OpenMed/multicare-articles huggingface dataset:
Haemophagocytic Lymphohistiocytosis with Leptospirosis: A Rare but Devastating Complication
Authors: B M Munasinghe, A G Arambepola, N Pathirage, U P M Fernando, N Subramaniam, S Nimalan, T Gajanthan
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Introduction:
Secondary haemophagocytic lymphohistiocytosis (sHLH), often associated with an array of infections, malignancies, and autoimmune diseases, is rarely seen with leptospirosis, which carries a relatively poor prognosis even with modern state-of-the-art medical care. We describe a patient with leptospirosis complicated by sHLH who succumbed to illness following multiorgan dysfunction. Case Description. A 74-year-old farmer presented with high-grade, unsettling fever for a week. Muddy water exposure and suggestive symptoms prompted investigation and management in the line of leptospirosis (IV ceftriaxone was instituted, and later, MAT (microscopic agglutination test) became positive). Subsequently, he developed severe acute hypoxemia requiring mechanical ventilation and acute renal failure requiring renal replacement therapy. Bone marrow biopsy and markedly elevated serum ferritin and triglyceride levels done on day 10 (with unresolving fever, hepatosplenomegaly, and pancytopaenia) confirmed the diagnosis of HLH. The routine cultures, retroviral studies, CMV, dengue, hanta and mycoplasma antibodies, tuberculosis and COVID-19 PCR, and malaria screening were all normal. There was no improvement of hypoxemia following intravenous methylprednisolone. He died on day 15 despite escalating organ support.
Conclusion:
Leptospirosis is a common zoonotic disease in the tropics with significant morbidity and mortality. In the case of severe leptospirosis, overlapping clinical features with sHLH make the diagnosis of the latter challenging. No assessment tools are available to date to predict the risk of developing sHLH in a patient having leptospirosis. Outcome following sHLH due to leptospirosis still remains majorly ominous. A high index of suspicion and low threshold for specific investigations could possibly alter the outcome following such an occurrence.
Allopurinol reverses mercaptopurine-induced hypoglycemia in patients with acute lymphoblastic leukemia
Authors: Melissa Zhang, Bruce Bostrom
Journal: F1000Res (2019)
Keywords: allopurinol, hypoglycemia, mercaptopurine, morning nausea, thiopurine methyltransferase
MeSH terms: Antimetabolites, Antineoplastic / adverse effects, Antimetabolites, Antineoplastic / therapeutic use, Enzyme Inhibitors / therapeutic use, Hypoglycemia / chemically induced, Hypoglycemia / drug therapy, Mercaptopurine / adverse effects, Mercaptopurine / therapeutic use, Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy, Case Reports, Allopurinol / therapeutic use, Blood Glucose, Blood Glucose Self-Monitoring, Child, Child, Preschool, Female, Humans, Antimetabolites, Antineoplastic, Blood Glucose, Enzyme Inhibitors, Allopurinol, Mercaptopurine

Fasting hypoglycemia is a known complication of mercaptopurine (6MP) maintenance therapy for acute lymphoblastic leukemia (ALL). It is associated with high levels of the methylated metabolite 6-methyl-mercaptopurine (6MMP). Symptoms of hypoglycemia include morning tremulousness, nausea and vomiting. We have previously shown that switching 6MP dosing from evening to morning resolved hypoglycemia by reducing 6MMP; however, the reduction of 6MMP was only transient, potentially resulting in return of hypoglycemia. In children and adults with Crohn's disease, co-prescribing allopurinol with 6MP blocks the activity of thiopurine methytransferase (TPMT), reducing 6MMP and improving its tolerance. As a consequence of inhibiting TPMT, 6MP is shunted toward the production of 6-thioguanine nucleotide (6TGN), which will result in pancytopenia if the dose of 6MP is not reduced. We demonstrate that allopurinol with a reduced dose of 6MP in two patients with ALL and 6MMP-associated hypoglycemia resulted in a complete and sustained suppression of 6MMP and rapid reversal of hypoglycemia and its symptoms.
Surgical Removal of Circumferentially Leaked Polymethyl Methacrylate in the Epidural Space of the Thoracic Spine after Percutaneous Vertebroplasty
Authors: Kenichiro Kita, Yoichiro Takata, Kosaku Higashino, Kazuta Yamashita, Fumitake Tezuka, Toshinori Sakai, Akihiro Nagamachi, Koichi Sairyo
Journal: Surg J (N Y) (2017)
Keywords: cement leakage, neurologic deficit, percutaneous vertebroplasty, surgical removal
MeSH terms: Case Reports

