OpenMed/multicare-articles huggingface dataset:
A Case Series of Thromboelastography-Guided Anticoagulation in COVID-19 Patients with Inherited and Acquired Hypercoagulable States
Authors: Anthony V Thomas, Kevin P Lin, John E Stillson, Connor M Bunch, Jacob Speybroeck, Grant Wiarda, Hamid Al-Fadhl, Laura Gillespie, Mahmud Zamlut, Daniel H Fulkerson, Rashid Z Khan, Hau C Kwaan, Mark M Walsh
Journal: Case Rep Med (2021)
MeSH terms: Case Reports

One of the complications of the novel coronavirus disease 2019 (COVID-19) is hypercoagulability. For this reason, patients presenting with COVID-19 are often put on therapeutic or intermediate anticoagulation upon hospitalization. A common issue of this anticoagulation is the progression to hypocoagulability resulting in hemorrhage. Therefore, monitoring the hemostatic integrity of critically ill COVID-19 patients is of utmost importance. In this case series, we present the cases of three coagulopathic COVID-19 patients whose anticoagulation was guided by thromboelastography (TEG). In each case, TEG permitted the clinical team to simultaneously prevent thrombotic and hemorrhagic events, a difficult task for COVID-19 patients admitted to the intensive care unit. The first two cases illustrate the utility of TEG to guide anticoagulant dosing for COVID-19 patients when the activated partial thromboplastin time (aPTT) is inaccurate. The first case was a severely ill COVID-19 patient with end-stage renal disease and a falsely elevated aPTT secondary to hypertriglyceridemia. The second case was a severely ill COVID-19 patient with chronic pulmonary disease who demonstrated a falsely elevated aPTT due to polycythemia and hemoconcentration. In both cases, TEG was sensitive to the hypercoagulability caused by the metabolic derangements which enabled the goal-directed titration of anticoagulants. The last case depicts a severely ill COVID-19 patient with an inherited factor V Leiden mutation who required abnormally high dosing to achieve therapeutic anticoagulation, guided by TEG. Hypercoagulopathic COVID-19 patients are difficult to anticoagulate without development of hypocoagulopathy. Treatment of these patients demands goal-directed therapy by diligent laboratory monitoring. This can be accomplished by the use of TEG coupled with aPTT to guide anticoagulation. This case series illustrates the necessity for active hemostatic monitoring of critically ill COVID-19 patients.
Thyroid Storm with Multiorgan Failure Treated with Plasmapheresis
Authors: Ann Miller, Kristi D Silver
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Background:
Thyroid storm is a severe manifestation of thyrotoxicosis and can present with multiorgan failure. First line treatment of thyroid storm is directed towards decreasing thyroid hormone production and peripheral conversion of T4 to T3, and treating adrenergic symptoms. When medical therapy fails, plasmapheresis is an alternative treatment option. Here we present a patient with thyroid storm and multiorgan failure who was treated with plasmapheresis.
Case:
A 50-year-old male with a history of hyperthyroidism, hypertension, and congestive heart failure presented to another hospital with fever and altered mentation. He was found to have pneumonia on imaging and was started on antibiotics. He developed shock complicated by atrial fibrillation with rapid ventricular rate which was treated with amiodarone. He was transferred to our hospital for further management. On arrival, TSH was <0.01 mIU/L, free T4 was >7 ng/dL and total T3 was 358 ng/dL. The endocrinology team determined he was in thyroid storm. His medical treatment of thyroid storm was aggressively titrated to maximal therapy. His hospital course was complicated by transaminitis, respiratory failure requiring intubation, shock requiring vasopressor support, kidney failure requiring continuous renal replacement therapy, and heart failure. Despite maximal anti-thyroid therapy, he had not improved clinically and T4 and T3 remained markedly elevated. A 4-day course of plasmapheresis was initiated resulting in marked lowering of T4 and T3 and clinical stability.
Conclusion:
While current guidelines for plasmapheresis for thyroid storm recommend individualized decision making, no further clarification is provided on who would be a good candidate for the procedure. We present a patient with thyroid storm and multiorgan failure who was treated with plasmapheresis after failing maximal medical therapy. Given the significant improvement seen with plasmapheresis, endocrinologists should consider this mode of treatment earlier in the course of thyroid storm when patients are not improving with medical therapy alone.
3D histopathology of stenotic aortic valve cusps using ex vivo microfocus computed tomography
Authors: Camille Pestiaux, Grzegorz Pyka, Louise Quirynen, David De Azevedo, Jean-Louis Vanoverschelde, Benoît Lengelé, David Vancraeynest, Christophe Beauloye, Greet Kerckhofs
Journal: Front Cardiovasc Med (2023)
Keywords: 3d histopathology, aortic stenosis, ex vivo imaging, microfocus computed tomography, microstructural characterization

