OpenMed/multicare-articles huggingface dataset:
Anti-corruption, Transparency and Accountability: Case Study of Healthcare in the Arab Countries
Authors: Mostafa Hunter, Rania Uwaydah Mardini, Arkan El-Seblani, Sammer Elsayed
Journal: Glob Health Action (2020)
Keywords: anti-corruption, transparency and accountability, corruption, governance, health, risk
MeSH terms: Delivery of Health Care / ethics, Delivery of Health Care / organization & administration, Fraud / ethics, Fraud / prevention & control, Health Care Reform / ethics, Social Responsibility, Research Support, Non-U.S. Gov't, Humans, United Arab Emirates

Background: The Arab states suffer from high levels of corruption. The UNDP's team there developed an approach to tackle corruption and enhance transparency and accountability in healthcare as part of its broader efforts to support the Sustainable Development Goals. This work evolved into a proper tool, the Conceptual Framework for Corruption Risk Assessment at Sectoral Level (hereafter 'Framework'), with implementation guides that enable tailoring to sector and country context.Objectives: This article documents the development of the Framework, its methodology and observed added value.Methods: Qualitative methods were utilized comprising desk research, field experience, stakeholder outreach, and focus group observation and documentation. It was most appropriate because the objective was to develop a methodology with specific characteristics.Results: The new approach uses anti-corruption as an explicit entry point to governance reforms. It articulates a structured evidence-based method to apply risk management methodology - tailored to the specificities of corruption as a risk - in healthcare whereby assessment and mitigation are (a) within institutions (b) focused on decision points and (c) around transactions while bringing together health and anti-corruption communities towards designing measurable results-oriented reforms.Conclusions: The Framework may be effective in driving concrete governance reform efforts that demonstrably reduce corruption by means of creating a common language and agenda among different stakeholders, changing the mindset towards reform, and developing targeted solutions with higher return on investment. As such, it may be capable of generating observable and sustainable progress towards healthcare reform.
The end of the line? A case of drug resistance to third-line antiretroviral therapy
Authors: Theresa M Rossouw, Sonia Hitchcock, Mariëtte Botes
Journal: South Afr J HIV Med (2016)
MeSH terms: Case Reports

HIV drug resistance has been described in all antiretroviral drug classes and threatens the long-term success of HIV treatment. Here, we describe the first reported case of acquired resistance to the integrase strand transfer inhibitors in South Africa. This case illustrates the dilemma of treatment in the context of inadequate adherence and poor psychosocial support and highlights the potential risk of transmission of multidrug-resistant virus.
Mitral stenosis in a teenager after rheumatic mitral valve regurgitation valve repair: A case report
Authors: Neguemadji Ngardig Ngaba, Uzoego Nwakaku Chibuzo, Meet Patel, Amit Gulati, Olatunde Ola, Allarangué Djindimadje, Imteyaz A Khan
Journal: Front Cardiovasc Med (2022)
Keywords: case report, complication, mitral stenosis, mitral valve (mv) repair, rheumatic mitral regurgitation
MeSH terms: Case Reports

