OpenMed/multicare-articles huggingface dataset:
Qualitative case study of needle exchange programs in the Central Appalachian region of the United States
Authors: Stephen M Davis, Danielle Davidov, Alfgeir L Kristjansson, Keith Zullig, Adam Baus, Melanie Fisher
Journal: PLoS One (2018)
MeSH terms: Epidemics / prevention & control, Hepatitis C / epidemiology, Needle-Exchange Programs / economics, Needle-Exchange Programs / legislation & jurisprudence, Substance Abuse, Intravenous / prevention & control, Adult, Aged, Appalachian Region / epidemiology, Female, Humans, Interviews as Topic, Law Enforcement, Male, Middle Aged, Needle Sharing, Qualitative Research, Risk Factors, Rural Population, West Virginia / epidemiology, Young Adult

Background:
The Central Appalachian region of the United States is in the midst of a hepatitis C virus epidemic driven by injection of opioids, particularly heroin, with contaminated syringes. In response to this epidemic, several needle exchange programs (NEP) have opened to provide clean needles and other supplies and services to people who inject drugs (PWID). However, no studies have investigated the barriers and facilitators to implementing, operating, and expanding NEPs in less populous areas of the United States.
Methods:
This qualitative case study consisted of interviews with program directors, police chiefs, law enforcement members, and PWID affiliated with two NEPs in the rural state of West Virginia. Interview transcripts were coded inductively and analyzed using qualitative data analysis software. Final common themes related to barriers and facilitators of past program openings, current program operations, and future program plans, were derived through a consensus of two data coders.
Results:
Both NEPs struggled to find existing model programs, but benefited from broad community support that facilitated implementation. The largest operational barrier was the legal conundrum created by paraphernalia laws that criminalize syringe possession. However, both PWID and law enforcement appreciated the comprehensive services provided by these programs. Program location and transportation difficulties were additional noted barriers. Future program operations are threatened by funding shortages and bans, but necessitated by unexpected program demand.
Conclusion:
Despite broad community support, program operations are threatened by growing participant volumes, funding shortages, and the federal government's prohibition on the use of funds to purchase needles. Paraphernalia laws create a legal conundrum in the form of criminal sanctions for the possession of needles, which may inadvertently promote needle sharing and disease transmission. Future studies should examine additional barriers to using clean needles provided by rural NEPs that may blunt the effectiveness of NEPs in preventing disease transmission.
Posterior reversible encephalopathy syndrome in an adult patient undergoing peritoneal dialysis: a case report and literature review
Authors: Brett R Graham, George B Pylypchuk
Journal: BMC Nephrol (2014)
MeSH terms: Brain / pathology, Magnetic Resonance Imaging, Peritoneal Dialysis / adverse effects, Posterior Leukoencephalopathy Syndrome / diagnosis, Posterior Leukoencephalopathy Syndrome / etiology, Renal Insufficiency, Chronic / complications, Renal Insufficiency, Chronic / therapy, Case Reports, Review, Adult, Humans, Male, Posterior Leukoencephalopathy Syndrome / therapy

Background:
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity characterized clinically by headache, altered mental status, seizures, visual disturbances, and other focal neurological signs, and radiographically by reversible changes on imaging. A variety of different etiologies have been reported, but the underlying mechanism is thought to be failed cerebral autoregulation. To the best of our knowledge, we report the third known case of PRES in an adult receiving intermittent peritoneal dialysis (PD).
Case presentation:
A 23-year-old male receiving PD was brought to hospital after experiencing a generalized seizure. On presentation he was confused and hypertensive. An MRI brain was obtained and showed multiple regions of cortical and subcortical increased T2 signal, predominantly involving the posterior and paramedian parietal and occipital lobes with relative symmetry, reported as being consistent with PRES. A repeat MRI brain obtained three months later showed resolution of the previous findings.
Conclusion:
Due to having a large number of endothelium-disrupting risk factors, including hypertension, uremia, and medications known to disrupt the cerebrovascular endothelium, we suggest that those with end-stage renal disease (ESRD) receiving PD are at high risk of developing PRES. Furthermore, we surmise that PRES is likely more prevalent in the ESRD population but is under recognized. Physicians treating those with ESRD must have a high index of suspicion of PRES in patients presenting with neurological disturbances to assure timely diagnosis and treatment.
Myocardial Infarction in Neonates: A Diagnostic and Therapeutic Challenge
Authors: Manuel Rodríguez Martínez, Eladio Ruiz González, Anna Parra-Llorca, Máximo Vento Torres, Marta Aguar Carrascosa
Journal: Case Rep Pediatr (2019)
MeSH terms: Case Reports

