OpenMed/multicare-articles huggingface dataset:
A case study evaluation of competitors undertaking an antarctic ultra-endurance event: nutrition, hydration and body composition variables
Authors: Scott Paulin, Justin Roberts, Michael Roberts, Ian Davis
Journal: Extrem Physiol Med (2015)
Keywords: antarctica, nutrition, south pole, ultra-endurance
MeSH terms: Case Reports

Background:
The nutritional demands of ultra-endurance racing are well documented. However, the relationship between nutritional consumption and performance measures are less obvious for athletes competing in Polar conditions. Therefore, the aim of this study was to evaluate dietary intake, hydration status, body composition and performance times throughout an 800-km Antarctic race.
Methods:
The event organisers declared that 17 competitors would participate in the South Pole race. Of the 17 competitors, pre-race data were collected from 13 participants (12 males and 1 female (M ± SD): age: 40.1 ± 8.9 years; weight: 83.9 ± 10.3 kg; and body fat percentage: 21.9 ± 3.8%). Dietary recall, body composition and urinary osmolarity were assessed pre-race, midway checkpoint and end race. Data were compared on the basis of fast finishers (the Norwegian team (n = 3) who won in a record of 14 days) and slower finishers (the remaining teams (n = 10) reaching the South Pole between 22 and 28 days).
Results:
The percentage contribution of macronutrients to daily energy intake for all participants was as follows: carbohydrate (CHO) = 23.7% (221 ± 82 g.day(-1)), fat = 60.6% (251 ± 127 g.day(-1)) and protein = 15.7% (117 ± 52 g.day(-1)). Energy demands were closer met by faster finishers compared to slower finishers (5,332 ± 469 vs. 3,048 ± 1,140 kcal.day(-1), p = 0.02). Average reduction in body mass throughout the race was 8.3 ± 5.5 kg, with an average loss of lean mass of 2.0 ± 4.1 kg. There was a significant negative correlation between changes in lean mass and protein intake (p = 0.03), and lean mass and energy intake (p = 0.03). End-race urinary osmolarity was significantly elevated for faster finishers compared to slower finishers and control volunteers (faster finishers: 933 ± 157 mOsmol.L(-1); slower finishers: 543 ± 92 mOsmol.L(-1); control: 515 ± 165 mOsmol.L(-1), p = 0.04).
Conclusions:
Throughout the race, both groups were subjected to a negative change in energy balance which partly explained reduced body mass. Carbohydrate availability was limited inferring a greater reliance on fat and protein metabolism. Consequently, loss in fat-free mass was more prevalent with insufficient protein and caloric intake, which may relate to performance.
Retroperitoneal leiomyosarcoma mimicking gastric cancer recurrence: A case report
Authors: Woo Yong Lee, Hye Kyeong Lee
Journal: Int J Surg Case Rep (2019)
Keywords: gastric cancer, leiomyosarcoma, local recurrence

Introduction:
Leiomyosarcoma is a rare soft tissue cancer that arises from smooth muscle cells that form involuntary muscles. Here, we report a rare case of retroperitoneal leiomyosarcoma that mimicked a metastatic tumor arising from a gastric cancer.
Presentation of case:
A 43-year-old man underwent radical total gastrectomy for gastric cancer. He underwent adjuvant chemotherapy with oral 5-fluorouracil (5-FU) for 2 years and regular follow-up. Twenty-nine months after gastrectomy, computed tomography (CT) was performed and revealed a solitary localized mass measuring 43 mm in diameter among retroperitoneal lymph nodes of the posterior inferior vena cava. This finding indicated that the previous gastric cancer recurred either in the lymph node or retroperitoneum. Second-line chemotherapy, consisting of oxaliplatin and 5-FU (FOLFOX) was administered in four cycles. However, serial CT scans showed increased tumor size. Retroperitoneal tumor did not respond to treatment, surgical resection was performed. Pathological findings led to a diagnosis of pleomorphic and epithelioid leiomyosarcoma without metastatic adenocarcinoma of the stomach.
Discussion:
When a diagnosis of locoregional recurrence of gastric cancer in the retroperitoneum is considered, retroperitoneal leiomyosarcoma should also be considered in the differential diagnosis.
Conclusion:
Early diagnosis and concerted therapeutic efforts are important for managing misdiagnosed metastatic gastric cancer.
Overlapping Leigh Syndrome/Myoclonic Epilepsy With Ragged Red Fibres in an Adolescent Patient With a Mitochondrial DNA A8344G Mutation
Authors: Cunzhou Shen, Wenbiao Xian, Hongyan Zhou, Xunhua Li, Xiuling Liang, Ling Chen
Journal: Front Neurol (2018)
Keywords: a8344g mutation, leigh syndrome, merrf, mitochondrial dna, mitochondrial disease
MeSH terms: Case Reports