Background:
Calcific aortic stenosis (AS) is the most prevalent heart valve disease in developed countries. The aortic valve cusps progressively thicken and the valve does not open fully due to the presence of calcifications. In vivo imaging, usually used for diagnosis, does not allow the visualization of the microstructural changes associated with AS.
Methods:

Ex vivo high-resolution microfocus computed tomography (microCT) was used to quantitatively describe the microstructure of calcified aortic valve cusps in full 3D. As case study in our work, this quantitative analysis was applied to normal-flow low-gradient severe AS (NF-LG-SAS), for which the medical prognostic is still highly debated in the current literature, and high-gradient severe AS (HG-SAS).
Results:
The volume proportion of calcification, the size and number of calcified particles and their density composition was quantified. A new size-based classification considering small-sized particles that are not detected with in vivo imaging was defined for macro-, meso- and microscale calcifications. Volume and thickness of aortic valve cusps, including the complete thickness distribution, were also determined. Moreover, changes in the cusp soft tissues were also visualized with microCT and confirmed by scanning electron microscopy images of the same sample. NF-LG-SAS cusps contained lower relative amount of calcifications than HG-SAS. Moreover, the number and size of calcified objects and the volume and thickness of the cusps were also lower in NF-LG-SAS cusps than in HG-SAS.
Conclusions:
The application of high-resolution ex vivo microCT to stenotic aortic valve cusps provided a quantitative description of the general structure of the cusps and of the calcifications present in the cusp soft tissues. This detailed description could help in the future to better understand the mechanisms of AS.
Endovascular treatment of a right-sided ureteroiliac fistula in a patient with a simultaneous left-sided ureteroileal fistula
Authors: G M Veenstra, L M C L Fossion, G Debonnaire, K de Laet
Journal: Case Rep Urol (2011)
MeSH terms: Case Reports

We describe an 80-year-old female with a left ureteroileal fistula and simultaneously a right ureteroiliac fistula. Her history highlights the predisposing factors of radiation, major surgery in the region, and presence of bilateral double-J-stents. She was successfully treated with an endovascular approach after being initially misdiagnosed. There seems to be an increase in reporting ureteral fistulas, however this entity remains a rare clinical condition that can lead to life-threatening situations. A fast and accurate diagnosis of an ureteroarterial fistula remains a challenge.
Nasal and cutaneous mucormycosis in two patients with lymphoma after chemotherapy and target therapy: Early detection by metagenomic next-generation sequencing
Authors: Qing Zhang, Xingchen Liu, Yanyan Liu, Huiqin Wang, Ran Zhao, Xiaodong Lv, Xudong Wei, KeShu Zhou
Journal: Front Cell Infect Microbiol (2022)
Keywords: m irregularis, cutaneous infection, lymphoma, metagenomic next-generation sequencing, mucormycosis, nasal infection lichtheimia ramosa
MeSH terms: Lymphoma, Mucormycosis / diagnosis, Mucormycosis / drug therapy, Mucormycosis / microbiology, Case Reports, Research Support, Non-U.S. Gov't, Amphotericin B / therapeutic use, Anti-Bacterial Agents, High-Throughput Nucleotide Sequencing / methods, Humans, Metagenomics / methods, Anti-Bacterial Agents, Amphotericin B