Introduction:
Mitral stenosis (MS) is a widely known complication of mitral valve repair for non-rheumatic mitral regurgitation (MR). Few reports are available on the occurrence of MS after mitral valve repair for rheumatic MR in young populations.
Case summary:
A 14-year-old girl presented with orthopnea, abdominal distension, and bilateral lower-limb edema. She was cachectic, with a high-pitched holosystolic murmur best heard at the cardiac apex, bilateral basal crackles, tender hepatomegaly, pitting pedal edema, and jugular venous distension. Antistreptolysin O (ASO) titer was elevated. Transthoracic echocardiography (TTE) revealed the loss of central coaptation of the mitral valve with leaflet restriction and MR, annular dilatation of the tricuspid valve, and tricuspid regurgitation (TR). She had AHA/ACC stage D mitral and TR s. Tricuspid annuloplasty and mitral valve repair for rheumatic MR were performed using Carpentier Edwards numbers 30 and 34, respectively. Following surgery, the weight and body mass index (BMI) rapidly normalized. The patient also developed progressive MS.
Discussion:
Previous studies in adults have described the etiopathogenesis of MS after non-rheumatic mitral valve repair. There is a paucity of reports describing the development of MS over the span of months after rheumatic MR valve repair in early pubescent children.
Conclusion:
Growth spurts during puberty can potentially affect MR repair, as the mitral valve prosthesis based on the preoperative Body Surface Area (BSA) is outgrown. There is a need for research on planning, prognostication, and development of an optimal, individualized, and adaptable approach to MR intervention in early pubescence.
Refractory Abdominal Pain in a Patient with Chronic Lymphocytic Leukemia: Be Wary of Acquired Angioedema due to C1 Esterase Inhibitor Deficiency
Authors: Abdullateef Abdulkareem, Ryan S D'Souza, Joshua Mundorff, Pragya Shrestha, Oluwaseun Shogbesan, Anthony Donato
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Acquired angioedema due to C1 inhibitor deficiency (C1INH-AAE) is a rare and potentially fatal syndrome of bradykinin-mediated angioedema characterized by episodes of angioedema without urticaria. It typically manifests with nonpitting edema of the skin and edema in the gastrointestinal (GI) tract mucosa or upper airway. Edema of the upper airway and tongue may lead to life-threatening asphyxiation. C1INH-AAE is typically under-diagnosed because of its rarity and its propensity to mimic more common abdominal conditions and allergic reactions. In this article, we present the case of a 62-year-old male with a history of recently diagnosed chronic lymphocytic leukemia (CLL) who presented to our hospital with recurrent abdominal pain, initially suspected to have Clostridium difficile colitis and diverticulitis. He received a final diagnosis of acquired angioedema due to C1 esterase inhibitor deficiency due to concomitant symptoms of lip swelling, cutaneous nonpitting edema of his lower extremities, and complement level deficiencies. He received acute treatment with C1 esterase replacement and icatibant and was maintained on C1 esterase infusions. He also underwent chemotherapy for his underlying CLL and did not experience further recurrence of his angioedema.
Frequent torsades de pointes in a child with novel AKAP9 mutation: A case report and literature review
Authors: Yefeng Wang, Chao Zuo, Xiang Wang, Yunbin Xiao, Qiming Liu, Zhi Chen
Journal: Front Pediatr (2023)
Keywords: akap9 gene, case report, implantable cardioverter defibrillator (icd), long qt syndrome (lqts), torsades de pointes (tdp)
MeSH terms: Case Reports

Introduction:
The aim of the present study is to report the diagnosis and treatment of a rare case of frequent torsades de pointes (Tdp) in a child with a novel AKAP9 mutation. A 13-year-old girl suffered from repeated syncope and frequent Tdp. An electrocardiogram (ECG) showed frequent multisource premature ventricular contractions with the R-ON-T phenomenon. The QTc ranged from 410 to 468 ms. The genetic test indicated a heterozygous mutation, namely, c.11714T > C (p.M3905T), in the AKAP9 gene, which is a controversial gene in long QT syndrome. After treatment with propranolol, recurrent syncope occurred, and the patient received an implantable cardioverter defibrillator (ICD). Due to frequent electrical storms at home, the child was additionally treated with propafenone to prevent arrhythmia. The antitachycardia pacing (ATP) function in the ICD was turned off, and the threshold of ventricular tachycardia (VT) assessment was adjusted from 180 beats/min to 200 beats/min. The patient was followed up for 12 months without malignant arrhythmia and electric shock.
Conclusion:
Genetic testing may be a useful tool to determine the origin of channelopathy, but the results should be interpreted in combination with the actual situation. Rational parameter settings for the ICD and application of antiarrhythmic drugs can reduce the mortality rates of children.
Severe Heterotopic Ossification with Proximal Entrapment of the Ulnar Nerve following Primary Anterior Shoulder Dislocation
Authors: Malik Jessen, Christian Gerhardt, Lars-Johannes Lehmann, Jonas Schmalzl
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Heterotopic ossifications (HO) in the shoulder are rare. The effectiveness of conservative treatment is limited, and therefore, symptomatic cases are usually treated surgically. However, there are no guidelines for the surgical treatment of HO. Herein, we report the case of a 45-year-old man with severe HO and proximal entrapment of the ulnar nerve following primary anterior shoulder dislocation without concomitant injuries (e.g., fracture and rotator cuff tears). Surgical intervention was indicated, including resection of HO and neurolysis of the brachial plexus. Nine months after surgery, the patient presented with restored shoulder function, pain relief, and good patient satisfaction. The case shows that the ulnar nerve can also be impaired due to HO following shoulder dislocation.
Case Report: Identifying Andersson-Like Lesions in Diffuse Idiopathic Skeletal Hyperostosis
Authors: Xiaojiang Sun, Han Qiao, Xiaofei Cheng, Haijun Tian, Kangping Shen, Wenjie Jin, Xingzhen Liu, Qiang Wang, Yiming Miao, Yue Xu, Changqing Zhao, Jie Zhao
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: andersson-like lesion (all), diffuse idiopathic skeletal hyperostosis (dish), focal stress concentration, ossification, spinal stability
MeSH terms: Hyperostosis, Diffuse Idiopathic Skeletal / pathology, Case Reports, Research Support, Non-U.S. Gov't, Aged, Aged, 80 and over, Female, Humans, Male, Spinal Fractures / metabolism, Spine / pathology, Spondylitis, Ankylosing / metabolism, Treatment Outcome