Neonatal acute myocardial infarction is an uncommon entity. We describe the case of a 4-day-old term baby who presented with respiratory distress and distal acrocyanosis. The chest radiograph demonstrated cardiomegaly without pleural effusion, and examination revealed hepatomegaly. An electrocardiogram revealed QS pattern in leads I, aVL, and V6, suggestive of ischemia. Cardiac enzymes were elevated, and echocardiogram revealed moderate left ventricular dysfunction with a thrombus at the level of the left atrial appendage. The patient required hemodynamic stabilization, vasodilatation to avoid congestive heart failure, and anticoagulation with heparin and aspirin. In the context of this unusual diagnosis, we reviewed our experience over the last 17 years as well as the existing literature on neonatal myocardial infarction.
Posterior uterine rupture causing fetal expulsion into the abdominal cavity: a rare case of neonatal survival
Authors: K Navaratnam, P Ulaganathan, M A Akhtar, S D Sharma, M G Davies
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby. Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response.
Persistent Increase in Serum 25-Hydroxyvitamin D Concentration in a Dog Following Cholecalciferol Intoxication
Authors: Charlotte Gerhard, Jared A Jaffey
Journal: Front Vet Sci (2020)
Keywords: 25(oh)d, 25-hydroxyvitamin d, hypercalcemia, rodenticide, vitamin d
MeSH terms: Case Reports

Cholecalciferol is becoming an increasingly utilized rodenticide in the United States due to changes implemented by the Environmental Protection Agency (EPA) to reduce unintended exposure of wildlife to second-generation anticoagulant rodenticides. The lipophilic properties of cholecalciferol and prolonged tissue elimination are well-documented; however, long-term clinical ramifications are unknown. This report describes unique clinicopathologic and treatment features during the acute phase of cholecalciferol rodenticide toxicosis in a 4-year-old neutered Shih-Tzu mix that presented for intermittent vomiting, anorexia, polyuria, and polydipsia. In addition, this report also highlights the potential benefit of serial measurements of serum 25-hydroxyvitamin D concentrations and long-term treatment in the chronic phase of cholecalciferol rodenticide toxicosis in dogs.
Laparoscopic Ovariectomy in a Domestic Yak
Authors: Drew W Koch, Katharine M Simpson, Jeremiah T Easley, Eileen S Hackett
Journal: Case Rep Vet Med (2020)
MeSH terms: Case Reports

Owners of a juvenile domestic yak elected bilateral ovariectomy to prevent future reproduction. The yak was noted to be healthy at presentation. Both ovaries were removed using a laparoscopic approach as follows: after induction and maintenance of general inhalant anesthesia, 15 degrees Trendelenburg positioning was required to view the ovaries. Ovariectomy was conducted within a surgical time of 50 minutes. Due to the small ovarian size, portal enlargement was not necessary for removal. Mild hemorrhage from the left ovarian pedicle was controlled with application of a vessel-sealing device. Postoperative complications were not encountered during hospitalization. At 12 months following surgery, the yak was healthy, and the owner was highly satisfied with the procedure. The described approach was successful for performing laparoscopic ovariectomy in a juvenile yak. Positioning for surgery was similar to other small ruminant species. Further case enrollment is needed to optimize the surgical approach and better describe clinical outcomes.
Retropharyngeal Ectopic Thymus in a Pediatric Patient With 22q11.2 Deletion Syndrome
Authors: Kacper Grudzień, Julia Kuzaj, Magdalena Dębicka, Stanisław Kwiatkowski, Olga Milczarek
Journal: Cureus (2023)
Keywords: 22q112 deletion, digeorge, ectopic, retropharyngeal, thymus
MeSH terms: Case Reports

The thymus gland plays a crucial role in the maturation process of lymphocyte T cells. Developmental disorders of this organ might be caused by genetic diseases, such as the 22q11.2 deletion and DiGeorge syndrome. Other manifestations of this condition are heart defects, a reduced number of T cells, hypocalcemia, and facial dysmorphia. A 13-year-old boy with 22q11 deletion syndrome presented with paresis and paresthesia of the right upper extremity. Magnetic resonance imaging (MRI) revealed a solid mass in the retropharyngeal and prevertebral areas. The lesion was excised and, upon histopathological examination, turned out to be ectopic thymic tissue. A follow-up examination showed no recurrence of the lesion. The ectopic thymus is a rare pathology, especially in 22q11 deletion syndrome patients. In general, thymic tissue can be found anywhere along its normal path of descent. In this case, however, its location cannot be explained solely by its embryological origin, as at no point should the thymus or its histological predecessor be located in the retropharyngeal area. As such, this finding challenges our current understanding of thymic embryological genesis.
Isolated Marked Inferior Vena Cava Dilatation: Unusual Presentation or Underrecognized Common Phenomenon?
Authors: Sneha R Gadi, Benjamin K Ruth, Alan Johnson, Sula Mazimba, Younghoon Kwon
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

