OpenMed/multicare-articles huggingface dataset:
Exploration of chemotherapy-free regimen after multi-line chemotherapy-induced renal impairment in recurrent ovarian cancer: Case report and literature review
Authors: Liu-Ping Zhang, Xiang Yang, Wei Zheng, Kai-Xun Feng, Hu Li
Journal: Front Oncol (2023)
Keywords: adenocarcinoma, chemotherapy-free regimen, niraparib, recurrent ovarian cancer, renal impairment
MeSH terms: Case Reports

Introduction:
Platinum-based combination chemotherapy is recommended first choice for relapsed ovarian cancer. However, many of the chemotherapeutic agents are nephrotoxic and can promote kidney dysfunction, which affect the efficacy of cancer treatment and the survival of the patient. There is a need to explore long-term treatments of chemotherapy-free regimen of chronic kidney disease in recurrent ovarian cancer.
Case presentation:
A 41-year-old female patient was presented with stage IIIC well-differentiated ovarian serous papillary adenocarcinoma in 2009. The patient had recurrence of platinum resistance after secondary cytoreductive surgery, and it was difficult to continue chemotherapy after multiple lines of chemotherapy due to myelosuppression, renal impairment and other factors. The patient accepted Niraparib-based treatment regimen after multi-line chemotherapy-induced stage 4 chronic kidney disease. Niraparib combined with anlotinib achieved median PFS of 11 months, disease re-progression, and the patient was switched to niraparib combined with letrozole from October 2021. No evidence of tumor progression was observed till date and the renal toxicity is acceptable.
Conclusions:
In patients with relapsed ovarian cancer, treatment becomes increasingly challenging to subsequent therapies because of renal impairment and emerging drug resistance. Niraparib-based treatment regimen may be a good choice for patients with well-differentiated serous adenocarcinoma of the ovary who are intolerant to chemotherapy.
Adult education and entrepreneurship: getting young adults involved
Authors: Isaac Kofi Biney
Journal: J Innov Entrep (2023)
Keywords: adult education, entrepreneurship, growth and enterprising mindsets, human capital theory

This paper reflects on adult education and the fostering of an entrepreneurial mindset. It solicits roles adult education, especially the non-formal education (NFE), could play in fostering entrepreneurial mindset of young adults. It examines short-to-medium, and long-term plans of young adults in nurturing growth and enterprising mindsets through involvement in NFE endeavours. It probes into entrepreneurial opportunities and challenges in the communities that young adults could recognise and create enterprises for themselves. This is a narrative case study which purposively selected, as the unit of analysis, an adult learner who was operating a micro-enterprise and pursuing a degree programme at Accra Learning Centre. An in-depth telephone interview was conducted to garner stories and experiences young adult have had innovating with an entrepreneurial mindset. Thematic, analytical, narrative and interpretivist approaches were adapted in presenting the results. The participant had a good experience in his start up, he learned lessons, and worked hard to grow his micro-enterprises. The savings culture he built allowed him to cope with difficulties posed by Covid-19 pandemic to his micro-enterprises. Governments and stakeholders in entrepreneurship should via policy, advisory and financial support motivate young adults to invest in entrepreneurship and create sustainable jobs for themselves.
Molecular and biochemical characterisation of a novel mutation in POLG associated with Alpers syndrome
Authors: André Schaller, Dagmar Hahn, Christopher B Jackson, Ilse Kern, Christophe Chardot, Dominique C Belli, Sabina Gallati, Jean-Marc Nuoffer
Journal: BMC Neurol (2011)
MeSH terms: DNA, Mitochondrial / metabolism, DNA-Directed DNA Polymerase / genetics, Diffuse Cerebral Sclerosis of Schilder / genetics, Mutation / genetics, Case Reports, Research Support, Non-U.S. Gov't, Cell Culture Techniques, Child, Preschool, DNA Polymerase gamma, Diffuse Cerebral Sclerosis of Schilder / metabolism, Fibroblasts / metabolism, Humans, Liver / metabolism, Male, Muscle, Skeletal / metabolism, Oxidative Phosphorylation, Sequence Analysis, DNA / methods, DNA, Mitochondrial, DNA Polymerase gamma, DNA-Directed DNA Polymerase