Mucormycosis is a conditionally pathogenic fungal disease with high morbidity that mainly affects patients with decreased immunity. Diagnosis relies on the histopathological examination of microorganisms with the typical structure of mucormycetes in tissues and subsequent confirmation via culture. Early detection of causative microorganisms is critical to rapidly administer appropriately targeted antibiotics. Metagenomic next-generation sequencing (mNGS) is an innovative and sensitive technique used to identify pathogenic strains. Here we used mNGS to timely diagnose an infection with Lichtheimia ramosa and Mucor irregularis in two patients with hematologic malignancies; the infections manifested as nasal and cutaneous infections and developed after chemotherapy and small molecule targeted therapy. Following treatment with amphotericin B cholesteryl sulfate complex, the symptoms were reduced significantly, and both patients obtained successful outcomes. Additionally, we searched and summarized the current medical literature on the successful diagnosis of mucormycosis using mNGS. These cases indicated that mNGS, a novel culture-independent method, is capable of rapid, sensitive, and accurate identification of pathogens. mNGS may be a complementary method for the early identification of mucormycosis, allowing for appropriate and timely antibiotic administration and thus improving patient outcomes.
Kaposi's sarcoma of the larynx: an unusual location in an HIV-negative patient (a case report)
Authors: Zeineb Naimi, Khalil Mahjoubi, Olfa Adouni, Rim Abidi, Maha Driss, Chiraz Nasr
Journal: Pan Afr Med J (2020)
Keywords: kaposi’s sarcoma, larynx, radiotherapy
MeSH terms: Laryngeal Neoplasms / diagnosis, Sarcoma, Kaposi / diagnosis, Case Reports, Aged, Deglutition Disorders / etiology, Hoarseness / etiology, Humans, Laryngeal Neoplasms / pathology, Laryngeal Neoplasms / radiotherapy, Male, Sarcoma, Kaposi / pathology, Sarcoma, Kaposi / radiotherapy, Non-AIDS-related Kaposi sarcoma

Head and neck involvement of Kaposi's sarcoma is rarely encountered, especially for the Mediterranean classic subtype. Here we report a case of non-AIDS related laryngeal Kaposi's sarcoma in a 77-year-old Tunisian man complaining of 4-month history of hoarseness and dysphagia. The patient underwent exclusive local radiotherapy with a prescription dose of 45 Gy delivered in 1.8 Gy daily fractions. He remained complaint-free for 3 months.
Heart Block Initiated by Candlenut Ingestion
Authors: Osayi Lawani, Mark Winter
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

The candlenut tree is a tropical plant that has a vast number of uses which include fertilizer, dye, ink for tattooing, and fuel. The inner seed of the nut is the most utilized portion of the plant and is often sold as a food additive, natural laxative, or a weight loss supplement. Unfortunately, the seed itself is very toxic when consumed whole and in its raw state. Typical symptoms of toxicity include abdominal pain, vomiting, and diarrhea. Rarely, it can cause cardiac dysrhythmias, most commonly bradycardia and atrioventricular heart block. We present a case of a young adult female with no significant past medical history who developed typical symptoms of toxicity, as well as atrioventricular heart block following ingestion of a candlenut. Most documented cases describe complete resolution of gastrointestinal and cardiac symptoms about one week following ingestion; however, treatment while inpatient can consist of inotropes or vasopressor support, intravenous fluid hydration, electrolyte replacement, and antiemetics. Although the mechanism of action remains unclear, this report provides physicians with an understanding of the risks of ingestion and the knowledge of typical management of the toxic effects of the candlenut.
Infra-low frequency neurofeedback and insomnia as a model of CNS dysregulation
Authors: Paul Terrence Moore
Journal: Front Hum Neurosci (2022)
Keywords: dysregulation, infra-low frequency, infra-low frequency neurofeedback, insomnia alternative treatments, neurofeedback, sleep disturbance
MeSH terms: Review

This paper will review what is conventionally known of sleep homeostasis and focus on insomnia as a primary manifestation of brain dysregulation, whether as a solitary symptom or as part of a larger syndrome such as post-traumatic stress disorder, PTSD. It will discuss in brief behavioral/mindfulness treatments that have been used to treat neurologic diseases, as this is germane to the phenomenology of neurofeedback (NF). It will explore how neurofeedback may work at the subconscious level and cover the current clinical experience of the effectiveness of this technique in the treatment of insomnia. It will conclude with a case presentation.
Reading speed, comprehension and eye movements while reading Japanese novels: evidence from untrained readers and cases of speed-reading trainees
Authors: Hiromitsu Miyata, Yasuyo Minagawa-Kawai, Shigeru Watanabe, Toyofumi Sasaki, Kazuhiro Ueda
Journal: PLoS One (2012)
MeSH terms: Comprehension / physiology, Eye Movements / physiology, Reading, Clinical Trial, Research Support, Non-U.S. Gov't, Adult, Asian People, Female, Humans, Japan, Male, Middle Aged

