OpenMed/multicare-articles huggingface dataset:
Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England
Authors: Nichola R Naylor, Stephanie Evans, Koen B Pouwels, Rachael Troughton, Theresa Lamagni, Berit Muller-Pebody, Gwenan M Knight, Rifat Atun, Julie V Robotham
Journal: Front Public Health (2022)
Keywords: antimicrobial resistance, burden, secondary effects, surgery, surgical site infection
MeSH terms: Communicable Diseases, Drug Resistance, Bacterial, Review, Research Support, Non-U.S. Gov't, Anti-Bacterial Agents, England, Humans, Information Storage and Retrieval, Anti-Bacterial Agents

Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the "primary effects" of AMR. Previous estimates of the burden of AMR have largely ignored the potential "secondary effects," such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilize in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilized in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.
Apicotomy as treatment for failure of orthodontic traction
Authors: Leandro Berni Osório, Vilmar Antonio Ferrazzo, Geraldo Serpa, Kívia Linhares Ferrazzo
Journal: Case Rep Dent (2013)

Objective. The purpose of this study was to present a case report that demonstrated primary failure in a tooth traction that was subsequently treated with apicotomy technique. Case Report. A 10-year-old girl had an impacted upper right canine with increased pericoronal space, which was apparent on a radiographic image. The right maxillary sinus showed an opacity suggesting sinusitis. The presumptive diagnosis was dentigerous cyst associated with maxillary sinus infection. The plan for treatment included treatment of the sinus infection and cystic lesion and orthodontic traction of the canine after surgical exposure and bonding of an orthodontic appliance. The surgical procedure, canine position, root dilaceration, and probably apical ankylosis acted in the primary failure of the orthodontic traction. Surgical apical cut of the displaced teeth was performed, and tooth position in the dental arch was possible, with a positive response to the pulp vitality test. Conclusion. Apicotomy is an effective technique to treat severe canine displacement and primary orthodontic traction failure of palatally displaced canines.
Modified exposure and response prevention to treat the repetitive behaviors of a child with autism: a case report
Authors: Brian A Boyd, Cooper R Woodard, James W Bodfish
Journal: Case Rep Psychiatry (2011)
MeSH terms: Case Reports

We report the case study of a school-aged child with autism whose repetitive behaviors were treated with a modified version of a technique routinely used in cognitive behavior therapy (i.e., exposure response prevention) to treat obsessive-compulsive disorder. A trained behavioral therapist administered the modified ERP treatment over the course of an intensive two-week treatment period with two therapy sessions occurring daily. The treatment was successful at decreasing the amount of child distress and cooccurring problem behavior displayed; however, the child's interest in the repetitive behavior eliciting stimulus (i.e., puzzles) remained. The case study demonstrates specific ways that exposure response prevention strategies can be adapted to the unique kinds of repetitive behaviors that present clinically in autism. A larger clinical trial is needed to substantiate these findings.
Pantoprazole-Induced Delirium: Review of a Case and Associated Literature
Authors: Anupriya Razdan, Ramaswamy Viswanathan, Alan Tusher
Journal: Case Rep Psychiatry (2018)
MeSH terms: Case Reports

Background:
Proton pump inhibitors (PPIs) are frequently prescribed antiulcer agents in hospitals and are shown to be safer than H-2 blockers. We present a case report of PPI-induced delirium, regarding which not much has been written in the literature.
Case report:
We present a case of a 93-year-old woman with no known past psychiatric history, who was hospitalized for syncope workup and who developed delirium after a double dose of pantoprazole.
Discussion:
Very few reports of PPI-induced delirium exist in the literature. In this case report, we attempt to highlight the mechanism of PPI induced delirium which in our case was most likely due to the primary effects of PPI and drug-drug interactions. Given the paucity of literature on this topic, we encourage further research into relationship between PPI and delirium and urge caution while using PPIs in geriatric population.
Large Brunner's Gland Hyperplasia with Bleeding: A Case Report
Authors: Yuki Okutomi, Takaharu Kato, Hidetoshi Aizawa, Yuhei Endo, Naoya Kasahara, Fumiaki Watanabe, Hiroshi Noda, Toishiki Rikiyama
Journal: Case Rep Surg (2021)
MeSH terms: Case Reports