Background:
DNA polymerase γ (POLG) is the only known mitochondrial DNA (mtDNA) polymerase. It mediates mtDNA replication and base excision repair. Mutations in the POLG gene lead to reduction of functional mtDNA (mtDNA depletion and/or deletions) and are therefore predicted to result in defective oxidative phosphorylation (OXPHOS). Many mutations map to the polymerase and exonuclease domains of the enzyme and produce a broad clinical spectrum. The most frequent mutation p.A467T is localised in the linker region between these domains. In compound heterozygote patients the p.A467T mutation has been described to be associated amongst others with fatal childhood encephalopathy. These patients have a poorer survival rate compared to homozygotes.
Methods:
mtDNA content in various tissues (fibroblasts, muscle and liver) was quantified using quantitative PCR (qPCR). OXPHOS activities in the same tissues were assessed using spectrophotometric methods and catalytic stain of BN-PAGE.
Results:
We characterise a novel splice site mutation in POLG found in trans with the p.A467T mutation in a 3.5 years old boy with valproic acid induced acute liver failure (Alpers-Huttenlocher syndrome). These mutations result in a tissue specific depletion of the mtDNA which correlates with the OXPHOS-activities.
Conclusions:
mtDNA depletion can be expressed in a high tissue-specific manner and confirms the need to analyse primary tissue. Furthermore, POLG analysis optimises clinical management in the early stages of disease and reinforces the need for its evaluation before starting valproic acid treatment.
Autoantibody with Cross-Reactivity between Insulin and Ductal Cells May Cause Diabetic Mastopathy: A Case Study
Authors: Katsutoshi Miura, Chikako Teruya, Nasu Hatsuko, Hiroyuki Ogura
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Lymphocytic mastopathy or diabetic mastopathy is a benign breast disease characterized by dense fibrosis, lobular atrophy, and aggregates of lymphocytes in a periductal and perilobular distribution. The condition usually affects women with a long history of diabetes mellitus (DM) and also those with autoimmune disorders. While the pathogenesis is unknown, a particular type of class II human leukocyte antigen has been associated with this disease. Herein, we report a case of diabetic mastopathy which clinically and radiologically mimicked primary breast neoplasms. The patient was a 74-year-old woman with a 31-year history of DM type II who presented with multiple firm lumps in bilateral breasts. Findings from mammography, ultrasonography, and magnetic resonance imaging of the breasts revealed an abnormal appearance which suspiciously resembled malignancy. An aspiration cytology specimen showed atypical accumulation of lymphoid cells, leading us to suspect lymphoma. Histology of an excisional biopsy showed the characteristic appearance of lymphocytic mastopathy, which predominantly consisted of B-lymphocytes. Autoantibodies in her serum reacted positively against her ductal epithelium as well as other diabetic and nondiabetic breast ductal cells. An antigen absorption test with insulin revealed attenuating intensity according to insulin concentration. These anti-insulin antibodies produced in the DM patient may cause ductitis because of antigen cross-reactivity.
Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries: A case report and literature review
Authors: Lin Cheng, Cheng Qiu, Xin-Yu Liu, Xi-Guang Sang
Journal: Chin J Traumatol (2023)
Keywords: american spinal injury association, fracture dislocation, lumbar spine, multiple trauma, spondyloptosis
MeSH terms: Multiple Trauma / complications, Spinal Injuries, Spondylolisthesis / complications, Spondylolisthesis / surgery, Review, Case Reports, Female, Humans, Lumbar Vertebrae / injuries, Lumbar Vertebrae / surgery, Middle Aged

Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.
Spindle cell oncocytoma of the pituitary tumor: A rare case report and literature reviews
Authors: Chia Ning Chang, Chiung Chyi Shen
Journal: Front Surg (2023)
Keywords: ttf-1 gene, benigh tumors, pituitary tumor, spindle cell, surgical resection
MeSH terms: Case Reports

