OpenMed/multicare-articles huggingface dataset:
Case Report: A Case of Sarocladium strictum Meningoencephalitis in an Immunocompetent Patient After Invasive Operation
Authors: Yue Cui, Jiali Meng, Jing Zhang, Lin Wang, Haihan Yan, Han Xia, Jingrong Cao, Liyong Wu
Journal: Front Med (Lausanne) (2021)
Keywords: sarocladium strictum, fungal infection, meningoencephalitis, metagenomic next-generation sequencing, treatment
MeSH terms: Case Reports

As an opportunistic phytopathogen, Sarocladium strictum has only been shown to cause neurological disease in immunocompromised patients, where antifungal therapy was not effective. We report a case of Sarocladium strictum meningoencephalitis in an apparently immunocompetent young woman who presented with severe headache and slight fever after undergoing transnasal endoscopic repair of cerebrospinal fluid rhinorrhea. Chronic sinusitis and suspicious intracranial fungal lesions were observed on enhanced magnetic resonance imaging (MRI). Both culture and metagenomic next-generation sequencing of her cerebrospinal fluid were positive for Sarocladium strictum. After local debridement, treatment with amphotericin B plus voriconazole and Ommaya reservoir implantation, the patient improved significantly. Unfortunately, her symptoms worsened again despite plenty of antifungal therapy for a month.
Intracochlear Hemorrhage: A Rare Cause of Sudden Sensorineural Hearing Loss
Authors: Myriam Jrad, Haifa Zlitni, Miriam Boumediene, Atef Ben Nasr, Meriem Bouzrara
Journal: Case Rep Radiol (2021)
MeSH terms: Case Reports

Inner ear hemorrhage is an extremely rare cause of sudden sensorineural hearing loss with few cases reported in the literature. We report the case of a 30-year-old male who presented with a sudden left ear hearing loss, with no tinnitus nor vertigo. The audiogram revealed a profound left sensorineural hearing loss. An MRI of the brain and internal auditory canal was performed 3 weeks after and revealed an increased signal intensity on T1-weighted (T1W) and T2 fluid-attenuated inversion recovery (FLAIR) images in the left cochlea. No other abnormalities were found, in particular no enhancement after intravenous administration of gadolinium. The CISS 3D sequence showed a signal of discreetly lower intensity in the left cochlea compared to the right one. The diagnosis of intracochlear hemorrhage was made. No improvement of the hearing loss has been noted after medical treatment and hyperbaric oxygen therapy.
Pulmonary embolism presenting as delirium: an acute confusional state in an elderly patient-a case report
Authors: Chidimma A Ahaneku, Benard B Akpu, Chibueze H Njoku, David E Elem, Bassey E Ekeng
Journal: Egypt J Intern Med (2023)
Keywords: acute confusional state, d-dimer, delirium, high-resolution computed tomography, pulmonary embolism
MeSH terms: Case Reports

Background:
Large numbers of elderly patients are admitted to hospitals in acute confusional states. In many, the underlying causes are easily found; in some, correct diagnosis is difficult. Pulmonary embolism (PE), the most serious clinical presentation of venous thromboembolism, is often misdiagnosed because of its non-specific features including delirium.
Case presentation:
A 73-year-old woman was admitted to our hospital in a confused state with no obvious risk factors of PE. D-dimer levels were elevated and contrast-enhanced high-resolution computed tomography (HRCT) of the chest confirmed the diagnosis of PE. She was treated with enoxaparin and discharged on dabigatran. Her symptoms had resolved at the time of discharge, and she has been stable for over three month's follow-up visit.
Conclusion:
PE should be regarded as a differential in elderly patients with an acute confusional state despite the absence of obvious risk factors. Investigating for and treating when confirmed may save a life.
Multipaddled anterolateral thigh chimeric flap for reconstruction of complex defects in head and neck
Authors: Canhua Jiang, Feng Guo, Ning Li, Wen Liu, Tong Su, Xinqun Chen, Lian Zheng, Xinchun Jian
Journal: PLoS One (2014)
MeSH terms: Carcinoma, Squamous Cell / pathology, Carcinoma, Squamous Cell / surgery, Head and Neck Neoplasms / pathology, Head and Neck Neoplasms / surgery, Plastic Surgery Procedures, Surgical Flaps / surgery, Thigh / surgery, Case Reports, Research Support, Non-U.S. Gov't, Adult, Female, Humans, Intraoperative Care, Male, Middle Aged, Preoperative Care, Squamous Cell Carcinoma of Head and Neck

