OpenMed/multicare-articles huggingface dataset:
Unilateral proptosis as a neglected case of sphenoid wing meningioma: a case report and healthcare challenges in rural Indonesia
Authors: Ivana Beatrice Alberta, Robert Shen, Mardjono Tjahjadi
Journal: Pan Afr Med J (2023)
Keywords: cerebral neoplasm, case report, meningioma, orbital neoplasm, rural healthcare
MeSH terms: Exophthalmos / etiology, Meningeal Neoplasms / pathology, Meningioma / pathology, Case Reports, Delivery of Health Care, Humans, Indonesia, Sphenoid Bone / pathology

Proptosis, an abnormal protrusion of the eyeball, is a manifestation of a wide variety of pathologies. The complication to be vision- or life-threatening makes early diagnosis is important, especially in rural primary health centers (PHCs) with far-distance referrals to capable hospitals. This case report examines a patient with obvious unilateral proptosis and blurry vision on the right eye for 4 years, with neglect because of prior inadequate diagnosis and explanation before the current complication. Examination shows no light perception, obvious proptosis (30 mm), exodeviation, and ophthalmoplegia. Referral for radiological examination showed a regular extra-axial lesion, well-defined, and broad-based on the right sphenoid wing with hyperostosis. The patient was diagnosed with sphenoid wing meningioma, which complicated into proptosis and blindness. This report aims to explain the current challenges of rural PHCs in Indonesia critically and to emphasize that rural PHCs should overcome the low level of public education, self-awareness of health, and tendency to reject the referral process. Clinicians also have a crucial role in early detection and prompt treatment to reduce further neglected cases.
Case Report: Obsessive compulsive disorder in posterior cerebellar infarction - illustrating clinical and functional connectivity modulation using MRI-informed transcranial magnetic stimulation
Authors: Urvakhsh Meherwan Mehta, Darshan Shadakshari, Pulaparambil Vani, Shalini S Naik, V Kiran Raj, Reddy Rani Vangimalla, Yc Janardhan Reddy, Jaya Sreevalsan-Nair, Rose Dawn Bharath
Journal: Wellcome Open Res (2020)
Keywords: cerebellar cognitive affective syndrome, cerebellar infarct, functional brain connectivity, neuromodulation, obsessive compulsive disorder, theta burst stimulation
MeSH terms: Case Reports

Objectives: We describe atypical and resistant neuropsychiatric clinical manifestations in a young male with posterior cerebellar gliosis. We also attempt to test the mediating role of the cerebellum in the clinical presentation by manipulating the frontal-cerebellar network using MRI-informed transcranial magnetic stimulation (TMS). Methods: A case report of a young adult male describing obsessive-compulsive symptoms, probably secondary to an infarct in the cerebellar right crus II, combined with an examination of behavioral and functional connectivity changes following TMS treatment. Results: Obsessions, compulsions, and pathological slowing were observed in the background of a posterior cerebellar infarct, along with impairments in vigilance, working memory, verbal fluency, visuospatial ability, and executive functions, in the absence of any motor coordination difficulties. These symptoms did not respond to escitalopram. MRI-informed intermittent theta-burst stimulation delivered to the pre-supplementary motor area identified based on its connectivity with the cerebellar lesion in the crus II resulted in partial improvement of symptoms with enhanced within and between-network modularity of the cerebellar network connectivity. Conclusion: We illustrate a case of OCD possibly secondary to a posterior cerebellar infarct, supporting the role of the cerebellum in the pathophysiology of OCD. Functional connectivity informed non-invasive neuromodulation demonstrated partial treatment response. A seriation technique showed extended connectivity of the cerebellar lesion regions following the neuromodulatory treatment.
In Search of Autonomy: Dancing With Rules
Authors: Frode Heldal, Erlend Dehlin
Journal: Front Psychol (2021)
Keywords: autonomy, interactionist perspective, management, practical judgement, rule breaking