Background:
A growing body of evidence suggests that meditative training enhances perception and cognition. In Japan, the Park-Sasaki method of speed-reading involves organized visual training while forming both a relaxed and concentrated state of mind, as in meditation. The present study examined relationships between reading speed, sentence comprehension, and eye movements while reading short Japanese novels. In addition to normal untrained readers, three middle-level trainees and one high-level expert on this method were included for the two case studies.
Methodology/principal findings:
In Study 1, three of 17 participants were middle-level trainees on the speed-reading method. Immediately after reading each story once on a computer monitor, participants answered true or false questions regarding the content of the novel. Eye movements while reading were recorded using an eye-tracking system. Results revealed higher reading speed and lower comprehension scores in the trainees than in the untrained participants. Furthermore, eye-tracking data by untrained participants revealed multiple correlations between reading speed, accuracy and eye-movement measures, with faster readers showing shorter fixation durations and larger saccades in X than slower readers. In Study 2, participants included a high-level expert and 14 untrained students. The expert showed higher reading speed and statistically comparable, although numerically lower, comprehension scores compared with the untrained participants. During test sessions this expert moved her eyes along a nearly straight horizontal line as a first pass, without moving her eyes over the whole sentence display as did the untrained students.
Conclusions/significance:
In addition to revealing correlations between speed, comprehension and eye movements in reading Japanese contemporary novels by untrained readers, we describe cases of speed-reading trainees regarding relationships between these variables. The trainees overall tended to show poor performance influenced by the speed-accuracy trade-off, although this trade-off may be reduced in the case of at least one high-level expert.
Synovial sarcoma of the buccal mucosa: a rare case report
Authors: Kumar T S Mahesh, Indira Annamalai Ponnuswamy, Maria Priscilla David, Peeyush Shivhare, Mahalakshmi Ikkanur Puttaranganayak, Pooja Sinha
Journal: Case Rep Dent (2013)

Synovial sarcoma (SS) is a rare malignant neoplasm that arises most commonly in joint capsules and articular tendons, but its relationship to the synovium is not always obvious. Synovial sarcoma is a malignant soft tissue tumor representing 5.6% to 10% of all soft tissue sarcomas. They are termed SS because of their histologic resemblance to the synovium, but they rarely involve a synovial structure and are thought to arise from pluripotential mesenchymal cells. The tumor usually occurs in close association with tendon sheaths, bursae, and joint capsules, primarily in the para-articular regions of the extremities, with approximately 9% occurring in the head and neck region. Synovial sarcoma has been reported rarely in the oral cavity. We report a very rare case of Synovial sarcoma of the buccal mucosa in a 24-year-old male patient.
Use of Extracorporeal Membrane Oxygenation in Pneumocystis Pneumonia of an Infant with AIDS
Authors: Grégoire Cane, Arnaud De Boislambert, Charlotte Sgro, Pierre Lavedan, Hélène Foulgoc, Nadir Tafer, Alexandre Ouattara
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Pneumocystis pneumonia is a common complication of cellular immunosuppression and may trigger severe pulmonary complications. Rapid onset of acquired immunodeficiency syndrome is possible in infants infected with human immunodeficiency virus (HIV). We report here the case of a 13-week-old girl who was previously healthy presenting with altered immunity and refractory acute respiratory distress syndrome (ARDS) initially attributed to bacterial pneumonia. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated because her condition was poor. An HIV infection was later fortuitously diagnosed after accidental exposure of a nurse to the child's urine. The mother had congenitally transmitted HIV to the child after late (undetected) infection during pregnancy. The lung lesions were finally attributed to Pneumocystis pneumonia. We prescribed combined antiretroviral, antibiotic, and steroid therapy aimed at preventing immune reconstitution inflammatory syndrome. VV-ECMO weaning progressed over 30 days to the time of decannulation, rapidly followed by extubation and hospital discharge. The case highlights the fact that rare curable causes of refractory pediatric ARDS should always be investigated early. VV-ECMO should not be excluded as an ARDS treatment for immunocompromised children.
Early-Onset Schizophrenia With Predominantly Negative Symptoms: A Case Study of a Drug-Naive Female Patient Treated With Cariprazine
Authors: Maria Judit Molnar, Idris János Jimoh, Helga Zeke, Ágnes Palásti, Marianna Fedor
Journal: Front Pharmacol (2020)
Keywords: cariprazine, early-onset schizophrenia, negative symptoms, schizophrenia, second-generation antipsychotic
MeSH terms: Case Reports