Background The major complication of percutaneous vertebroplasty (PVP) using polymethyl methacrylate (PMMA) is epidural leakage of PMMA that damages the spinal cord. Methods This is a case report. Result A 77-year-old man presented to our institution with a 6-month history of muscle weakness and an intolerable burning sensation of both lower limbs after PVP with PMMA for thoracic compression fracture at T7 at another hospital. His past medical history was significant for hypertension. He had no history of smoking and alcohol. Computed tomography revealed massive leakage of PMMA into the T6 and T7 spinal canal circumferentially surrounding the spinal cord that caused marked encroachment of the thecal sac. Magnetic resonance images revealed cord compression and intramedullary signal change from T6 to T7 level. After we verified that the leaked PMMA could be easily detached from the dura mater in the cadaveric lumbar spine, surgical decompression and removal of epidural PMMA was performed. The leaked PMMA was carefully thinned down with a high-speed diamond burr. Eight pieces of PMMA were detached from the dura mater easily without causing a dural tear. No neurologic deterioration was observed in the postoperative period. The burning sensation resolved, but the muscle weakness remained unchanged. One and a half years postoperatively, the muscle weakness has improved to ⅘ on the manual muscle strength test, but he could not walk without an aid because of spasticity. Conclusion This report demonstrates the catastrophic epidural extrusion of PMMA following PVP. Extravasated PMMA can be removed through a working space created by means of laminectomy and subtraction of the affected pedicle. Spine surgeons should recognize the possible neurologic complications of PVP and be prepared to treat them using suitable approaches.
Differential Effects of Ethical Education, Physical Hatha Yoga, and Mantra Meditation on Well-Being and Stress in Healthy Participants-An Experimental Single-Case Study
Authors: Karin Matko, Peter Sedlmeier, Holger C Bringmann
Journal: Front Psychol (2021)
Keywords: differential effects, ethical education, incremental effects, mantra meditation, mixed-method, multilevel modeling, single-case research, yoga components

Traditionally, yoga is a multicomponent practice consisting of postures, breathing techniques, meditation, mantras, and ethics. To date, only a few studies have tried to dismantle the effects of each of these components and their combinations. To fill this gap, we examined the incremental effects of ethical education and physical Hatha yoga on mantra meditation using a single-case multiple-baseline design. This study was part of a project evaluating the new mind-body program Meditation-Based Lifestyle Modification. Fifty-seven healthy participants with no regular yoga or meditation practice were randomly assigned to three baselines (7, 14, and 21 days) and four conditions using a random number generator. The conditions were mantra meditation alone (MA), meditation plus physical yoga (MY), meditation plus ethical education (ME), and meditation plus yoga and ethical education (MYE). All the interventions lasted for 8 weeks and were run consecutively according to baseline length. During the baseline and treatment phases, participants received daily questionnaires measuring their well-being (WHO-5 Well-Being Index), stress (Perceived Stress Scale), and subjective experiences. Forty-two participants completed the treatment and were entered in the analyses. We analyzed our data using visual inspection, effect size estimation (Tau-U), and multilevel modeling. Almost all participants showed a longitudinal increase in well-being. Regarding between-group differences, participants who received ethical education exhibited the largest increases in well-being (Tau-U = 0.30/0.23 for ME/MYE), followed by participants in the MY condition (Tau-U = 0.12). Conversely, participants in the MA condition showed no change (Tau-U = 0.07). There was a tendency for the combined treatments to decrease stress. This tendency was strongest in the MY condition (Tau-U = -0.40) and reversed in the MA condition (Tau-U = 0.17). These results emphasize the incremental and differential effects of practicing meditation in combination with other practices from the eight-fold yoga path. This approach is valuable for better understanding the multifaceted practice of yoga. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04252976.
Use of Rituximab After Orbital Decompression Surgery in Two Grave's Ophthalmopathy Patients Progressing to Optic Neuropathy
Authors: Benping Zhang, Yaling Li, Weijie Xu, Bei Peng, Gang Yuan
Journal: Front Endocrinol (Lausanne) (2020)
Keywords: dysthyroid optic neuropathy, grave’s disease, grave’s ophthalmopathy, orbital decompression, rituximab
MeSH terms: Decompression, Surgical / adverse effects, Graves Ophthalmopathy / surgery, Inflammation / prevention & control, Ophthalmologic Surgical Procedures / adverse effects, Optic Nerve Diseases / drug therapy, Rituximab / therapeutic use, Case Reports, Antineoplastic Agents, Immunological / therapeutic use, Graves Ophthalmopathy / pathology, Humans, Inflammation / etiology, Inflammation / pathology, Male, Middle Aged, Optic Nerve Diseases / etiology, Optic Nerve Diseases / pathology, Prognosis, Retrospective Studies, Antineoplastic Agents, Immunological, Rituximab