Purpose: Autonomy in organisations cannot exist without rules nor relationships. Yet, previous research tends to elicit understandings of autonomy as freedom from external constraints to enact free individual will. And there are numerous positive effects related to autonomy at work. But research has not kept pace with modern-day organisations that are highly flexible and dynamic. Current understandings of autonomy are static. Autonomy is mainly regarded as something individuals possess, more or less constricted by rules. Our purpose is to contribute a more flexible and practice-oriented concept of autonomy to answer the research question: How is autonomy developed and practiced in relation to formal rules in high-risk organisations? Design: To investigate autonomy as a dynamic and flexible concept, we draw on two case studies comprised of a total of 52 interviews and more than 10 h of observation. The cases include a factory and a hospital unit. Findings: We suggest, based on the data, that autonomy is a relational phenomenon. We suggest four different autonomy-rule dynamics: Passive, loyal, self-promoting, and co-generative learning. Research Implications: Regarding autonomy as relational rather than individual contributes to our understanding of organisations as always in the making. In this, we emphasise the interactive element of autonomy. Practical Implications: Practitioners and managers may use our suggestions to work with autonomy in a different way, spurring creativity and improvisation by constructively using rules. Originality: Little research has paid attention to the concept of autonomy (despite its importance), and arguably, a trend in the available research concerns a commodification of the phenomenon, primarily aligning autonomy with (degrees of) negative freedom and individual decision making. We unpack the concept with attention to interaction - what we have called dancing with rules.
Keratolenticular adhesion removal for type 2 Peters anomaly: a case report
Authors: Zhangliang Li, Rui Zou, Yune Zhao
Journal: Eye Vis (Lond) (2020)
Keywords: cataract, endothelium, pediatric, peters anomaly
MeSH terms: Case Reports

Background:
Type 2 Peters anomaly is a rare anterior segment disorder characterized by central corneal leukoma with keratolenticular adhesion and cataract. Performing cataract surgery without corneal tissue transplantation in patients of type 2 Peters anomaly is extremely rare and challenging. We present a case of type 2 Peters anomaly treated by peeling off the adhesion without penetrating keratoplasty (PKP), in which restoration of corneal transparency is observed.
Case presentation:
An 11-month-old female infant of type 2 Peters anomaly presented with bilateral corneal opacity with distinct demarcation, keratolenticular adhesion and cataract, which was first noted at the age of 3 months. By peeling off the adhesion from corneal endothelium combined with lensectomy and vitrectomy, there was a gradual reduction in corneal opacity and improvement in visual acuity after surgery over a 2-year period. Her visual acuity had improved from light perception preoperatively to 20/50 at the latest follow-up. No sight-threatening postoperative complications were noted.
Conclusion:
It is safe and effective to peel off the keratolenticular adhesion in patients of type 2 Peters anomaly presented with distinctly demarcated corneal opacity.
Native tricuspid valve infective endocarditis with Staphylococcus lugdunesis: An unusual complication post spinal epidural injection - Case report and literature review
Authors: Osama Nweiran Al-Khalaila, Laith Fawzat Tbishat, Mohamed Salah Abdelghani, Ahmad A A Al Bishawi, Adila Shaukat Kashaf, Dina Alwaheidi, Abdulwahid Al Mulla
Journal: IDCases (2021)
Keywords: coagulase negative staphylococcus, epidural injection, infective endocarditis, staphylococcus lugdunesis, tricuspid valve
MeSH terms: Case Reports

Infective Endocarditis (IE) is a very rare complication following spinal epidural injection and requires high index of suspicion for early diagnosis and effective management. Staphylococcus Lugdunesis is a coagulase negative staphylococcus (CoNS) that, unlike other CoNS, may result in aggressive form of native valve infective endocarditis (IE) mimicking IE caused by S aureus. Surgical intervention is usually needed to control infection in most cases of S. Lugdunesis IE. Herein, we report a case of young lady with congenital Gerbode defect who developed tricuspid native valve IE with S. Lugdunesis secondary to spondylodiscitis post lumbar epidural injection that was performed for disk prolapse. She required urgent surgical intervention and had an excellent outcome.
Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings: ethical considerations
Authors: Clara Calia, Amit Chakrabarti, Emmanuel Sarabwe, Anna Chiumento
Journal: Wellcome Open Res (2023)
Keywords: bioethics, community engagement, global mental health, impact, international partnerships, low and middle income countries, research ethics

Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection. Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.
Rare case of concomitant juxtarenal aortic aneurysm and type 1 Inferior Vena Cava duplication: -intraoperative challenges to avoid catastrophe
Authors: Cherring Tandup, Arunanshu Behera, Kailash Chand Kurdia, Charan Singh
Journal: J Vasc Bras (2021)
Keywords: ivc anomaly, abdominal aortic aneurysm
MeSH terms: Case Reports

Duplication of the inferior vena cava is a rare congenital anomaly, with an incidence of 0.2-3%. Despite being asymptomatic, anomalies of IVC are important in aortoiliac and retroperitoneal surgeries. Preoperative CT imaging is essential to identify any IVC anomaly and to prevent unexpected hemorrhage during surgery. Here, we report a case of a juxtarenal abdominal aortic aneurysm in which we encountered a type I IVC duplication anomaly intraoperatively while performing transperitoneal aneurysmorrhaphy and took precautions to avoid any iatrogenic injuries to either of the two trunks or the pre-aortic trunk of the anomalous duplicate IVC.
Cryptococcal meningoencephalitis in patients with mantle cell lymphoma on ibrutinib
Authors: Kai Sun, Saro Kasparian, Swaminathan Iyer, Sai Ravi Pingali
Journal: Ecancermedicalscience (2018)
Keywords: cryptococcal meningoencephalitis, ibrutinib, mental cell lymphoma
MeSH terms: Case Reports

Ibrutinib, a Bruton's tyrosine kinase inhibitor, has been increasingly widely used in relapsed and refractory mantle cell lymphoma (MCL) and chronic lymphocytic leukaemia [1, 2]. With its use becoming more common, there have been emerging case reports of opportunistic infections like cryptococcal infections [3-8]. These infections in patients receiving ibrutinib were mostly reported in patients with chronic lymphocytic leukaemia, who have poor immune reconstitution. Here, we report two cases of cryptococcal meningoencephalitis in patients with MCL on ibrutinib.
Laparoscopic Surgery for Ovarian Cyst Infection with Avoidance of Ureteral Injury and Uterine Perforation following Intrauterine Insemination after Abdominal Modified Radical Trachelectomy
Authors: Moito Iijima, Shigenori Hayashi, Yusuke Kobayashi, Kosuke Tsuji, Eiichiro Tominaga, Kouji Banno, Daisuke Aoki
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Pelvic inflammatory disease (PID) sometimes develops after intrauterine insemination (IUI). We herein present a case of PID which developed after IUI performed after abdominal modified radical trachelectomy (AmRT) and was treated with laparoscopic surgery. To our knowledge, this is the first case report of laparoscopic surgery for PID that occurred after AmRT in Japan. A 39-year-old woman who was diagnosed with cervical cancer stage IA1 with lymphovascular invasion underwent AmRT and pelvic lymphadenectomy. At 3 years and 6 months after the surgery, she had fever and pain in her left lower abdomen 10 days after IUI. She was diagnosed with PID with left ovarian cyst infection and underwent laparoscopic left ovarian cystectomy. Before surgery, bilateral ureteral catheters were inserted because of possible difficulty identifying the ureters. During surgery, severe adhesion was seen in the pelvic cavity. By moving the catheters manually back and forth from outside the body, we were able to identify the ureters visually. A uterine manipulator was inserted during surgery, rather than before surgery, to avoid the risk of uterine perforation. Laparoscopic surgery with ureteral catheters and a uterine manipulator can be applied safely for such cases after AmRT even when severe intraperitoneal adhesion is present.
Severe Vertex Epidural Hematoma in a Child: A Case Report of a Management without Expert Neurosurgical Care
Authors: Christophe Brévart, Antoine Bertani, Hassan Abdourahman Aden, Paul Menguy, Renaud Dulou
Journal: Case Rep Surg (2011)
MeSH terms: Case Reports