We report a rare case of a large Brunner's gland hyperplasia (BGH) with severe anemia. A 33-year-old woman was transferred to our hospital with anemia and a duodenal mass. She had a 2-week history of melena and mild shortness of breath. Her hemoglobin level was 4.9 g/dl, and she required a blood transfusion. Abdominal computed tomography revealed a 7 cm tumor in the descending duodenum, and duodenoscopy revealed a polyp-like tumor with an ulcer at the duodenal bulb. We decided to perform surgery to prevent further bleeding. Intraoperatively, the tumor stalk was located at the anterior wall of the duodenal bulb; the ampulla was not involved, and we resected the tumor with the wall of the duodenal bulb. The resected tumor measured 7.0 × 4.0 × 2.3 cm, and pathologically, the tumor consisted of proliferated Brunner's glands in a small amount of fibrous stroma. The histological diagnosis was BGH with no malignancy. Most cases of BGH are benign and asymptomatic; however, it is important to be aware that some patients have severe anemia, gastrointestinal obstruction, or malignant potential.
Distinct cell clusters touching islet cells induce islet cell replication in association with over-expression of Regenerating Gene (REG) protein in fulminant type 1 diabetes
Authors: Kaoru Aida, Sei Saitoh, Yoriko Nishida, Sadanori Yokota, Shinichi Ohno, Xiayang Mao, Daiichiro Akiyama, Shoichiro Tanaka, Takuya Awata, Akira Shimada, Youichi Oikawa, Hiroki Shimura, Fumihiko Furuya, Soichi Takizawa, Masashi Ichijo, Sayaka Ichijo, Jun Itakura, Hideki Fujii, Akinori Hashiguchi, Shin Takasawa, Toyoshi Endo, Tetsuro Kobayashi
Journal: PLoS One (2014)
MeSH terms: Diabetes Mellitus, Type 1 / pathology, Islets of Langerhans / metabolism, Islets of Langerhans / pathology, Lithostathine / metabolism, Pancreas / pathology, Case Reports, Research Support, Non-U.S. Gov't, Adolescent, Adult, Aged, Diabetes Mellitus, Type 1 / metabolism, Humans, Male, Microscopy, Electron, Transmission, Middle Aged, Pancreas / metabolism, Lithostathine, REG1A protein, human

Background:
Pancreatic islet endocrine cell-supporting architectures, including islet encapsulating basement membranes (BMs), extracellular matrix (ECM), and possible cell clusters, are unclear.
Procedures:
The architectures around islet cell clusters, including BMs, ECM, and pancreatic acinar-like cell clusters, were studied in the non-diabetic state and in the inflamed milieu of fulminant type 1 diabetes in humans.
Result:
Immunohistochemical and electron microscopy analyses demonstrated that human islet cell clusters and acinar-like cell clusters adhere directly to each other with desmosomal structures and coated-pit-like structures between the two cell clusters. The two cell-clusters are encapsulated by a continuous capsule composed of common BMs/ECM. The acinar-like cell clusters have vesicles containing regenerating (REG) Iα protein. The vesicles containing REG Iα protein are directly secreted to islet cells. In the inflamed milieu of fulminant type 1 diabetes, the acinar-like cell clusters over-expressed REG Iα protein. Islet endocrine cells, including beta-cells and non-beta cells, which were packed with the acinar-like cell clusters, show self-replication with a markedly increased number of Ki67-positive cells.
Conclusion:
The acinar-like cell clusters touching islet endocrine cells are distinct, because the cell clusters are packed with pancreatic islet clusters and surrounded by common BMs/ECM. Furthermore, the acinar-like cell clusters express REG Iα protein and secrete directly to neighboring islet endocrine cells in the non-diabetic state, and the cell clusters over-express REG Iα in the inflamed milieu of fulminant type 1 diabetes with marked self-replication of islet cells.
Metastasis to the Bladder: A Rare Site of Recurrence of Renal Cell Carcinoma
Authors: Amanda Smart, Michael Wynne, Ezra Baraban, Yasser Ged, Armine Smith
Journal: Case Rep Urol (2022)
MeSH terms: Case Reports