The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14-23) cm and the mean width was 4.9 (range: 2.5-7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck.
No Free Lunch With Herbal Preparations: Lessons From a Case of Parkinsonism and Depression Due to Herbal Medicine Containing Reserpine
Authors: Michel Rijntjes, Philipp T Meyer
Journal: Front Neurol (2019)
Keywords: parkinson, rauwolfia, vmat, ayurvedic, complementary therapies, depression, reserpine
MeSH terms: Case Reports

The increasing use of herbal medicines calls for a heightened awareness of their potential side-effects. This especially pertains to western countries, where patients tend to use herbal medicine as self-medication, often alongside regular prescriptions, and physicians have less experience with their application. Here we report a case in which Parkinsonism, depression, and an atypical finding detected by dopamine transporter single-photon emission computed tomography were all belatedly recognized as side-effects of herbal medicine. This only occurred because one of its active ingredients, reserpine, has been extensively studied. For most other herbal medicines, however, knowledge about side-effects remains scarce or unavailable. Therefore, we suggest that physicians, when taking a medication history, should actively ask for the use of any herbal preparations.
The Role of Targeted Osmotic Lysis in the Treatment of Advanced Carcinoma in Companion Animals: A Case Series
Authors: Harry J Gould 3rd, Samantha Edenfield, Paige R Miller, Kelly Jean Sherman, Brian Melius, Alissa Whitney, Robert P Hunter, Fabio Del Piero, Dennis Tracey, Dennis Paul
Journal: Case Rep Vet Med (2022)
MeSH terms: Case Reports

Background:
Targeted osmotic lysis (TOL) is a novel technology that involves concomitant stimulation of voltage-gated sodium channels (VGSCs) and the pharmacological blockade of Na+, K+-ATPase causing lysis of highly malignant cancer cells. Hypothesis/Objectives. TOL offers an option for treating advanced carcinomas in companion animals. Animals. Two cats and 2 dogs that presented to veterinary hospitals for evaluation and treatment of one of several forms of carcinoma.
Methods:
Digoxin was administered to achieve steady-state, therapeutic concentrations. The animals were then exposed to pulsed electric field stimulation. Pre- and posttreatment assessments of tumor size and quality of life were compared. The treatment frequency and survivability varied, based on the patient's premorbid functioning and response to treatment.
Results:
Regardless of cancer type, TOL consistently increased survival beyond expected, often improving, but without compromising of quality of life. Conclusions and Clinical Importance. TOL warrants consideration as an option for managing advanced carcinomas.
A novel missense mutation of the paired box 3 gene in a Turkish family with Waardenburg syndrome type 1
Authors: Filiz Hazan, A Taylan Ozturk, Hamit Adibelli, Nurettin Unal, Ajlan Tukun
Journal: Mol Vis (2013)
MeSH terms: Mutation, Missense, Paired Box Transcription Factors / genetics, Waardenburg Syndrome / genetics, Case Reports, Research Support, Non-U.S. Gov't, Amino Acid Substitution / genetics, Base Sequence, Case-Control Studies, DNA Mutational Analysis, Eye / pathology, Female, Genetic Carrier Screening, Humans, Infant, Male, PAX3 Transcription Factor, Pedigree, Phenotype, Turkey, Waardenburg Syndrome / pathology, PAX3 Transcription Factor, PAX3 protein, human, Paired Box Transcription Factors