Introduction:
Spindle cell oncocytoma (SCO) of the pituitary gland is increasingly established with improvements in histological and immunohistochemical examination. However, the diagnosis was often mistaken based on imaging studies and nonspecific clinical manifestations.
Purpose:
This case is presented to provide an overview of the characteristics of the rare tumor as well as to demonstrate the difficulties in diagnosis and current treatments.
Clinical discussion:
The pathogenesis of SCO remains unclear, and a possible origin was described. Further research is needed to optimize pre-operative diagnosis and surgical strategy.
Conclusion:
SCO should be considered when images indicate some features. Gross total resection (GTR) after surgery seems to have better long-term tumor control, and radiotherapy may help decrease tumor progression in patients with non-GTR. Regular follow-up is advised because of the higher recurrence rate.
Case report of pelvic tuberculosis resulting in Asherman's syndrome and infertility
Authors: Mary Louise Fowler, Shruthi Mahalingaiah
Journal: Fertil Res Pract (2019)
Keywords: asherman’s syndrome, infertility, intrauterine adhesions, tuberculosis
MeSH terms: Case Reports

Approximately one-third of the world's population is infected with Mycobacterium tuberculosis, and it is a leading cause of infertility in endemic countries. The global incidence of tuberculosis (TB) is growing at approximately 0.4% per year, and much faster in sub-Saharan Africa. TB causing fertility is rare in developed countries. We present a case of genital tuberculosis causing Asherman's syndrome and resultant infertility. The patient is a 34-year-old P0 who presented to care after a prolonged period of secondary amenorrhea and infertility. She underwent a hysterosalpingogram which demonstrated no free spill and a diagnostic hysteroscopy which had findings of mottled endometrium. Pathology returned positive for Mycobacterium tuberculosis. The patient was treated with 9 months of antituberculous therapy. While she has not yet succeeded in becoming pregnant, the patient has started to notice cyclic spotting, indicating possible return of menses. This case highlights the importance of TB treatment and considering TB in patients who present with unexplained infertility.
Case Report: Circulating Tumor DNA Fraction Analysis Using Ultra-Low-Pass Whole-Genome Sequencing Correlates Response to Chemoradiation and Recurrence in Stage IV Small-Cell Carcinoma of the Cervix - A Longitudinal Study
Authors: Ata Abbas, Morgan Gruner, Jennifer Karohl, Peter G Rose, Amy Joehlin-Price, Daniel Stover, Haider Mahdi
Journal: Front Oncol (2021)
Keywords: ulp-wgs, cervix, ctdna, response to chemo-radiation, small cell carcinoma, tumor fraction
MeSH terms: Case Reports

Neuroendocrine carcinoma of the cervix is a rare and aggressive form of cervical cancer that presents with frequent metastasis at diagnosis and high recurrence rates. Primary treatment is multimodal, which often includes chemotherapy with or without radiation therapy. There are no data available to guide treatment for recurrence, and second-line therapies are extrapolated from small-cell lung carcinoma data. Close monitoring of these patients for recurrence is paramount. Evaluation of circulating tumor DNA (ctDNA) in the peripheral blood is an attractive approach due to its non-invasive nature. Ultra-low-pass whole-genome sequencing (ULP-WGS) can assess tumor burden and response to therapy and predict recurrence; however, data are lacking regarding the role of ULP-WGS in small-cell carcinoma of the cervix. This study demonstrates a patient whose response to chemotherapy and cancer recurrence was accurately monitored by ctDNA analysis using ULP-WGS and confirmed with radiologic imaging findings.
Aneurysmal subarachnoid haemorrhage in pregnancy: a case series
Authors: Maurizio Guida, Roberto Altieri, Valeria Palatucci, Federica Visconti, Renato Pascale, Marialuisa Marra, Giampiero Locatelli, Renato Saponiero, Rosalba Tufano, Francesca Bifulco, Ornella Piazza
Journal: Transl Med UniSa (2012)
Keywords: aneurismal subarachnoid hemorrhage, headache, pregnancy

Pregnancy is a recognized risk factor for aneurysmal subarachnoid hemorrhage (SAH). Headache is very frequent in normal pregnancy and it is a common sign shared between several intracranial diseases. We present a case series of 10 women in the third trimester of pregnancy admitted to our intensive care unit (ICU) with neurological signs and symptoms. 4 of these patients were diagnosed with SAH. Data in this study suggest that a timely diagnosis and an appropriate treatment is crucial for mother and baby.
Case report: A particularly rare case of endogenous hyperinsulinemic hypoglycemia complicated with pregnancy treated with short-acting somatostatin analog injections
Authors: Ádám Barsi, Artúr Beke, Beatrix Sármán
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: case report, endogenous hyperinsulinemic hypoglycemia, nesidioblastosis, octreotide, pregnancy
MeSH terms: Congenital Hyperinsulinism / complications, Congenital Hyperinsulinism / drug therapy, Somatostatin / therapeutic use, Case Reports, Adult, Blood Glucose, Blood Glucose Self-Monitoring, Cesarean Section, Child, Diazoxide / therapeutic use, Female, Humans, Hypoglycemic Agents, Infant, Infant, Newborn, Octreotide / therapeutic use, Pregnancy, Pregnancy Outcome, Blood Glucose, Hypoglycemic Agents, Somatostatin, Diazoxide, Octreotide