Background:
While orbital decompression can alleviate optic nerve compression and prevent further vision loss in dysthyroid optic neuropathy (DON), it cannot relieve inflammatory symptoms. Very high doses of intravenous glucocorticoids (GCs) are the first-line therapy for DON; however, the effective rate is only 40% and might be much lower in patients who fail high-dose GC pulse therapy and progressed to DON. The results of two case series studies indicated that rituximab treatment had a much better curative effect compared to very high doses of intravenous GCs, but some patients required urgent orbital decompression after rituximab injection because rituximab might lead to the release of cytokines, aggravated intraorbital edema, and further vision loss.
Methods:
We retrospectively studied the therapeutic process of two Grave's ophthalmopathy (GO) patients complicated with DON who failed high-dose GC pulse therapy and underwent orbital decompression. Both patients received single-dose (500 mg) rituximab treatment.
Results:
During more than 2 years of follow-up, rituximab treatment exhibited significant improvement in inflammatory symptoms, as manifested by a substantial decrease in Clinical Activity Score (CAS); meanwhile, the vision of both patients improved significantly and their diplopia was relieved.
Conclusions:
The results of this study were consistent with those of two previous case series studies indicating the significant and lasting effect of rituximab treatment on DON, especially for patients with GC resistance or recurrence after GC therapy. Orbital decompression before rituximab treatment might reduce the incidence of rapid vision loss and urgent orbital decompression surgery caused by aggravated orbital edema after rituximab injection; however, the necessity for preventive decompression surgery requires further study.
Acute Effect of Robotic Therapy (G-EO System™) on the Lower Limb Temperature Distribution of a Patient with Stroke Sequelae
Authors: Fábio Marcon Alfieri, Caren da Silva Dias, Artur Cesar Aquino Dos Santos, Linamara Rizzo Battistella
Journal: Case Rep Neurol Med (2019)
MeSH terms: Case Reports

Robotic therapy has been gaining prominence in poststroke rehabilitation programs. An example of these devices is the G-EO System™, which simulates gait as well as other more complexes standards of gait such as the steps on stairs. However, to the best of our knowledge, there are no studies that apply thermography as a tool to evaluate stroke patients who undertook rehabilitation programs with the aid of robotic devices. The patient IWPS undergoes sequelae of hemorrhagic stroke for 19 months and consequently hemiplegia, had scores of 93 points in the Fugl-Meyer scale, is undertaking a physical rehabilitation program for six months, has no complaints of discomfort due to thermic sensitivity imbalances between the plegic and the contralateral sides, and voluntarily reports that he realizes functionality improvements especially, according to his perception, due to the aid of the robotic therapy in his gait training with the G-EO System™. The thermographic images were captured by an infrared sensor FLIR T650SC. By analyzing the temperature differences between both hemispheres of the body, before, immediately after, and 30 minutes after a robotic therapy for gait training, we observed that the values firstly increased immediately after the training, but after the 30-minute rest an important thermoregulation was achieved.
Closure of a Tracheocutaneous Fistula With a Local Turnover Flap Combined With Pregrafted Palatal Mucosa: A Case Report
Authors: Takeshi Kitazawa, Masato Shiba
Journal: Eplasty (2016)
Keywords: closure, flap, mucosal graft, staged surgery, tracheocutaneous fistula
MeSH terms: Case Reports

Objectives: A method of closing a large tracheocutaneous fistula by a combination of a palatal mucosal graft with a turnover adiposal flap is presented. Methods: Mucosa of the same size as the tracheal defect was harvested from the hard palate and grafted just caudal to the fistula. After the mucosal graft had taken, a local flap containing the mucosal graft was turned over the tracheal defect facing the mucosa inward of the tracheal lumen. The defect caused by harvesting the flap was closed horizontally. Results: The fistula was closed successfully, and 1 year after the operation, the patient had no airway compromise and the operative scar was inconspicuous. Conclusions: Although the described method is a 2-stage procedure, it can be used to simply and reliably reconstruct the mucosal layer of the tracheal lumen and overlying skin.
Granulomatous Prostatitis Mimicking Invasive Prostate Cancer
Authors: Romain Gillard, Laurent Médart, Amélie Parisel
Journal: J Belg Soc Radiol (2022)
Keywords: bcg therapy, granulomatous prostatitis, prostate cancer
MeSH terms: Case Reports