Purpose:
Screening of mutations in the paired box 3 (PAX3) gene in three generations of a Turkish family with Waardenburg syndrome type 1 (WS1).
Methods:
WS1 was diagnosed in a 13-month-old girl according to the WS Consortium criteria. Detailed family history of the proband revealed eight affected members in three generations. Routine clinical and audiological examination and ophthalmologic evaluation were performed on eight affected and five healthy members of the study family. Dystopia canthorum was detected in all affected patients; however, a brilliant blue iris was present in five patients who also had mild retinal hypopigmentation. Genomic DNA was extracted from the peripheral blood of affected and unaffected individuals in the family as well as 50 unrelated healthy volunteers. All coding exons and adjacent intronic regions of PAX3 were sequenced directly.
Results:
A novel missense heterozygous c.788T>G mutation was identified in eight patients. This nucleotide alteration was not found in unaffected members of the study family or in the 50 unrelated control subjects. The mutation causes V263G amino-acid substitution in the homeodomain of the PAX3 protein, which represents the 45(th) residue of helix 3.
Conclusions:
We identified a novel missense c.788T>G mutation in PAX3 in a family with Waardenburg syndrome with intrafamilial phenotypic heterogeneity.
Combined treatment with laser sintering and zirconium: a case report of dentinogenesis imperfecta
Authors: Simel Ayyildiz, Cem Sahin, Ozlem Marti Akgün, Feridun Basak
Journal: Case Rep Dent (2013)

Osteogenesis imperfecta (OI) is a heterogeneous disorder of connective tissue that manifests mainly as skeletal deformity and bone fragility. Dentinogenesis imperfecta (DI) is sometimes an accompanying symptom of OI. The treatment protocol of these patients varies according to the clinical appearance. The case report here describes complete mouth rehabilitation of an 18-year-old male patient with OI and DI using direct metal laser sintering (DMLS) technique of metal-ceramic restorations and zirconium all-ceramic crowns. DMLS is an additive metal fabrication technology that is simpler, more precise, and healthier than conventional manufacturing and can be remarkably cost effective. Moreover, the technique affords highly accurate production of fixed partial dentures with ideal marginal fit and excellent mechanical properties. The patient was treated using a multidisciplinary strategy that focused on controlling caries, protecting teeth from further wear, obtaining an appropriate vertical dimension, and providing soft tissue support to return the facial profile to a normal appearance using new technology in the field of prosthetics.
When Patients Recover From COVID-19: Data-Driven Insights From Wearable Technologies
Authors: Muzhe Guo, Long Nguyen, Hongfei Du, Fang Jin
Journal: Front Big Data (2022)
Keywords: covid-19, neural networks, pattern extraction, uncertainty quantification, wearable data

Coronavirus disease 2019 (COVID-19) is known as a contagious disease and caused an overwhelming of hospital resources worldwide. Therefore, deciding on hospitalizing COVID-19 patients or quarantining them at home becomes a crucial solution to manage an extremely big number of patients in a short time. This paper proposes a model which combines Long-short Term Memory (LSTM) and Deep Neural Network (DNN) to early and accurately classify disease stages of the patients to address the problem at a low cost. In this model, the LSTM component will exploit temporal features while the DNN component extracts attributed features to enhance the model's classification performance. Our experimental results demonstrate that the proposed model achieves substantially better prediction accuracy than existing state-of-art methods. Moreover, we explore the importance of different vital indicators to help patients and doctors identify the critical factors at different COVID-19 stages. Finally, we create case studies demonstrating the differences between severe and mild patients and show the signs of recovery from COVID-19 disease by extracting shape patterns based on temporal features of patients. In summary, by identifying the disease stages, this research will help patients understand their current disease situation. Furthermore, it will also help doctors to provide patients with an immediate treatment plan remotely that addresses their specific disease stages, thus optimizing their usage of limited medical resources.
Extensive central nervous system involvement in Merkel cell carcinoma: a case report and review of the literature
Authors: Kasim Abul-Kasim, Kristina Söderström, Lennart Hallsten
Journal: J Med Case Rep (2011)