Andersson lesions (ALs) in ankylosing spondylitis (AS) pose a severe risk to the stability of ankylosed spine, which might result in significant deterioration of spinal cord function after traumatic or inflammatory causes. Herein, erosive discovertebral lesions in diffuse idiopathic skeletal hyperostosis (DISH) presented important clinical similarities to AL in AS, but failed to completely recognize unstable spinal lesions. Therefore, we pioneered to identify spinal discovertebral lesions similar to Andersson-like lesions (ALLs) in DISH, followed by the characterization and summarization of the etiology, radiology, laboratory results, clinical symptoms, and treatment strategies for AL in AS with ALL in DISH. By characterizing the ALL in DISH cases, we showed that the ALL was mainly traumatic and established at the junction of focal stress between two adjacent ossified level arms. Erosive discovertebral ALLs were formed after trivial stress of direct impact and could be subdivided into transdiscal, transvertebral, and discovertebral types radiologically. Patients who presented with ALL frequently suffered from consistent back pain clinically and experienced a decrease in motion ability that could reflect skeletal stability, which received treatment effectiveness after conservative external spinal immobilization or further surgical internal fixation, indicating the significance of recognizing ALL in the ankylosed DISH spine to further maintain spinal stability in order to prevent catastrophic neurologic sequelae. Our work highlighted the clinical relevance of ALL in DISH in comparison with AL in AS, which provided broader insight to identify ALL in DISH, thus facilitating early intervention against DISH deterioration.
Case report: Acrodermatitis enteropathica result from a novel SLC39A4 gene mutation
Authors: Wenjing Hua, Jialin Zou, Yuan Zhuang, Taiguang Zhou
Journal: Front Pediatr (2022)
Keywords: slc39a4 gene, acrodermatitis enteropathica, child, mutation, zinc deficiency
MeSH terms: Case Reports

The clinical data and gene sequencing results in a child with acrodermatitis enteropathica were retrospectively reported, and the related literature was reviewed. A girl aged 9 years and 4 months presented with a repeated skin rash, mainly distributed in the perioral, anogenital, and acral areas, accompanied with alopecia, and a low blood zinc level was found many times. A significant improvement was seen after continuous zinc supplementation. The genetic sequencing test demonstrated that the patient had compound heterozygous for two SLC39A4 mutations: c.1466dupT (p.S490Efs*155) and c.295G > A (p.A99T), and her parents were heterozygous carriers of these two mutations. An improvement was achieved after continuous zinc supplementation. This case report might guide further research on this aspect.
Syphilitic aortic aneurysm with a pulmonary lesion: a case report and literature view
Authors: Wei Li, Xiu-Jun Yin, Hua-Ying Liu, Rong Yang
Journal: Springerplus (2016)
Keywords: angiography, endovascular stenting, lung cancer, surgery, syphilitic aortic aneurysm