Inferior vena cava (IVC) diameter and respirophasic variation are commonly used echocardiographic indices to estimate right atrial pressure. While dilatation of the IVC and reduced collapsibility have traditionally been associated with elevated right heart filling pressures, the significance of isolated IVC dilatation in the absence of raised filling pressures remains poorly understood. We present a case of an asymptomatic 28-year-old male incidentally found to have IVC dilatation, reduced inspiratory collapse, and normal right heart pressures.
Fluid Structure Interaction on Paravalvular Leakage of Transcatheter Aortic Valve Implantation Related to Aortic Stenosis: A Patient-Specific Case
Authors: Adi A Basri, Mohammad Zuber, Ernnie I Basri, Muhammad S Zakaria, Ahmad F A Aziz, Masaaki Tamagawa, Kamarul A Ahmad
Journal: Comput Math Methods Med (2020)
MeSH terms: Aortic Valve Stenosis / physiopathology, Aortic Valve Stenosis / surgery, Transcatheter Aortic Valve Replacement / adverse effects, Case Reports, Aged, Aortic Valve / diagnostic imaging, Aortic Valve / physiopathology, Aortic Valve / surgery, Aortic Valve Stenosis / diagnostic imaging, Blood Flow Velocity, Computational Biology, Computer Simulation, Heart Valve Prosthesis, Hemodynamics, Hemorheology, Humans, Hydrodynamics, Imaging, Three-Dimensional, Male, Models, Cardiovascular, Patient-Specific Modeling / statistics & numerical data, Prosthesis Design, Tomography, X-Ray Computed

This study investigated the impact of paravalvular leakage (PVL) in relation to the different valve openings of the transcatheter aortic valve implantation (TAVI) valve using the fluid structure interaction (FSI) approach. Limited studies were found on the subject of FSI with regards to TAVI-PVL condition, which involves both fluid and structural responses in coupling interaction. Hence, further FSI simulation with the two-way coupling method is implemented to investigate the effects of hemodynamics blood flow along the patient-specific aorta model subjected to the interrelationship between PVL and the different valve openings using the established FSI software ANSYS 16.1. A 3D patient-specific aorta model is constructed using MIMICS software. The TAVI valve identical to Edward SAPIEN XT 26 (Edwards Lifesciences, Irvine, California), at different Geometrical Orifice Areas (GOAs), is implanted into the patient's aortic annulus. The leaflet opening of the TAVI valve is drawn according to severity of GOA opening represented in terms of 100%, 80%, 60%, and 40% opening, respectively. The result proved that the smallest percentage of GOA opening produced the highest possibility of PVL, increased the recirculatory flow proximally to the inner wall of the ascending aorta, and produced lower backflow velocity streamlines through the side area of PVL region. Overall, 40% GOA produced 89.17% increment of maximum velocity magnitude, 19.97% of pressure drop, 65.70% of maximum WSS magnitude, and a decrement of 33.62% total displacement magnitude with respect to the 100% GOA.
Asymmetrical pedicle subtraction osteotomy for progressive kyphoscoliosis caused by a pediatric Chance fracture: a case report
Authors: Satoshi Suzuki, Nobuyuki Fujita, Tomohiro Hikata, Akio Iwanami, Ken Ishii, Masaya Nakamura, Morio Matsumoto, Kota Watanabe
Journal: Scoliosis Spinal Disord (2017)
Keywords: asymmetrical pedicle subtraction osteotomy, case report, chance fracture, flexion-distraction injury, kyphoscoliosis
MeSH terms: Case Reports

Background:
Although most pediatric Chance fractures (PCFs) can be treated successfully with casting and bracing, some PCFs cause progressive spinal deformities requiring surgical treatment. There are only few reports of asymmetrical osteotomy for PCF-associated spinal deformities.
Case presentation:
We here report a case of a 10-year-old girl who suffered an L2 Chance fracture from an asymmetrical flexion-distraction force, accompanied by abdominal injuries. She was treated conservatively with a soft brace. However, a progressive spinal deformity became evident, and 10 months after the injury, examination showed segmental kyphoscoliosis with a Cobb angle of 36°, a kyphosis angle of 31°, and a coronal imbalance of 30 mm. Both the coronal and sagittal deformities were successfully corrected by asymmetrical pedicle subtraction osteotomy.
Conclusions:
Initial kyphosis and posterior ligament complex should be evaluated at some point when treating PCFs. Asymmetrical pedicle subtraction osteotomy can be a useful surgical option when treating rigid kyphoscoliosis associated with a PCF.
Pancreatic duplication cyst misdiagnosed as distal pancreatic tumor: A case report and surgical approach
Authors: Lara Zain, Raghad Sweity, Khaled Alshawwa, Sami Bannoura, Bashar Jaber, Omar Abu-Zaydeh
Journal: Front Surg (2023)
Keywords: gastric-type duplication cyst, pancreas, pancreatic duplication cyst, pancreatic neoplasms, pancreatic pseudocysts, surgical resection
MeSH terms: Case Reports