Teaching Point: Benign granulomatous prostatitis mimics prostate cancer on MRI. Peculiar urological history of a patient undergoing prostate MRI helps sorting out that differential, such as a treatment with topic Bacilli Calmette-Guerin instillations.
Idiopathic Pulmonary Hemosiderosis in a Child with Recurrent Macrophage Activation Syndrome Secondary to Systemic Juvenile Idiopathic Arthritis
Authors: Kenan Barut, Sezgin Sahin, Amra Adrovic, Velat Sen, Ozgur Kasapcopur
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

Macrophage activation syndrome, a severe complication of systemic juvenile idiopathic arthritis and other inflammatory diseases, represents one of the most important rheumatological emergencies. Delayed diagnosis could lead to life-threatening complications. Pulmonary hemosiderosis has been classically characterized by a triad of anemia, hemoptysis, and lung infiltrates on chest radiogram. Although the majority of patients of pulmonary hemosiderosis are considered idiopathic, secondary hemosiderosis associated with known diseases could be seen. In this case report, we aimed to present gradually increased pulmonary manifestations due to pulmonary hemosiderosis with recurrent macrophage activation syndrome attacks in a child with systemic juvenile idiopathic arthritis.
A paraneoplastic syndrome characterized by extremity swelling with associated inflammatory infiltrate heralds aggressive transformation of myelodysplastic syndromes/myeloproliferative neoplasms to acute myeloid leukemia: a case series
Authors: James K Mangan, Selina M Luger
Journal: Case Rep Hematol (2012)

There has been a long history of reports describing a variety of paraneoplastic phenomena associated with myelodysplastic syndromes, particularly those with autoimmune manifestations. We report here a series of patients with an antecedent myelodysplastic syndrome (MDS) or myeloproliferative neoplasm (MPN) that underwent aggressive transformation to acute myeloid leukemia (AML). In each case, the transformation to AML was preceded by an inflammatory syndrome characterized by unilateral extremity swelling and an associated inflammatory skin infiltrate, as well as other signs of inflammation, including profound hyperferritinemia without evidence of a hemophagocytic syndrome. We suggest that such an inflammatory syndrome may herald aggressive transformation of MDS/MPN to AML. Patients with known MDS/MPN who present with these features may benefit from early bone marrow examination to assess disease status. Early intervention with corticosteroids in select patients may result in improvement or resolution of the symptoms and permit intensive therapy for AML to be delivered.
An Off-Label Use of a Unibody Aortic Stent-Graft System for the Treatment of Infrarenal Abdominal Aortic Dissections
Authors: Joseph Faraj, Rebekah L W Tan, Bibombe P Mwipatayi
Journal: Case Rep Vasc Med (2019)
MeSH terms: Case Reports

Infrarenal abdominal aortic dissections (IAAD) are exceedingly rare, accounting for 1-4% of all aortic dissections. The evidence is scarce on how to best manage IAAD when they become symptomatic. Two main interventional approaches exist, open surgery and the endovascular approach. Conventional stent-graft systems make it difficult to treat nonaneurysmal aortic disease due to limb competition in a narrow distal aorta. Thus, we present a novel use of the Endologix Anatomical Fixation 2 (AFX2) Abdominal Aortic Aneurysm (AAA) endograft system for the treatment of four patients with IAAD. We also highlight an individual case study that was treated with an alternative endovascular approach and the complications that followed. This was to highlight and compare our successful experience with Endologix AFX2 AAA endograft system. There were multiple benefits for choosing this stent-graft; however the main advantage is its suitability in the narrow distal aorta. Our aim was to highlight an alternative endovascular approach for the successful treatment of a rare, challenging, and potentially fatal pathology.
Case report: Urolithiasis, nephrolithiasis and a urinary bladder malformation in a seven-month-old alpaca cria
Authors: Johannes Schregel, Sven Kleinschmidt, Alexandra von Altrock, Doris Hoeltig, Martin Ganter, Matthias G Wagener
Journal: Front Vet Sci (2022)
Keywords: south american camelid, azotemia, kidney function analysis, nephrolithiasis, ultrasound, urinary dysfunction, urolithiasis
MeSH terms: Case Reports