Introduction:
Merkel cell carcinoma is a rare malignant cutaneous neoplasm that is locally invasive and frequently metastasizes to lymph nodes, liver, lungs, bone and brain. The incidence of Merkel cell carcinoma has increased in the past three decades.
Case presentation:
A 65-year-old Caucasian man presented with a sudden onset of severe headache and a three-month history of balance disturbance. Magnetic resonance imaging revealed a large meningeal metastasis. The radiologic workup showed retroperitoneal and inguinal lymph node metastases. Biopsy of the inguinal lymph nodes showed metastases of Merkel cell carcinoma. Biopsy from three different suspected skin lesions revealed no Merkel cell carcinoma, and the primary site of Merkel cell carcinoma remained unknown. Leptomeningeal metastases, new axillary lymph node metastases, and intraspinal (epidural and intradural) metastases were detected within six, seven and eight months, respectively, from the start of symptoms despite treating the intracranial metastasis with gamma knife and the abdominal metastases with surgical dissection and external radiotherapy. This indicates the aggressive nature of the disease.
Conclusion:
To the best of our knowledge, this is the first report in the literature of an intracranial meningeal metastasis of Merkel cell carcinoma treated with gamma knife and of intraspinal intradural metastases of Merkel cell carcinoma. Despite good initial response to radiotherapy, recurrence and occurrence of new metastases are common in Merkel cell carcinoma.
The Use of Botulinum Toxin in a Case of Acquired Periodic Alternating Nystagmus
Authors: Nadia Venturi, Gillian Adams, Maria Theodorou
Journal: Br Ir Orthopt J (2021)
Keywords: abnormal head posture (ahp), nystagmus, oscillopsia, visual acuity
MeSH terms: Case Reports

Aim:
To describe a case of acquired Periodic Alternating Nystagmus (PAN) with oscillopsia treated with botulinum toxin injections into four horizontal rectus muscles.
Method:
A 22-year-old woman presented with sudden onset PAN. The only abnormality found following extensive investigations was bilateral superior cerebellar peduncle atrophy on MRI. Various treatment options were discussed, with reasonable response to baclofen, less so to gabapentin. However, she was keen for a longer-term solution without medication-related adverse effects. She was offered weakening of all four horizontal rectus muscles recessions, either with botulinum toxin or surgery, and she opted for the former to simulate the effects of surgery. 2.5 units of Dysport were injected into each horizontal rectus muscle without adverse effect.
Results:
Off all treatment, Snellen Visual Acuity (VA) was 6/12 in either eye with oscillopsia as a result of the PAN. Post-botulinum toxin VA was 6/5 and 6/6 on the right and left respectively, with both subjective and objective improvement in the nystagmus and oscillopsia.
Conclusion:
Botulinum toxin has an important role in the nystagmus and strabismus clinics. Depending on the circumstances, it may be used as either long term treatment, or for surgical planning to simulate the effects of surgery. In this case, the effects were equivalent to high dose of baclofen and four horizontal rectus muscles recessions, which she underwent when the effects of the botulinum toxin had worn off. Botulinum toxin could be considered as a treatment option in acquired PAN, particularly in women of childbearing age and/or if intolerant or refractory to medical treatment, but ideally not as a long-term treatment option.
Digenic Inheritance of Shortened Repeat Units of the D4Z4 Region and a Loss-of-Function Variant in SMCHD1 in a Family With FSHD
Authors: Raffaella Cascella, Claudia Strafella, Valerio Caputo, Rosaria Maria Galota, Valeria Errichiello, Marianna Scutifero, Roberta Petillo, Gian Luca Marella, Mauro Arcangeli, Luca Colantoni, Stefania Zampatti, Enzo Ricci, Giancarlo Deidda, Luisa Politano, Emiliano Giardina
Journal: Front Neurol (2018)
Keywords: dux4 gene, smchd1 gene, facioscapulohumeral muscular dystrophy, familial investigation, genetic counseling, methylation analysis, neuromuscular symptoms
MeSH terms: Case Reports