Renal cell carcinoma (RCC) is considered to be the deadliest urologic cancer with high rates of metastasis and recurrence after nephrectomy. RCC can metastasize to nearly any organ but most commonly metastasizes to the liver, lung, brain, and bone. To date, there are only about 40 reported cases of RCC with solitary bladder metastasis. The following report contributes to this limited data set of patients with RCC who develop solitary metastasis to the bladder. A 69-year-old male presented with occasional gross hematuria and was found to have a left renal mass infiltrating the collecting system. Ureteroscopic biopsy revealed clear cell RCC, and the patient subsequently underwent radical left nephrectomy. Eight months after nephrectomy, the patient presented to the clinic with gross hematuria. In-office cystoscopy demonstrated a nodular lesion in the bladder arising from the left ureteral orifice. The patient underwent transurethral resection of the bladder mass and pathology demonstrated clear cell RCC. Subsequent imaging showed no evidence of metastatic disease. Five months after transurethral resection, the patient was found to have a left distal ureteral mass and underwent left ureterectomy with partial cystectomy. Pathology again demonstrated clear cell RCC. RCC with solitary metastasis to the bladder is rare, and there are no targeted guideline recommendations for management. Per standard of care, patients with painless hematuria and risk factors for malignancy should undergo cystoscopy. In patients with a history of RCC, metastasis to the bladder should be considered in the differential diagnosis. Patients with metastatic RCC to the bladder should undergo a thorough work-up for additional sites of metastasis. In patients with RCC who develop solitary bladder metastasis amenable to resection following nephrectomy, there is a lack of evidence to guide therapy and a multidisciplinary discussion is warranted. However, if the tumor is amenable to resection, metastasectomy is a reasonable therapeutic approach and offers the patient an improved quality of life and an opportunity for remission.
CPEO and Mitochondrial Myopathy in a Patient with DGUOK Compound Heterozygous Pathogenetic Variant and mtDNA Multiple Deletions
Authors: V Montano, C Simoncini, Cassi L Calì, A Legati, G Siciliano, M Mancuso
Journal: Case Rep Neurol Med (2019)
MeSH terms: Case Reports

The classic features of deoxyguanosine kinase (DGUOK) deficiency are infantile onset hepatic failure with nystagmus and hypotonia; mitochondrial DNA studies on affected tissue reveal mitochondrial DNA depletion. Later, it has been shown that the mutations in the same gene may present with adult-onset mitochondrial myopathy and mitochondrial DNA multiple deletions in skeletal muscle. Here we report the case of a 42-year-old Italian woman presenting with a chronic progressive external ophthalmoplegia and myopathy with mtDNA multiple deletions and the compound heterozygous c.462T>A (p.Asn154Lys) and c.707+2T>G pathogenic variants in DGUOK.
Intussusception of the appendix secondary to endometriosis: a case report
Authors: Samia Ijaz, Surjit Lidder, Waria Mohamid, Martyn Carter, Hilary Thompson
Journal: J Med Case Rep (2008)