Hyperinsulinemic hypoglycemia is a rare disease, and only two cases complicated with pregnancy were published previously when our patient became pregnant. We introduce a successful management of a pregnancy in a patient with endogenous hyperinsulinemic hypoglycemia, a condition also known as non-insulinoma pancreatogenous hypoglycemia syndrome or formerly as nesidioblastosis. A 29-year-old female patient was treated with endogenous hyperinsulinemic hypoglycemia since the age of 4 months, taking daily 3 × 75 mg diazoxide, which adds up to 225 mg per day. Adequate glycemic control could be achieved with this therapy. Genetic testing and various imaging examinations were carried out earlier to specify the disease and to exclude focal forms. The patient came to the clinic with a positive pregnancy test and consequential hypoglycemic episodes. Hospital admission was needed to correct the metabolic condition. Although the patient was informed about the potential risks, she decided to carry out the pregnancy. According to the quite limited literature, somatostatin analogs are the only therapy used previously during pregnancy in hyperinsulinemic hypoglycemic patients. One publication reported normal pregnancy outcomes, but in another case, restricted fetal growth was observed. In our case, we stopped diazoxide and parallelly introduced short-acting somatostatin analog octreotide in the therapy, and further dietetic changes were proposed. In addition to daily regular self-blood glucose monitoring, regular gynecological controls were carried out monthly, and healthy fetal development was confirmed. The patient gave birth to her first child, a well-developed female neonate, in the 38th week, by a cesarean section.
A Case Report of an Atypical Presentation of IgG4-Related Disease and Idiopathic CD4 Lymphocytopenia
Authors: Francesco Rapisarda, Luca Zanoli, Grazia Portale, Salvo Scuto, Pietro Castellino
Journal: Case Rep Med (2015)

The IgG4-related disease is a fibroinflammatory disease characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum levels of IgG4. Idiopathic CD4 lymphocytopenia is a heterogenic and rare syndrome characterized by the detection of a persistent absolute CD4 T cells count <300 cells/mm(3) (or <20% of total T cells) in more than one occasion and no evidence of HIV infection in absence of immunodeficiency or therapy associated with depressed levels of CD4 T cells. We report the case of a 50-year-old man with a multiorgan IgG4-related disease presenting in a temporal association with a profound and symptomatic idiopathic CD4 lymphocytopenia. Both clinical pictures improved after steroid treatment. Idiopathic CD4 lymphocytopenia has been associated with a number of autoimmune conditions but, to the best of our knowledge, this is the first case in which an association with the IgG4-related disease is reported.
Simultaneous occurrence of ocular, disseminated mucocutaneous, and multivisceral involvement of leishmaniasis
Authors: Cyriac Abby Philips, Chetan Ramesh Kalal, K N Chandan Kumar, Chhagan Bihari, Shiv Kumar Sarin
Journal: Case Rep Infect Dis (2014)