We present the case of a 16-year-old boy with a family history of epilepsy who presented with acute respiratory failure, limb weakness, diabetes mellitus, sinus tachycardia, lactic acidosis, and pneumonia. He went on to develop cranial nerve palsy, myoclonus, generalized seizures, ataxia, recurrent pneumonia, and hypotension. Biochemical investigation revealed elevated lactate, pyruvate, and glucose levels. Cerebral magnetic resonance imaging (MRI) revealed bilateral, symmetric, high-intensity T2-weighted signals in the thalamus, brainstem, and gray matter of the spinal cord. Histochemical analyses revealed ragged red fibers (RRF) and decreased cytochrome oxidase activity. Blood and muscle-derived DNA demonstrated a high level (95% and 96%, respectively) of the m.8344A>G mutation, while almost all of his maternal relatives (n = 17, including his mother) carried the same point mutation. The point mutation level of his mother (who had short stature, high blood lactate levels, and epilepsy) was 77% (blood-derived DNA). Although this mutation has been identified in approximately 30 individuals with these disorders, to our knowledge, this is the first reported case of overlapping Leigh syndrome/myoclonic epilepsy with RRF in an adolescent patient, and the largest reported pedigree of mitochondrial DNA A8344G mutation.
Laparoscopic and endoscopic cooperative surgery for cholecystogastric fistula: A case report
Authors: Goshi Fujimoto
Journal: Int J Surg Case Rep (2020)
Keywords: case report, cholecystogastric fistula, lecs, laparoscopic and endoscopic cooperative surgery, malignancy
MeSH terms: Case Reports

Introduction:
Cholecystoenteric fistula (CEF) is rare in biliary tract surgery, and cholecystogastric fistula (CGF) is the rarest form of CEF. Although open cholecystectomy with the closure of the fistula is the gold standard treatment for nonobstructing biliary-enteric fistulas, the optimal treatment for CGF has not been established. Laparoscopic and endoscopic cooperative surgery (LECS), a minimally invasive surgery for gastric submucosal tumors, reportedly helps achieve favorable postoperative outcomes. This report presents a case wherein CGF was treated with LECS.
Case presentation:
An-84-year-old man with a history of chemotherapy for ileocecal diffuse large B cell lymphoma presented with fever and abdominal pain. He was diagnosed with cholangitis, and endoscopic lithotripsy was performed. Abdominal contrast-enhanced computed tomography revealed gastric wall thickening close to the gallbladder, indicating a malignant lymphoma. Esophagogastroduodenoscopy revealed a concavity on the anterior wall of the antrum of the stomach. Direct endoscopic cholangiography, which was performed by the injection of a contrast medium into the concavity, confirmed the concavity to be a CGF. Cholecystectomy with the closure of the fistula using the LECS was performed to check for suture line leakage and the positional relation of the suture line and the pylorus. The resected specimen showed acute and chronic cholecystitis without malignancy. The patient did not experience postoperative complications in the subsequent 3 months.
Discussion:
Resection and closure of the fistula using LECS were performed successfully.
Conclusion:
LECS can be performed for CGF. LECS enables intraoperative observation of the fistula and suture line, and thus reduces postoperative complications.
Novel SCN5A Frameshift Mutation in Brugada Syndrome Associated With Complex Arrhythmic Phenotype
Authors: Emanuele Micaglio, Michelle M Monasky, Giuseppe Ciconte, Gabriele Vicedomini, Manuel Conti, Valerio Mecarocci, Luigi Giannelli, Federica Giordano, Alberto Pollina, Massimo Saviano, Paolo R Pozzi, Chiara Di Resta, Sara Benedetti, Maurizio Ferrari, Vincenzo Santinelli, Carlo Pappone
Journal: Front Genet (2019)
Keywords: brugada syndrome, scn5a, arrhythmia, atrial fibrillation, genetic testing, mutation, sodium channel, sudden cardiac death

