood and the prognosis remains grave. It is proposed that certain medications, including warfarin, contribute to its evolution. The optimal anticoagulation therapy in those with concomitant warfarin-induced calciphylaxis and mechanical valves is undetermined. Further studies are essential to establish new anticoagulation regimens in these devastating circumstances.
Laparoscopic approach of a unicornuate uterus with noncommunicating rudimentary horns
Authors: Lidia Rosi Medeiros, Daniela Dornelles Rosa, Fabio Rosa Silva, Bruno Rosa Silva, Maria Ines Rosa
Journal: ISRN Obstet Gynecol (2011)
MeSH terms: Case Reports

Background. Müllerian duct malformations delineate a miscellaneous group of congenital anomalies that result from arrested development, abnormal formation, or incomplete fusion of the mesonephric ducts. Case. This paper describes the diagnosis and management of a noncommunicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. Conclusion. This condition was diagnosed by laparoscopy and hysteroscopy examination. Operative videolaparoscopy proved to be a successful approach for the treatment of this congenital Müllerian anomaly.
A case of acute paraplegia that improved with dialysis
Authors: Govarthanan Rajendiran, Rajamahesh Jayabalan, Saravanan Chandrahasan, Ashwin Kumar Mani
Journal: Indian J Crit Care Med (2008)
Keywords: acute paraplegia, hemodialysis, hyperkalemia
MeSH terms: Case Reports

Acute severe hyperkalemia can present as acute paraplegia independent of cardiac effects, even though cardiac muscle is more sensitive to serum potassium changes. We managed a patient with acute hyperkalemic paralysis who did not have threatening cardiac/electrocardiographic manifestations. The limb weakness became normal after hemodialysis.
Fatal Acinetobacter baumanii Necrotizing Fasciitis following Open Reduction Internal Fixation in a Polytrauma Patient
Authors: Alexandre Nehme, Nabih I Joukhadar, Elias Saidy, Mohammad Darwiche, Dany K Aouad, Hicham G Abdel Nour
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Necrotizing fasciitis is an uncommon and potentially fatal infection that can affect the epidermis, dermis, and more commonly the subcutaneous, fascia, and muscle layers. NF is usually caused by toxin-producing bacteria with a relatively fast progression associated with severe surrounding tissue destruction. Early diagnosis and management are crucial factors for survival. Broad-spectrum antibiotics along with surgical debridement, sometimes multiple, are needed in order to stop or slow down the progression of NF. Despite optimal care, necrotizing fasciitis remains a highly morbid condition with a high mortality rate. We present a case of a 28-year-old male patient with rapidly developing fatal A. baumannii associated with necrotizing fasciitis, after open reduction and internal fixation (ORIF) of multiple fractures after polytrauma.
(1)H MR Spectroscopy in Gliomatosis: Is there a Sensitivity Issue?
Authors: M Szewczyk-Bieda, A K Kanodia, G Main, M S Eljamel
Journal: Case Rep Radiol (2011)
MeSH terms: Case Reports

Objective. (1)H MR spectroscopy (MRS) is widely performed for assessment of brain tumours and is considered a highly sensitive technique capable of differentiating benign from malignant conditions and tumour grading. Method. We present a case of a 69 year old woman who was suspected to have gliomatosis on MRI. Results. MRS performed using single voxel and chemical shift/multivoxel techniques was within normal limits. A repeat scan 6 months later showed progressive disease, and biopsy was performed that proved the diagnosis of glioblastoma. Conclusion. Normal MRS in a patient with suspicion of gliomatosis on MRI should not reassure clinicians into assuming a benign aetiology or a good prognosis in short term.
SYNJ1 gene associated with neonatal onset of neurodegenerative disorder and intractable seizure
Authors: Nuha Al Zaabi, Noora Al Menhali, Fatma Al-Jasmi
Journal: Mol Genet Genomic Med (2018)
Keywords: synj1, intractable seizure, neurodegenerative disorder, whole-genome sequencing
MeSH terms: Phosphoric Monoester Hydrolases / genetics, Phosphoric Monoester Hydrolases / physiology, Case Reports, Research Support, Non-U.S. Gov't, Brain / physiopathology, Child, Preschool, Consanguinity, Female, Genes, Recessive, Humans, Infant, Newborn, Male, Microcephaly / genetics, Muscle Hypotonia / genetics, Mutation, Neurodegenerative Diseases / genetics, Pedigree, Phenotype, Phosphoric Monoester Hydrolases / metabolism, Seizures / diagnosis, Seizures / genetics, Synaptic Vesicles / genetics, Tauopathies / genetics, Phosphoric Monoester Hydrolases, phosphoinositide 5-phosphatase