Introduction:
Intussusception of the appendix is an extremely rare condition that ranges from partial invagination of the appendix to involvement of the entire colon. Endometriosis is an exceptionally rare cause of appendiceal intussusception and only very few cases have been reported in the literature to date.
Case presentation:
A 40 year-old woman presented to clinic with a long history of lower abdominal pain, loose motions and painful, heavy periods. Subsequent colonoscopy revealed submucosal endometriotic nodules in the sigmoid as well as a polyp thought to be arising from the appendix, which had inverted itself. She was referred to a colorectal surgeon because the polyp could not be removed endoscopically despite several attempts. At laparotomy, the appendix had intussuscepted but it was possible to reduce it and therefore a simple appendicectomy was carried out. On histology, there were widespread endometrial deposits within the wall of the appendix and this was thought to be the basis for the intussusception.
Conclusion:
Histological evidence of the lead point is of crucial importance in cases of appendiceal intussusception, in order to exclude an underlying neoplastic process. Consequently, surgical resection is necessary either through an open or a laparoscopic approach. Gastrointestinal endometriosis should be considered as a cause of appendiceal intussusception in post-menarchal women with episodic symptoms and proven disease.
Multidisciplinary Diagnosis of Subcutaneous Soft Tissue Metastasis of Follicular Thyroid Carcinoma: A Case Report
Authors: Yanfang Wang, Fang Nie, Qingqing Fang
Journal: Front Endocrinol (Lausanne) (2020)
Keywords: tert promoter, case report, diagnosis, follicular thyroid carcinoma, metastasis
MeSH terms: Adenocarcinoma, Follicular / pathology, Adenocarcinoma, Follicular / surgery, Soft Tissue Neoplasms / secondary, Subcutaneous Tissue / pathology, Thyroid Neoplasms / pathology, Case Reports, Aged, Humans, Male, Prognosis, Soft Tissue Neoplasms / surgery, Subcutaneous Tissue / surgery, Thyroid Neoplasms / surgery

Background: Subcutaneous soft tissue metastasis of follicular thyroid carcinoma (FTC) is rarely diagnosed before surgery for clinicians. Case Report: We present a case of a 67-year-old man with a history of FTC and papillary thyroid microcarcinoma for 5 years. Multiple protruding subcutaneous nodules of the neck were found and removed from the surface of the sternocleidomastoid muscle. Ultrasound, computed tomography and technetium-99 m pertechnetate single-photon emission computed tomography of the neck were performed before the operation, which unfortunately indicated suspicious malignant lesions. Serum Tg was > 300 ng/ml (0.83-68.0 ng/ml), TSH was 36.580 uIU/ml (0.380-4.340 uIU/ml) and AbTg was negative. The pathologic diagnosis was metastatic FTC, invading the surrounding striated muscle, adipose tissue and vessels. Immunohistochemical staining revealed the tumor cells to be positive for thyroglobulin and TTF-1. The specimens of these nodules were further investigated for TERT promoter mutation and the result revealed mutated type (position g 1,295, 228 C>T). Conclusion: Preoperative diagnosis and prognostic prediction of metastatic FTC may be available through a combination of clinical, multimodal imaging and molecular genetic test (viz. multidisciplinary diagnosis). A long-term standardized follow-up is required for patients with a previous diagnosis of FTC.
Role of surgery in breast metastasis from carcinoma of the cervix
Authors: Parveen Yadav, Nml Manjunath, Svs Deo, Nk Shukla, Prashant Durgapal, Dillip K Muduly
Journal: Indian J Palliat Care (2011)
Keywords: cervix, metastasis, palliative
MeSH terms: Case Reports

Carcinoma of the cervix is the most common malignancy among women in India. Although metastatic disease is common, metastasis to breast is rare. A limited number of case reports are published in the world literature. Most of the previous reports of metastatic cervical carcinoma to breast are either autopsy series or widely disseminated disease where no treatment options were available. A rare case of cervical carcinoma presenting as metastasis in breast is reported here where palliative mastectomy improved the general condition of the patient. A female patient aged 58 years was diagnosed and treated for cervical carcinoma, FIGO stage 2B. Four months after the treatment which included both external beam and intracavitory radiotherapy, the patient presented with breast and lung metastasis. Palliative mastectomy was done which improved the general condition of the patient. Metastatic carcinoma of the cervix can present as a case of breast carcinoma. In an appropriate setting, this possibility should be kept in mind. Palliative mastectomy should be offered for patients of cervical carcinoma with metastasis to breast when needed.
Use of Nasotracheal Intubation during General Anesthesia in Two Ponies with Tracheal Collapse
Authors: Keila K Ida, Aurélie Sauvage, Alexandra Gougnard, Magda Grauwels, Didier Serteyn, Charlotte Sandersen
Journal: Front Vet Sci (2018)
Keywords: emergencies, horses, intubation, recovery from anesthesia, risk factors
MeSH terms: Case Reports