In this case report, we characterize a novel inherited frameshift mutation c.4700_4701del (p.Phe1567Cysfs*221) in a single copy of the SCN5A gene and its association with Brugada syndrome (BrS). The proband experienced a life-threatening ventricular arrhythmia successfully treated with DC-shock and he also suffered from supraventricular tachycardia. Ajmaline test confirmed the BrS diagnosis. No other mutation nor low frequency variants in the other 23 analyzed genes were detected. The same mutation was found in the father and sister, who were both diagnosed with BrS. We hypothesize that this mutation could be responsible for BrS and potentially linked to supraventricular tachycardias. Further studies are needed to confirm this observation and to assess the clinical relevance of this mutation, in terms of risk-stratification.
Case report: Tongdu Xingshen acupuncture for a patient with persistent vegetative state after herpes simplex virus encephalitis
Authors: Bingxu Jin, Yuyuan Tang, Yunyun Wu, Zhenhuan Liu
Journal: Front Neurol (2022)
Keywords: acupuncture, case report, herpes simplex virus encephalitis (hsve), persistent vegetative state (pvs), traditional chinese medicine
MeSH terms: Case Reports

Introduction:
A persistent vegetative state (PVS) can be caused by traumatic or non-traumatic brain injury. PVS is a complex clinical condition with numerous complications. Nursing care, medical treatment, and comprehensive rehabilitation are necessary to improve the outcomes of PVS. However, the prognosis remains unsatisfactory. Acupuncture therapy has been used as a rehabilitation strategy to treat patients with PVS in China, showing better results in the recovery of consciousness, intellectual capability, and motor function.
Case description:
We present the case of a 4-month-long PVS after herpes simplex virus encephalitis (HSVE) in a 3.5-year-old boy who underwent Tongdu Xingshen acupuncture integrated with Western medicine and rehabilitation. The patient regained consciousness post-treatment. His intelligence and motor function gradually recovered after seven treatment sessions.
Conclusion:
Tongdu Xingshen acupuncture is a potential complementary therapy to optimize clinical outcomes in PVS.
The changing pattern of ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin's lymphoma as non-AIDS-defining cancers, by HIV status, in Tanzania over 11 years (2002-2012): a retrospective case-report study
Authors: Clare Meernik, Amr S Soliman, Twalib Ngoma, Crispin Kahesa, Julius Mwaiselage, Sofia D Merajver
Journal: Infect Agent Cancer (2014)
Keywords: hiv, non-aids-defining cancer, ocean road cancer institute, squamous cell carcinoma of the eye, tanzania

Background:
In Tanzania, 5.1% of adults aged 15-49 are infected with HIV. While rates of HIV-related malignancies have declined globally with antiretroviral therapy (ART), including Tanzania, rates of non-AIDS-defining cancers (NADCs) are believed to have increased. Therefore, we determined trends of three NADCs in Tanzania: ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin's lymphoma.
Methods:
This study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam. All medical records of patients diagnosed with ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin's lymphoma between 2002 and 2012 were reviewed regarding HIV status, cancer clinical characteristics and management. Analysis was conducted to determine trends and proportions in these three NADCs and patient characteristics.
Results:
We identified 980 NADCs. The relative proportion of these three NADCs at ORCI out of all cancers treated increased from 2.37% in 2002 to a peak of 4.34% in 2009. The prevalence of HIV in patients diagnosed with these NADCs also increased-from 6.67% in 2002 to 20.87% in 2010-and 85% of squamous cell carcinoma of the eye cancer patients with a reported HIV status were HIV-positive.
Conclusions:
The frequency and proportions of these three NADCs in Tanzania have increased over the past 11 years, as has the prevalence of HIV positivity amongst these NADC patients. The current and possibly increasing burden of NADCs in Tanzania and other low- and middle-income countries with high HIV rates should be a focus for future cancer prevention and control and HIV therapy programs.
SARS-CoV-2 and Streptococcus pneumoniae Coinfection in a Previously Healthy Child
Authors: Kimberly C Vu, Gloria P Heresi, Michael L Chang
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in December 2019 in Wuhan, China. This novel coronavirus has been responsible for a pandemic that continues to devastate nations worldwide. COVID-19, like other viruses, causes pneumonia. However, unlike other viral respiratory tract infections such as influenza, bacterial coinfection in COVID-19 patients has uncommonly been described in adult and pediatric patients. We report a case of Streptococcus pneumoniae and COVID-19 coinfection in a previously healthy 4-year-old child.
Removal of Eroded Gastric Bands Using a Transgastric SILS Device
Authors: C Spitali, K De Vogelaere, G Delvaux
Journal: Case Rep Surg (2013)