Introduction:
Syphilitic aortic aneurysm (SAA) is caused by tertiary stage of syphilis infection. As the wide application of penicillin, this complication is becoming rarer than before. The SAA with lung cancer is a very rare disease in patient.
Case description:
A 55-year-old male was admitted to the hospital complaining "progressive hoarseness for 3 months" and the patient has been diagnosed with syphilis after specific blood exams, computed tomography angiography (CTA) and 3dimensional (3D) reconstructions of cardiac vessels. Chest computed tomography displayed an anomalous soft tissue mass with slightly lobular borders in the peripheral segment of the left lower lobe. According to the aneurysm's and lung neoplasm's location, several procedures could be selected such as aneurysm resection with artificial graft replacement or endovascular stenting under angiography. Then, the lesion was removed by lobectomy using video-assisted thoracic surgery.
Discussion and evaluation:
Cardiovascular syphilis remains a major cause of ascending aortic aneurysm. The clinical manifestations of patients with syphilis aortic aneurysm could vary. Aortic imaging is necessary to confirm the diagnosis and to determine the anatomic extent of the aneurysm. The differential diagnosis of the lesion in the pulmonary is mostly the tumor like pulmonary lesion, Pulmonary syphilis. Some studies showed that thoracic aortic aneurysm has been reduced by using penicillin. However, penicillin therapy alone is not always sufficient in recent years. The serologic response to treatment is more significant and faster in patients treated with the enhanced regimen compared to patients treated with the standard penicillin regimen.
Conclusions:
Syphilitic aortic aneurysm with lung cancer is a rare disease in patient. Chest CT and CTA scans are able to indicate the presence of SAA. Pathological analysis is an effective method to clarify the diagnosis of the lung lesion. The interventional therapy and surgery are regular treatment method for SAA and pulmonary neoplasm.
A Rare Life-Threatening Presentation of Shoulder Pain: Cervical Epidural Hematoma
Authors: Takshak Shankar, Vempalli Nagasubramanyam, Archana Bairwa, Ashwani Pundir
Journal: Cureus (2023)
Keywords: atypical presentation shoulder pain, bilateral shoulder pain, cervical epidural hematoma, shoulder joint pain, spontaneous cervical epidural hematoma
MeSH terms: Case Reports

Shoulder pain is a common complaint of patients presenting to emergency department. Various conditions, intrinsic and extrinsic to the shoulder, can result in shoulder pain. Some of these extrinsic conditions can pose a threat to life. We present a case of a young, previously healthy male who initially had bilateral shoulder pain, later developed quadriparesis, and was ultimately diagnosed with a spontaneous cervical epidural hematoma. He underwent an emergency C7-T1 laminectomy with hematoma evacuation and had a full recovery. Cervical epidural hematoma is a rare surgical emergency where timely diagnosis and treatment are crucial.
The enigma of asymptomatic idiopathic pneumoperitoneum: A dangerous trap for general surgeons
Authors: M Masood Sidiqi, David Fletcher, Tasfeen Billah
Journal: Int J Surg Case Rep (2020)
Keywords: asymptomatic, idiopathic, pneumoperitoneum
MeSH terms: Case Reports

Introduction:
Idiopathic pneumoperitoneum is an extremely rare condition that can easily be misdiagnosed as an acute abdomen. Awareness of this phenomenon can help avoid unnecessary surgical intervention and the potential associated morbidities.
Presentation of case:
A 76 year old man presented to hospital with dyspnoea and productive cough and was diagnosed with an infective exacerbation of COPD. He subsequently had a CTPA which showed a significant amount of free intraperitoneal gas in the upper abdomen. He was completely asymptomatic from this with no abdominal pain, distension, or significant rise in inflammatory markers. Of note, he had never had previous abdominal surgery or endoscopic procedures. He showed no signs of peritonism and was closely observed with serial abdominal examinations for 24 h. He subsequently tolerated oral intake and was discharged 8 days after admission.
Discussion:
Spontaneous pneumoperitoneum can be due to a variety of intrathoracic, gynaecologic, intra-abdominal and iatrogenic causes. This is a rare case of asymptomatic idiopathic pneumoperitoneum where no clear aetiology or risk factors were found for his free intraperitoneal gas. To the best of our knowledge there have only been two published case reports in the English literature describing idiopathic pneumoperitoneum in a patient that was completely asymptomatic from it.
Conclusion:
As a general surgeon it is important to be aware of the non-surgical causes of pneumoperitoneum. Knowledge of this uncommon condition may help reduce the risk of unnecessary laparotomy.
A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia
Authors: Muhammad Adeel Samad, Dhaval Patel, Martin Asplund, Diane C Shih-Della Penna, Yaseen Tomhe
Journal: Case Rep Vasc Med (2021)
MeSH terms: Case Reports