Schizophrenia is a chronic and severe mental disorder characterized by positive, negative, and cognitive symptoms. Negative symptoms are usually present from the prodromal phase; early diagnosis and management of negative symptoms is a major health concern since an insidious onset dominated by negative symptoms is associated with a worse outcome. Antipsychotic medications, which are effective for treating positive symptoms, are generally ineffective for treating negative or cognitive symptoms. We present a 23-year-old woman showing severe symptoms at her first visit to our department. The patient's parents reported that their daughter had experienced several years of psychosocial decline and putative psychiatric symptoms, but no medical attention had been previously sought; as such, the diagnosis of schizophrenia with predominantly negative symptoms was very much delayed. Early onset of schizophrenia, longer duration of untreated psychosis, and severe negative symptoms, which have limited treatment options, suggested a poor prognosis. We initiated monotherapy with cariprazine, a novel antipsychotic that has recently been proven efficacious in treating schizophrenia with predominantly negative symptoms. This report describes a 52-week cariprazine treatment regimen and follows the patient's impressive clinical improvement confirmed by PANSS and CGI scores, and psychological tests.
Cryptococcus infection in a non-HIV patient: a case report
Authors: Charmian D Sittambalam, Heidi Hanna, Justin Martello, Dimitra Mitsani
Journal: J Community Hosp Intern Med Perspect (2012)
Keywords: chronic steroid use, cryptococcal infection, cryptococcal meningitis
MeSH terms: Case Reports

Cryptococcal infections are fungal infections most commonly seen in immunocompromised patients. Chronic high-dose steroid may precipitate such an immunocompromised state and thus create susceptibility to fungal infections. Cryptococcus neoformans is a saprophyte usually found in soil contaminated with pigeon droppings. Suspicion to diagnose begins with clinical symptoms that can be non-specific such as fevers, cough, and headaches. We present a case of steroid-induced cryptococcal infection in a non-HIV-infected person.
Delayed diagnosis of myocardial infarction in a young man with a blunt chest trauma
Authors: Marzieh Nikparvar, Sayed Mohammadbagher Asghari, Hossein Farshidi
Journal: J Cardiovasc Thorac Res (2019)
Keywords: blunt chest trauma, myocardial infarction, percutaneous coronary intervention
MeSH terms: Case Reports

A 19 year old man was admitted to emergency department (ED) because of motorcycle to motorcycle accident. In ED he was evaluated as a multiple trauma patient and after overnight observation, was discharged with stable vital signs (VS) next morning. Twenty four hours later, he developed chest pain and dyspnea, and was admitted to ED for the second time. This time he was evaluated as a chest trauma patient and chest X ray and CT scanning were performed. According to cardiology consult, an electrocardiogram was recorded and extensive anterolateral ST elevation myocardial infarction (STEMI) was confirmed. Coronary angiography revealed total thrombotic occlusion of left anterior descending artery (LAD) from ostium. Percutaneous coronary intervention (PCI) was performed and LAD stented successfully. After 10 days of ICU admission, he was discharged with an ejection fraction (EF) of 35%.
Giant diaphragmatic angiosarcoma of adult: a case report and review of literature
Authors: Tao Ren, Xue-Qian Chen
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Angiosarcoma is a rare vascular malignant soft tissue tumor, with highly malignant, invasive, and multifocal characteristics of biology, which is prone to local recurrence and distant metastasis, so the prognosis is extremely poor. It rarely involves the diaphragm. We present the case of an adult patient who had a primary giant angiosarcoma of the left-sided diaphragm.
An interdisciplinary approach for rehabilitating a patient with amelogenesis imperfecta: a case report
Authors: Niloufar Khodaeian, Mahmoud Sabouhi, Ebrahim Ataei
Journal: Case Rep Dent (2012)

Amelogenesis imperfecta (AI) has been defined as a group of hereditary enamel defects. It can be characterized by enamel hypoplasia, hypomaturation, or hypocalcification of the teeth. AI may be associated with some other dental and skeletal developmental defects. Restoration for patients with this condition should be oriented toward the functional and esthetic rehabilitation. This clinical report describes the oral rehabilitation of a young patient diagnosed with the hypoplastic type of AI in posterior teeth and hypomatured type of AI in anterior teeth.