Background. Laparoscopic adjustable gastric banding (LAGB) is a popular method for the treatment of morbid obesity. One of the most feared complications is gastric band erosion which occurs with a reported incidence of 0.3 to 14%. Intragastric migrated bands are best managed by endoscopic removal. Recent case studies reported successful endoscopic removal of intragastric migrated bands, but it is not always possible. We report our first experience with a transgastric removal of eroded bands using a Single Incision Laparoscopic Surgery (SILS) device. Methods. A patient who underwent gastric banding in the past (2007) presented with symptoms of epigastric pain and weight gain. Preoperative gastroscopy revealed stomach wall erosion with the gastric band partially (2/3) migrated into the gastric lumen. Attempts to remove the band by endoscopy were not successful. A laparoscopy was performed and multiple adhesions with evidence of inflammation was seen in the upper abdomen around the band. A SILS port was inserted through a 2 cm incision in the left hypochondrium with the internal ring of the port placed into the stomach through a small anterior gastrotomy. The band was cut in the stomach and removed. The anterior gastrotomy was closed. We had a perfect intragastric view of the gastric banding. Results. There were no intra- or postoperative complications. The patient was discharged on the fifth postoperative day on a gastric adapted diet. Conclusion. Removal of a gastric band after gastric erosion by SILS is feasible, safe, and effective. This is the first reported case of transgastric removal of eroded bands using an SILS device.
Bacterial Pericarditis Caused by Campylobacter fetus subsp. fetus After Mutton Consumption
Authors: Takaaki Shigematsu, Yasushi Shibue
Journal: Cureus (2023)
Keywords: acute pericarditis, bacteremia, blood stream infection, campylobacter fetus, campylobacteriosis, foodborne illness, pericarditis, raw meat, undercooked meat, zoonoses
MeSH terms: Case Reports

Campylobacter fetus subsp. fetus causes systemic diseases including bacteremia and meningitis. However, it rarely causes bacterial pericarditis. We present a rare case of bacterial pericarditis caused by Campylobacter fetus subsp. fetus. A man in his 60s presented with a fever and dyspnea. Electrocardiography revealed ST segment elevation in all leads except augmented vector right (aVR), and contrast-enhanced computed tomography of the chest revealed a large pericardial effusion. Campylobacter fetus subsp. fetus, appearing as curved, gull-wing-shaped gram-negative rods on microscopy, was identified on blood culture. The patient was diagnosed with acute pericarditis caused by Campylobacter fetus subsp. fetus. Further, history-taking revealed that he had consumed undercooked mutton before the onset of his illness. He recovered after treatment with antibiotics (ceftriaxone, ampicillin, and amoxicillin) for four weeks. With a blood culture revealing gull-wing shaped gram-negative rods, and the patient's history including potential contact with animals or the consumption of raw or undercooked meat, Campylobacter fetus subsp. fetus infection should be suspected.
Parathyroid carcinoma: an unusual presentation of a rare neoplasm
Authors: Sharma Shruti, Fouzia Siraj
Journal: Ger Med Sci (2017)
Keywords: hyperparathyroidism, parathyroid adenoma, parathyroid carcinoma
MeSH terms: Adenoma / diagnosis, Carcinoma / diagnosis, Carcinoma / pathology, Parathyroid Neoplasms / diagnosis, Parathyroid Neoplasms / pathology, Case Reports, Adult, Diagnosis, Differential, Female, Humans, Neoplasm Invasiveness