Facioscapulohumeral muscular dystrophy (FSHD) is a neuromuscular disorder which is typically transmitted by an autosomal dominant pattern, although reduced penetrance and sporadic cases caused by de novo mutations, are often observed. FSHD may be caused by a contraction of a repetitive element, located on chromosome 4 (4q35). This locus is named D4Z4 and consists of 11 to more than 100 repeated units (RU). The D4Z4 is normally hypermethylated and the genes located on this locus are silenced. In case of FSHD, the D4Z4 region is characterized by 1-10 repeats and results in the region being hypomethylated. However, 5% of FSHD cases do not carry the short allele of D4Z4 region. To date, two forms of FSHD (FSHD1 and FSHD2) are known. FSHD2 is usually observed in patients without the D4Z4 fragment contraction and carrying variants in SMCHD1 (18p11.32) gene. We report the case of a young adult patient who shows severe symptoms of FSHD. Preliminary genetic analysis did not clarify the phenotype, therefore we decided to study the family members by genetic and epigenetic approaches. The analysis of D4Z4 fragment resulted to be 8 RU in the affected proband and in his father; 26 RU in the mother and 25 RU in the maternal uncle. SMCHD1 analysis revealed a heterozygous variation within the exon 41. The variant was detected in the proband, her mother and the uncle. Furthermore, epigenetic analysis of CpG6 methylation regions showed significant hypomethylation in the affected patient (54%) and in the mother (56%), in contrast to the father (88%) and the uncle (81%) carrying higher methylation levels. The analysis of DR1 methylation levels reported hypomethylation for the proband (19%), the mother (11%), and the uncle (16%). The father showed normal DR1 methylation levels (>30%). Given these results, the combined inheritance of SMCHD1 variant and the short fragment might explain the severe FSHD phenotype displayed by the proband. On this subject, SMCHD1 analysis should be promoted in a larger number of patients, even in presence of D4Z4 contractions, to facilitate the genotype-phenotype correlation as well as, to enable a more precise diagnosis and prognosis of the disease.
An abdominal presentation of churg-strauss syndrome
Authors: J R E Rees, P Burgess
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Churg-Strauss syndrome is a small and medium vessel vasculitis that is also known as allergic granulomatous angiitis. It most commonly presents with an asthma like symptoms. It was first described in Mount Siani Hospital, New York in 1951 by Jacob Churg and Lotte Stauss and was recognised after the study of a series of 13 patients who had asthma, eosinophilia, granulomatous inflammation necrotising systemic vasculitis and necrotising glomerulonephritis. We describe a case of Churg-Strauss syndrome presenting with abdominal pain and later during the hospital admission a mono-neuritis multiplex syndrome affecting the lower limbs. The patient presented in such an atypical fashion with abdominal signs and symptoms that they required laparotomy and the diagnosis was made after histological examination of tissue taken at the time of surgery. Treatment with immunosuppression and aggressive rehabilitation achieved a progressive recovery which continued on discharge from hospital.
Orthodontic elastic separator-induced periodontal abscess: a case report
Authors: Talia Becker, Alex Neronov
Journal: Case Rep Dent (2012)
MeSH terms: Case Reports

Aim. Orthodontic elastic bands were proposed as being the source of gingival abscesses that can rapidly lead to bone loss and teeth exfoliation. We report an adolescent, otherwise, healthy patient whose periodontal status was sound. Shortly after undergoing preparations for orthodontic treatment consisting of orthodontic separators, he presented with a periodontal abscess for which there was no apparent etiology. A non-orthoradial X-ray was inconclusive, but an appropriate one revealed a subgingival orthodontic separator as the cause of the abscess. Removal of the separator and thorough scaling led to complete resolution of the abscess, but there was already residual mild damage to the alveolar bone. Summary. Failure to use appropriate imaging to reveal the cause of gingival abscesses can result in the delay of implementing treatment and halting irreversible alveolar bone loss. An inflammatory process restricted to the gingiva and refractive to conventional therapy should raise the possibility of a foreign body etiology.
A Case of Kratom Overdose in a Pediatric Patient
Authors: Andrew Wong, Monique Mun
Journal: Case Rep Psychiatry (2020)
MeSH terms: Case Reports

Kratom is a synthetic opioid that is federally unregulated and thus available for purchase through online retail and smoke shops in most states. Due to its availability, there is concern for misuse in the pediatric population. There is existing literature describing toxicity of kratom in adults; yet, to the best of our knowledge, there are no cases describing kratom toxicity in the pediatric population. Thus, we present the case of kratom overdose in a pediatric patient.
Fever of unknown origin: an unusual case
Authors: R A Bansal, G R Hayman, A S Bansal
Journal: Case Rep Infect Dis (2011)
MeSH terms: Case Reports

Recurrent episodic fever of unknown origin (FUO) arising from tumour of the gastrointestinal tract is rare. We report an otherwise healthy 62-year-old man with recurrent circumscribed bouts of fever and raised CRP for 3 years who has remained well and fever-free 2 years after the removal of a well-differentiated adenocarcinoma of the colon. Occult colonic neoplasm should be considered and sought when routine investigations for FUO are negative.