Vertex epidural hematomas (VEDHs) are an uncommon situation and difficulties may be encountered in their diagnosis and management. This is more complicated when the surgical management has to be performed by general surgeons, not specialized in neurosurgery, in a remote location. It was in this context that we were brought to care in charge a 2-year-old boy who required a neurosurgical emergency rescue for a severe VEDH in Djibouti. Through the description of this case, we want to emphasize the value of developing a network of teleconsultation for the benefit of remote and isolated locations and learning basic techniques of emergency neurosurgery.
Rare Case of 6 cm Right Atrial Myxoma in Patient with Synchronous Endometrial Adenocarcinoma
Authors: Mohammad Altujjar, Feras Zaiem, Erin Sheehan, Willy Gan, Mohammed Mhanna, Waleed Khokher, Ikram Ullah, Mohammad Tokir Mujtaba
Journal: Case Rep Cardiol (2021)
MeSH terms: Case Reports

Primary cardiac tumors are extremely rare. Cardiac myxomas most frequently appear in the left atrium. In this article, we present a case of an asymptomatic 6 cm right atrial mass in a patient undergoing staging for endometrial cancer. The mass was resected, and final pathology was consistent with cardiac myxoma.
Concurrent insulinoma and pancreatic adenocarcinoma: report of a rare case and review of the literature
Authors: Panagiotis G Athanasopoulos, George Polymeneas, Dionysios Dellaportas, George Mastorakos, Evi Kairi, Dionysios Voros
Journal: World J Surg Oncol (2011)
MeSH terms: Adenocarcinoma / pathology, Carcinoma, Islet Cell / pathology, Insulinoma / pathology, Neoplasms, Second Primary, Pancreatic Neoplasms / pathology, Case Reports, Review, Adenocarcinoma / surgery, Aged, Carcinoma, Islet Cell / surgery, Humans, Insulinoma / surgery, Male, Pancreatic Neoplasms / surgery, Tomography, X-Ray Computed

Pancreatic adenocarcinoma is the 5th leading cause of cancer-related death in Western countries and insulinomas are rare endocrine neoplasms of the pancreas. The concurrent appearance of pancreatic adenocarcinoma and insulinoma is very rare and to the best of our knowledge has never been reported again. Herein, we present such an occurrence in a 74-year-old man. Resection of a mass in the uncinate process of the pancreas revealed pancreatic adenocarcinoma with severe desmoplastic reaction. Two years later, due to symptomatology persistence the patient was re-examined and a new 2 cm mass in the uncinate process was found leading to surgery, which demonstrated a 2 cm endocrine islet-cell tumor. Establishing a diagnosis in patients with insulinoma is difficult and the imaging studies still have low sensitivity and specificity except for intra-operative ultrasonography, which is the most accurate method detecting 90% of these lesions.
Post-vaccine COVID-19 acute myocarditis: case reports and literature review
Authors: Abderrahmane Bouchaala, Jaouad Nguadi, Abdelakder Benhlima, Manal Arfaoui, Hamza Elhamzaoui, Mustapha Alilou
Journal: Pan Afr Med J (2023)
Keywords: acute myocarditis, covid-19, covid-vaccines, case report
MeSH terms: COVID-19 Vaccines / adverse effects, COVID-19 / prevention & control, Myocarditis / diagnosis, Myocarditis / etiology, Review, Case Reports, Humans, SARS-CoV-2, Vaccination, Vaccines, COVID-19 Vaccines, Vaccines

COVID-19 vaccines have reduced both lethality and hospitalization rates of the novel coronavirus disease. Nevertheless, multiple side effects have been reported in the literature, most often are harmless. We report two cases of acute myocarditis, hospitalized in the emergency department for chest pain occurring after the second dose of mRNA vaccine AstraZeneca. The SARS-Cov-2 infection was ruled out in both patients with a negative PCR obtained by nasal swabs and normal thoracic CT scans. Both patients had high levels of high-sensitive cardiac troponin I. Acute coronary syndromes were excluded with cardiac catheterization. Cardiac Magnetic resonance imaging (MRI) showed signs in favor of acute myocarditis. The evolution was favorable for both patients after being put on anti-inflammatory treatment. The universality and accumulation of reports concerning acute myocarditis following COVID vaccination, in the absence of any other diagnostic element that could explain the myocardial injury, establish a strong causal link, although the etiopathogenesis of such injury remains poorly elucidated.
Acute Liver Failure among Patients on Efavirenz-Based Antiretroviral Therapy
Authors: Innocent Lule Segamwenge, Miriam Kaunanele Bernard
Journal: Case Reports Hepatol (2018)
MeSH terms: Case Reports