Background:
An aortoenteric fistula (AEF) describes a communication of the aorta or aortic graft with an adjacent loop of the bowel. Aortic graft erosion is a rare complication of abdominal aortic aneurysm repair. We describe a case of a patient presenting with sepsis from Candida glabrata fungemia secondary to aortoenteric erosion without any symptoms or signs of gastrointestinal bleeding. This is a unique case of Candida glabrata fungemia from aortoenteric graft erosion. Case Summary. This patient is a 75-year-old male with a history of a prior aortobifemoral bypass graft in 2005. He presented with complaints of right paraspinal pain and chills. He had no symptoms of gastrointestinal bleeding or abdominal pain. His white blood cell count was 25,600/mcl (4,000-11,000/mcL) with left shift. The erythrocyte sedimentation rate was 11 mm/hr (0-38 mm/hr), and C-reactive protein was 95.5 mg/L (<=10.0 mg/L). Blood cultures were obtained and eventually grew Candida glabrata. A computed tomography angiogram (CTA) of abdomen and pelvis demonstrated inflammation surrounding the graft concerning for graft infection with additional inflammatory changes tracking down both femoral limbs. He underwent staged bilateral femoralaxillary bypass followed by the excision of aortobifemoral bypass.
Conclusion:
Patients with aortoenteric erosion can present with sepsis in absence of gastrointestinal bleeding. Emergent computed tomography angiogram (CTA) of abdomen and pelvis should be performed to assess for aortic graft erosion or fistula. Empiric treatment with antibiotics should include antifungal agent like micafungin until the final culture is reported. The definite management is an extra anatomic bypass, followed by graft excision.
Co-amoxiclav-induced Stevens Johnson syndrome in a child
Authors: Neila Fathallah, Zayani Hanen, Raoudha Slim, Lobna Boussofara, Ghariani Najet, Kamel Bouraoui, Chaker Ben Salem
Journal: Pan Afr Med J (2013)
Keywords: stevens johnson syndrome, child, co-amoxiclav
MeSH terms: Amoxicillin-Potassium Clavulanate Combination / adverse effects, Anti-Bacterial Agents / adverse effects, Stevens-Johnson Syndrome / chemically induced, Case Reports, Humans, Infant, Male, Anti-Bacterial Agents, Amoxicillin-Potassium Clavulanate Combination

Stevens-Johnson syndrome is an uncommon life threatening disease generally induced by drugs. Antibiotics, mainly sulphonamides, are the most involved drugs in Stevens-Johnson syndrome in children. Co-amoxiclav is a well tolerated antibiotic. It has never been reported to cause, lonely this syndrome in children. Herein, we report a co-amoxiclav-induced Stevens-Johnson syndrome occurring in an 18-month-old child. The diagnosis of SJS is often challenging in children and other possible diseases should be ruled out. The etiology of this syndrome is not yet fully understood. It is thought to be mediated by an immunologic mechanism. Management involves early identification, withdrawal of the culprit drug and rapid initiation of supportive therapies.
Acute Brucellosis and Cirrhosis: The Triggering Event of Fatal Liver Decompensation
Authors: Maria Kosmidou, Eleftherios Klouras, Iro Rapti, Sebastien Filippas-Ntekouan, Haralampos Milionis
Journal: Case Reports Hepatol (2020)
MeSH terms: Case Reports

Cirrhotic patients are known to be particularly susceptible to infectious complications that may vary according to regional endemic patterns. Brucellosis, a common zoonosis with worldwide distribution, exhibits a predilection for the reticuloendothelial system and thus resulting in hepatic involvement. We describe three cirrhotic patients in whom acute brucellosis and/or its treatment served as the triggering factor of hepatic decompensation, with deleterious effects. The patients suffered from alcoholic cirrhosis and culture-proven brucellosis. All patients came from an area endemic to brucellosis. The first patient exhibited a relapsing brucellosis course with progressive deterioration of his fragile liver function. The second patient progressed rapidly to jaundice, possibly partly attributed to antibiotic pharmacotoxicity, and died during liver transplantation. The third patient eventually succumbed to diffuse intravascular coagulation. Brucellosis can be a triggering event of fatal liver decompensation in cirrhotic patients. Enhancing health literacy of the patients, particularly in endemic areas, is of paramount importance for prevention of exposure to similar pathogens.