Background:
Synaptojanin 1 is encoded by the SYNJ1(MIM 604297) and plays a major role in phosphorylation and recycling of synaptic vesicles. Mutation of SYNJ1 is associated with two distinct phenotypes; a known homozygous missense mutation (p.Arg258Gln) associated with early-onset Parkinson disease (MIM 615530), whereas mutation with complete loss of SYNJ1 function result in a lethal neurodegenerative disease with intractable seizure and tauopathies (MIM 617389).
Methods:
We report two related children from consanguineous family presented with intractable seizure, profound developmental delay, failure to thrive, acquired microcephaly, and hypotonia. The brain MRI is normal and EEG showed hypsarrhythmia.
Result:
The diagnosis was achieved via whole-genome sequencing which showed homozygous mutation in SYNJ1 (c.709C>T, p.Gln237*).
Conclusion:
A clinical pattern of neonatal-onset intractable seizure, profound developmental delay, muscular hypotonia, hypsarrhythmia, and no focal abnormality of brain MRI should prompt initiation of molecular genetic analysis of SYNJ1. Establishment of the diagnosis permits genetic counseling, prevents patients undergoing unhelpful diagnostic procedures and allows for accurate prognosis.
Intracranial hemorrhage revealing pseudohypoparathyroidism as a cause of fahr syndrome
Authors: Abhijit Swami, Giridhari Kar
Journal: Case Rep Neurol Med (2011)
MeSH terms: Case Reports

Pseudohypoparathyroidism is an infrequently encountered disease. It is one of the causes of Fahr syndrome which also is a rare clinical entity caused by multiple diseases. A 4-year-old man hospitalized for sudden onset left hemiparesis and hypertension was diagnosed to have right thalamic and midbrain hemorrhage on plain CT scan of the head which also revealed co-existent extensive intracranial calcifications involving the basal ganglia and cerebellum bilaterally. General physical examination revealed features of Albright hereditary osteodystrophy, goitre, hypertension, left hemiparesis, and signs of cerebellar dysfunction. Laboratory findings suggested hypocalcemia, hyperphosphatemia along with high TSH, low FT(4), low FT(3), and high anti-TPO antibody. Though bilateral intracranial calcifications are usually encountered as an incidental radiological finding in the CT scan of brain, in this case, the patient admitted for thalamic and midbrain hemorrhage was on investigation for associated intracranial calcification, and goitre was also found to have coexisting pseudohypoparathyroidism and autoimmune hypothyroidism.
Dramatic secukinumab-mediated improvements in refractory leprosy-related neuritis via the modulation of T helper 1 (Th1) and T helper 17 (Th17) immune pathways
Authors: Patrícia Shu Kurizky, Jorgeth de Oliveira Carneiro da Motta, Natanael Victor Furtunato Bezerra, Marcia Carolline Dos Santos Sousa, Danilo Corazza, Taiana Karla Dos Santos Borges, Ciro Martins Gomes
Journal: Rev Soc Bras Med Trop (2021)
MeSH terms: Antibodies, Monoclonal, Humanized / therapeutic use, Leprosy / complications, Leprosy / drug therapy, Neuritis / drug therapy, Neuritis / etiology, Case Reports, Adult, Cytokines, Female, Humans, Th1 Cells, Th17 Cells, Antibodies, Monoclonal, Humanized, Cytokines, secukinumab

A 39-year-old woman was diagnosed with relapsed multibacillary leprosy and refractory neuritis. Here, we describe an evident loss of therapeutic effectiveness after the third pulse of corticosteroids, which may be attributed to tachyphylaxis and the posterior modulation of interferon- γ (IFN-γ), tumor necrosis factor- α (TNF-α,) interleukin-17A (IL-17A), and IL-12/23p40 after the induction phase of secukinumab. In this case, plasma cytokine analysis showed that secukinumab induced a reduction in IL-17 concomitant with impressive clinical improvements in the patient's neural function. Interestingly, secukinumab induced reductions in cytokines related to Th1 responses and earlier stages of the Th17 response, including IL-23/12.