Objectives:
To describe the clinical characteristics of patients presenting with fulminant liver failure after varying periods of exposure to Efavirenz containing antiretroviral medications.
Methods:
We report a series of 4 patients with human immunodeficiency virus (HIV) infection who were admitted with acute liver failure (ALF) over a 6-month period. All these patients had been treated with a range of Efavirenz containing antiretroviral regimens and were negative for hepatitis A, B, and C infections as well as other opportunistic infections, all were negative for autoimmune hepatitis, and none had evidence of chronic liver disease or use of alcohol or herbal medications. Information on patient clinical characteristics, current antiretroviral regimen, CD4 count, HIV-1 RNA levels, and clinical chemistry parameters was collected. Informed consent was provided.
Results:
During a 6-month period, four patients without other known risk factors for acute hepatitis presented with symptomatic drug-induced liver injury with varying symptoms and outcomes. The pattern of liver injury was hepatocellular for all the 4 cases. Liver biopsies were done for all the four cases and the results showed a heavy mixed inflammatory cell infiltrate with eosinophils. For three patients withdrawal of Efavirenz from their antiretroviral regimen was sufficient to restore transaminase levels to normal and led to improvement of clinical symptoms. For one patient his clinical course was characterized by fulminant liver failure and fluctuating episodes of hepatic encephalopathy which ultimately resulted in his death.
Conclusion:
Hepatotoxicity of Efavirenz is not as rare as previously described in the literature and does actually present with fatal outcomes. The key message to note is that frequent monitoring of liver enzymes should be done at initiation of antiretroviral therapy and should continue throughout the treatment period.
Interactions between Obsessional Symptoms and Interpersonal Ambivalences in Psychodynamic Therapy: An Empirical Case Study
Authors: Shana Cornelis, Mattias Desmet, Kimberly L H D Van Nieuwenhove, Reitske Meganck, Jochem Willemsen, Ruth Inslegers, Jasper Feyaerts
Journal: Front Psychol (2017)
Keywords: ambivalence, empirical single case study, interpersonal characteristics, obsessional symptoms, psychodynamic psychotherapy, symptom specificity, theory-building case study

The classical symptom specificity hypothesis (Blatt, 1974) particularly associates obsessional symptoms to interpersonal behavior directed at autonomy and separation from others. Cross-sectional group research, however, has yielded inconsistent findings on this predicted association, and a previous empirical case study (Cornelis et al., in press; see Chapter 2) documented obsessional pathology to be rooted in profound ambivalences between autonomous and dependent interpersonal dynamics. Therefore, in the present empirical case study, concrete operationalizations of the classical symptom specificity hypothesis are contrasted to alternative hypotheses based on the observed complexities in Chapter 2. Dynamic associations between obsessional symptoms and interpersonal functioning is further explored, aiming at further contribution to theory building (i.e., through suggestions for potential hypothesis-refinement; Stiles, 2009). Similar to the first empirical case study (Chapter 1), Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of supportive-expressive psychodynamic therapy. In line with findings from Chapter 1, findings reveal close associations between obsessions and interpersonal dynamics, and therapist interventions focusing on interpersonal conflicts are documented as related to interpersonal and symptomatic alterations. Observations predominantly accord to the ambivalence-hypothesis rather than to the classical symptom specificity hypothesis. Yet, meaningful differences are observed in concrete manifestations of interpersonal ambivalences within significant relationships. Findings are again discussed in light of conceptual and methodological considerations; and limitations and future research indications are addressed.