Enteric duplication cysts (EDCs) are a benign and uncommon congenital malformation, with a nonspecific and extremely variable clinical presentation. EDCs associated with the pancreas are called pancreatic duplication cysts (PDCs). They are especially rare and can present with recurrent abdominal pain or even severe pancreatitis. These cysts often get confused with pancreatic neoplasms or pseudocysts, thus posing diagnostic and surgical challenges. Here, we report a case of a 20-year-old male patient with a 14-year history of recurrent abdominal pain and many hospital admissions, who had several imaging studies revealing a persistent focal heterogeneous lesion affecting the tail of the pancreas, surrounding a small pseudocyst. An ultrasound (U/S) guided biopsy was avoided due to the location of the mass. Surgical resection was carried out for the suspicion of malignancy and final pathology report showed benign findings while revealing that what was thought to be a pseudocyst turned out to be a gastric-type PDC, and after reviewing the available literature, we encountered 16 similar cases regarding misdiagnosing PDCs. We conclude that PDCs are very rare and have a variable clinical presentation as well as a likelihood of being confused with other pancreatic neoplasms. Therefore, PDCs need a high index of suspicion to avoid recurrent hospital admissions and unnecessary procedures due to the fact that sometimes a simple cystectomy is adequate.
Amoxicillin/Clavulanic Acid-Induced Symmetric Drug-Related Intertrigious and Flexural Exanthema
Authors: Gulistan Alpagat, Ayse Baccioglu, Betul Dumanoglu, Sumeyra Alan Yalim, Ayse Fusun Kalpaklioglu
Journal: Cureus (2023)
Keywords: amoxicilline, anti-histamin, drug-induced hypersensitivity, sdrife, steroid treatment
MeSH terms: Case Reports

β-Lactams, particularly penicillins, may cause several allergic reactions. We described symmetric drug-related intertriginous and flexural exanthema (SDRIFE) illness in this case, a rare instance of systemic contact dermatitis caused by amoxicillin/clavulanic acid that needs to be considered in the differential diagnosis. A 65-year-old male patient was admitted to our Allergy Outpatient Clinic because of increased blue-purple pigmentation on the flexural surfaces of the hip, forearm, axilla, and posterior face of the neck. The patient was receiving a combination of angiotensin receptor blocker (ARB) and hydrochlorothiazide diuretic medication for hypertension. The patient used an antibiotic containing amoxicillin three months ago; As a result, there was localized redness, itching, and black spotting without any systemic symptoms. Similarly, the patient reported that when he used amoxicillin for an upper respiratory tract infection eight months ago, he experienced similar side effects within 20 days and recovered when he applied corticosteroid ointment. Due to the symmetrical site involvement following the consumption of penicillin group antibiotics with a five-month gap and subsequent comparable reactions in our patient, SDRIFE was taken into consideration. The results of the skin punch biopsy identified Baboon Syndrome (SDRIFE). Treatment with topical corticosteroids and antihistamines began. Clinically speaking, SDRIFE is distinguished by significant erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal/perigenital area, symmetric involvement of at least one other intertriginous or flexural area, and the absence of systemic signs or symptoms. The possibility that the medication may have contributed to the patient's erythematous eruption in the flexural regions should be taken into account, and the patient should be advised to stop taking the medication and not use it again.
Pneumatosis Intestinalis of the Colon and Greater Omentum following Small Bowel Resection
Authors: Matthew G K Benesch, Mark F O'Driscoll
Journal: Case Rep Surg (2022)
MeSH terms: Case Reports

Introduction:
Pneumatosis intestinalis (PI) is a condition of gas collection within the bowel wall that can represent either a benign clinical finding or a forerunner to potential gastrointestinal catastrophe. As a potentially sinister discovery typically first detected on radiographic imaging, clinicians need to astutely assess the need for additional urgent medical or surgical management in these patients. Apart from portal venous gas, PI outside of the bowel wall is an extremely rare entity that is poorly described. Hence, it is not necessarily clear if PI outside the bowel wall warrants more aggressive management. Case Presentation. We describe a patient with intermittent abdominal pain who presented with PI of the greater omentum in addition to the right and transverse colon nearly two weeks after small bowel resection. Due to his clinical stability, we elected to closely observe him. His condition completely resolved with conservative management. Discussion. PI in the omentum has not been described in a patient who has survived their underlying pathology. Our patient demonstrated PI radiographically in his right and transverse colon and omentum with complete resolution. We did not have to alter our clinical management because of this unique clinical presentation.
Conclusion:
This case highlights that pneumatosis intestinalis can extend extraluminally and still be managed conservatively with judicious monitoring in the otherwise stable patient.