Urolithiasis is a common condition in male small ruminants where predisposing factors have been identified. Occasionally, urolithiasis is diagnosed in South American camelids (SACs). However, nephrolithiasis is rarely diagnosed in ruminants. To our knowledge, this is the first report focusing on a combined appearance of nephrolithiasis and urolithiasis in an alpaca cria. A 7-month-old alpaca cria suffering from impaired urinary flow was presented for examination. On admission, the alpaca had a wet prepuce and showed a standing posture with a wide-based stance. Ultrasonographic examination of the abdomen showed a distended bladder. Clinical chemistry revealed azotemia and hypophosphatemia. After the first examination, repeated urination was observed. Conservative therapy using antibiotics, anti-inflammatory and spasmolytic drugs was started with the suspected diagnosis of urinary calculus. During the first 24 h, plasma concentrations of creatinine and urea decreased, but increased again during the following days. During the second day after admission, urination was not observed for 16 h while the concentration of urea and creatinine further increased. Therefore, the animal was euthanized due to financial concerns of the owner. Necropsy revealed that calculi were located in the left kidney as well as in the urethra. In addition, the animal exhibited uroperitoneum. The urinary bladder was intact, moderately distended with urine and showed a malformation, which was covered with a translucent mucosal membrane. Histologic examination revealed that this malformation was a bladder diverticulum. The extent to which the unilateral nephroliths affected the general condition and renal function of the animal is unclear, since the uroliths also cause azotemia, and abdominal pain. Further studies are needed for a better understanding of obstructive urinary disease in SACs.
Combined Negative- and Positive-Pressure Ventilation for the Treatment of ARDS
Authors: Konstantinos Raymondos, Jörg Ahrens, Ulrich Molitoris
Journal: Case Rep Crit Care (2015)

Objective. Tracheal intubation and positive-pressure ventilation as the current standard of care for the adult respiratory distress syndrome (ARDS) seem to have reached their limit in terms of a further relevant reduction of the still very high mortality. Case Presentation. A 75-year-old male patient developed ARDS after abscess drainage with deteriorating oxygenation, despite positive end-expiratory pressure (PEEP) values above 15 cm H2O. We applied external negative-pressure ventilation with a chamber respirator using -33 cm H2O at inspiration and -15 cm H2O at expiration, combined with conventional pressure support using a PEEP of about 8 cm H2O and a pressure support of 4-12 cm H2O. Alveolar infiltrates disappeared rapidly and PaO2/FiO2 values surpassed 300 mmHg after the first application and 500 mmHg after the second. Negative-pressure ventilation was used for 6-18 hours/day over five days. Now, 13 years later, the patient is still alive and has a good quality of life. Conclusion. Using this or similar concepts, not only in intubated patients but also as a noninvasive approach in patients with ARDS, offers new options that may genuinely differ from the present therapeutic approaches and may, therefore, have the potential to decrease the present high mortality from ARDS.
Combination of chest CT and clinical features for diagnosis of 2019 novel coronavirus pneumonia
Authors: Xin Wang, Peng Wen, Zhi-Gang Sun, Chun-Yan Xing, Yun Li
Journal: Open Med (Wars) (2020)
Keywords: covid-19, ct, coronavirus pneumonia, nucleic acid test
MeSH terms: Case Reports

In December 2019, novel coronavirus pneumonia-19 (COVID-19) was discovered in the viral pneumonia cases that occurred in Wuhan, China, and then quickly spread around the world. This report described the clinical course of two COVID-19 patients and the purpose of the study was to discuss the combination of chest CT and clinical features for diagnosis of COVID-19. The first case was a typical COVID-19 case. A 66-year-old female presented to our hospital with a 3-day history of fever. She had contact with a COVID-19 patient. Chest CT showed a typical COVID-19 appearance. She was diagnosed with COVID-19 by a positive nucleic acid test. The second case was a 50-year-old male with a 2-day history of fever. He denied having been to Wuhan. Chest CT also showed typical features of COVID-19 pneumonia. COVID-19 nucleic acid tests were repeated up to seven times and the results remained controversial. Eventually, he was diagnosed with COVID-19. Our study shows that chest CT has high sensitivity for diagnosis of COVID-19 in clinical practice, particularly when the nucleic acid test is negative. The chest CT should be considered as a diagnostic tool for the COVID-19 screening, comprehensive evaluation, and follow-up and patients would benefit from effective treatments in time.