Leishmaniasis is a tropical infection caused by the protozoan, belonging to the group of Leishmania which causes Old World and New World disease. These are typically divided into cutaneous, mucocutaneous, visceral, viscerotropic, and disseminated disease. Cutaneous leishmaniasis in the presence of visceral disease is a rarity. Isolated case reports have documented this occurrence, in the immunocompromised setting, and few otherwise. The concurrent presence of visceral leishmaniasis (bone marrow involvement) with solitary cutaneous and ocular disease and also solitary cutaneous and visceral disease (bone marrow involvement) has been reported before. Here, we present an immunocompetent patient who was diagnosed to have visceral leishmaniasis (liver and bone marrow involvement) along with simultaneous disseminated mucocutaneous and ocular involvement, a combination that has never been reported before.
Medical Abortion of a First-Trimester Pregnancy with Large Multiple Uterine Leiomyomata
Authors: Somsook Santibenchakul, Unnop Jaisamrarn
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Introduction:
Termination of pregnancy in a patient with huge uterine leiomyomata poses significant challenges to clinicians. In this study, we report the successful termination of pregnancy in a patient with large multiple uterine leiomyomata using a combined regimen of drugs for medical abortion.
Case:
A 42-year-old woman, 6 weeks pregnant, presented to the Family Planning Clinic with an unintended pregnancy. She had a large, irregular abdominal midline mass, equivalent in size to 30-32 weeks of pregnancy. Abdominal and transvaginal ultrasound examinations revealed a small intrauterine gestational sac with a yolk sac and multiple large uterine leiomyomata. Treatment with mifepristone (200 mg) was initiated at the clinic. In addition, she was instructed to sublingually take 800 μg of misoprostol after 24-48 h. Two weeks later, at the follow-up visit, the patient complained of continued light bleeding. A pelvic examination showed that her cervix was dilated by 1 cm. In addition, abdominal and transvaginal ultrasound revealed a thick, inhomogeneous endometrium. Owing to light bleeding and no anemia or infection, the patient received two additional doses of 800 μg misoprostol vaginally. Her bleeding subsided for 61 days, and she resumed her normal menstrual cycle.
Conclusion:
A first-trimester pregnancy with large multiple uterine leiomyomata can be safely terminated using a combination regimen of drugs for medical abortion. However, an additional dose of misoprostol is required for the successful termination of pregnancy.
Case Report: Five-Level Unilateral Laminectomy Bilateral Decompression (ULBD) by Two-Stage Unilateral Biportal Endoscopy (UBE)
Authors: Wen-Long Wang, Zheng Liu, Si-Jun Wu
Journal: Front Surg (2022)
Keywords: case report, lumbar spinal stenosis (lss), multilevel, unilateral biportal endoscopy (ube), unilateral laminectomy bilateral decompression (ulbd)
MeSH terms: Case Reports

Introduction:
Unilateral biportal endoscopy (UBE) is a relatively new yet common minimally invasive procedure in spine surgery, capable of achieving adequate decompression for lumbar spinal stenosis through unilateral laminectomy bilateral decompression (ULBD). Neither additional fusion nor rigid fixation is required, as UBE-ULBD rarely causes iatrogenic lumbar instability. However, to our knowledge, five-level ULBD via two-stage UBE without lumbar fusion has been yet to be reported in the treatment of multilevel lumbar spinal stenosis.
Case description:
We present a case of an 80-year-old female patient who developed progressive paralysis of the lower extremities. Radiographic examinations showed multilevel degenerative lumbar spinal stenosis and extensive compression of the dural sac and nerve roots from L1-2 to L5-S1. The patient underwent five-level ULBD through two-stage UBE without lumbar fusion or fixation. One week after the final procedure, the patient could ambulate with walking aids and braces. Moreover, no back pain or limited lumbar motion was observed at the 6-month follow-up.
Conclusion:
Multilevel ULBD through UBE may provide elderly patients with an alternative, minimally invasive procedure for treating spinal stenosis. This procedure could be achieved by staging surgeries. In this case, we reported complaints of little back pain, despite not needing to perform lumbar fusion or fixation.
A case of severe bronchial asthma controlled with tacrolimus
Authors: Hirokazu Taniguchi, Kotaro Tokui, Yasuhiro Iwata, Hitoshi Abo, Saburo Izumi
Journal: J Allergy (Cairo) (2011)
MeSH terms: Case Reports

Background. The control of severe bronchial asthma, such as corticosteroid-resistant asthma, is difficult. It is also possible that immunosuppressive agents would be effective for bronchial asthma. Case Summary. A 55-year-old Japanese female presented with severe bronchial asthma controlled with tacrolimus. She had been diagnosed with bronchial asthma during childhood. Her asthma worsened, and a chest radiograph showed atelectasis of the left lung. Bronchoscopy revealed the left main bronchus to be obstructed with viscous sputum consisting of 82% neutrophils and no eosinophils. The atelectasis did not improve with corticosteroid treatment, but was ameliorated by administration of tacrolimus. Discussion. This patient had severe asthma due to neutrophilic inflammation of the airways. Tacrolimus is effective for treating severe asthma, for example, in corticosteroid-resistant cases.