Ponies with tracheal collapse may have an increased anesthetic risk due to airway obstruction during induction and recovery. To our knowledge, there are no anesthetic descriptions of these patients, despite a reported 5.6% incidence and 77% mortality rate. Two Shetland ponies with tracheal collapse, a 12-year-old male (pony 1) and a 27-year-old female (pony 2), were referred for right eye enucleation due to a perforating corneal ulcer and severe recurrent uveitis, respectively. Pony 1 was stressed, had lung stridor and hyperthermia, and developed inspiratory dyspnea with handling. Radiography confirmed collapse of the entire trachea as well as inflammation of the lower airways. Corticosteroids and bronchodilators were administered by nebulization for 1 week before surgery. Pony 2 had a grade III/VI mitral murmur and a clinical history of esophageal obstructions and tracheal collapse requiring tracheostomy. Both ponies were premedicated with acepromazine and xylazine; anesthesia was induced with midazolam and ketamine. Nasotracheal intubation was performed in left lateral recumbency with extension of the neck and head and was guided by capnography. The nasotracheal tube consisted of two endotracheal tubes attached end-to-end to create a tube of adequate length and diameter. Pony 2 was orotracheally intubated during surgery and later reintubated with a nasotracheal tube. Anesthesia was maintained with isoflurane using volume-controlled ventilation. Analgesia was provided by a retrobulbar blockade with mepivacaine and lidocaine. Cardiovascular support consisted of lactated Ringer's solution and dobutamine. After surgery, the ponies were administered xylazine and supplemented with oxygen through the nasotracheal tube. Recovery was assisted by manual support of the head and tail. Successful extubation was achieved following butorphanol administration after approximately 1 h in standing position. Both ponies were discharged from the clinic a few days after surgery.
MPGN and mixed cryoglobulinemia in a patient with hepatitis C - new treatment implications and renal outcomes
Authors: Shannon B Palombo, Eric C Wendel, Laura R Kidd, Farshid Yazdi, Mihran V Naljayan
Journal: Clin Nephrol Case Stud (2017)
Keywords: cryoglobulinemia, direct-acting antivirals (daa), hepatitis c (hcv), membranoproliferative glomerulonephritis (mpgn)
MeSH terms: Case Reports

Introduction:
The association of hepatitis C virus (HCV), cryoglobulinemia, and membranoproliferative glomerulonephritis (MPGN) is well known. Treatment of underlying HCV infection has greatly improved in recent years with the introduction of direct-acting antivirals (DAA), which have demonstrated curative sustained viral response (SVR) rates for select viral genotypes with the added benefit of less drug side effects. However, a mainstay of newer DAAs is sofosbuvir, which is contraindicated in patients with severe renal impairment.
Case history:
We are reporting the case of a 65-year-old female with chronic systolic heart failure, hypertension, and chronic HCV genotype 1b with biopsy-proven type I MPGN with cryoglobulinemia type II, who presented with rapidly progressive renal failure requiring emergent hemodialysis. After initiation of DAA therapy including ombitasvir-paritaprevir-ritonavir plus dasabuvir, in conjunction with plasmapheresis, corticosteroids, and rituximab, there was significant improvement in renal function such that hemodialysis was no longer needed.
Discussion:
This patient's HCV treatment is estimated to induce a greater than 90% SVR, which is notably promising for the reduction and/or reversal of HCV-related glomerulopathy. Most recent HCV guidelines from 2015 recommend this regimen; however, there is little data to evaluate the safety and efficacy of treatment. Therefore, it is valuable to report positive preliminary results at this time. Overall, we anticipate this treatment regimen to become a basis in the management of HCV-related renal disease; however, larger studies will still be needed to prove its efficacy in improving renal outcomes.