Parathyroid carcinoma is an extremely rare malignant endocrine neoplasm that is very challenging in its diagnosis as well as its treatment. Clinically the disease is detected earlier in patients who present with hyperparathyroidism with signs of profound hypercalcemia. Differentiation between benign and malignant disease of the parathyroid is challenging both for the clinician and for the pathologist. Complete surgical resection at the time of first operation offers the best chance of cure. Even after radical excision which is the standard management, local recurrence and metastases are frequent. The disease usually has a slow indolent course and most patients suffer from complications of hypercalcemia rather than tumor invasion or metastasis. We report a case of a 31-year-old woman who presented with renal colic. Various hematological, biochemical and radiological investigations were performed and a slightly enlarged right parathyroid was found. A clinical diagnosis of parathyroid adenoma was made and a right parathyroidectomy was done. Intraoperatively the surgeon had no suspicion of malignancy but microscopically the lesion was malignant and a final diagnosis of parathyroid carcinoma was rendered based on the criteria of invasion. Since there is no gold standard, a multidisciplinary approach, including the entire clinical, biochemical, radiological and pathological profile of the disease aids in an accurate diagnosis. Here we are reporting a case of a functional parathyroid carcinoma presenting in a relatively young patient with all the biochemical and radiological investigations and intraoperative findings pointing towards a benign parathyroid disease.
A case of traumatic thoracic aorta rupture - A life threatening emergency
Authors: Rupesh Kumar, Javid Raja, Ganesh Kumar Munirathinam, Anand Kumar Mishra, Rana Sandeep Singh, Shyam Kumar Singh Thingnam
Journal: J Cardiovasc Thorac Res (2019)
Keywords: aorta, aortic rupture, aortic transection
MeSH terms: Case Reports

Traumatic aortic transection is a life threatening emergency where there is a near-complete tear through all the layers of the aorta due to trauma. This condition is most often lethal and requires immediate medical attention. Symptoms of an aortic rupture may include severe chest pain, back pain, abdominal pain and signs of external chest injury. Treatment should be prompt in hemodynamically unstable patient in the form of endovascular or open surgical technique. We present a twenty nine year old male with aortic transection following motor vehicle accident where an interposition tube graft was placed after trimming the lacerated segments of the aorta under cardiopulmonary bypass. The patient is doing well with two years of follow up at our institution.
Gestational Choriocarcinoma Presenting with Lacrimal Gland Metastasis: A First Reported Case
Authors: Naushad A B Ahamed, Khalid Sait, Nisreen Anfnan, Khader Farwan, S H M Nizamuddin, Saleh S Baeesa
Journal: Case Rep Obstet Gynecol (2015)

Background. Gestational choriocarcinoma (GC) is a recognized clinicopathological subtype of gestational trophoblastic neoplasia that usually metastasizes hematogenously to highly vascular organs like the lung, liver, and brain. However, orbital metastasis to the choroid and lacrimal gland is a rare occurrence. Case Presentation. A 21-year-old female presented with headache and left orbital swelling one year after resection of a complete hydatidiform mole followed by adjuvant methotrexate chemotherapy. A metastatic imaging screening revealed multiple metastases in the lungs, brain, and adrenal gland, in addition to the choroid and lacrimal gland. Based on her modified WHO risk factors scoring she was started on chemotherapy and whole brain radiotherapy, which resulted in a complete response. At two-year follow-up, serum b-HCG level was with normal limits; imaging surveillance was uneventful. Conclusion. We present the first case of lacrimal gland metastasis in a young girl from GC relapse.
Demystifying Acute Pain Management in the Emergency Department: A Case-Based Approach
Authors: Morgan Sehdev, Jason Lewis, Antje Barreveld
Journal: MedEdPORTAL (2023)
Keywords: acute pain, analgesia, case-based learning, chalk talk, clinical teaching/bedside teaching, emergency medicine, pain management, pain medicine
MeSH terms: Acute Pain / diagnosis, Acute Pain / therapy, Pain Management, Case Reports, Calcium Carbonate, Education, Medical, Graduate, Emergency Service, Hospital, Humans, Calcium Carbonate

Introduction:
Acute pain is one of the most common complaints that presents to the emergency department. Despite its ubiquity, oligoanalgesia, or the undertreatment of pain, remains a problem in medicine, possibly due to minimal dedicated pain teaching for senior medical students transitioning to residency.
Methods:
We designed a 2.5-hour interactive seminar for senior medical students transitioning into residency. The seminar included a chalk talk and case-based discussion, reviewed pain physiology, revisited pain assessment, and introduced pain management strategies using a novel acute pain plan to organize an analgesic approach from presentation through disposition from the emergency department. The didactic chalk talk was interwoven with a case of acute pain. Seminar materials promoted a near-peer teaching opportunity for future facilitators. Learners completed open-ended pre-/postsession knowledge assessments.
Results:
Data were obtained from 19 fourth-year medical students enrolled in three iterations of a preinternship course at Harvard Medical School. Prior to the seminar, learners scored an average of 23.0 out of 53.0 points (SD = 9.0) on the knowledge assessment, which improved to 36.6 out of 53.0 points (SD = 6.7) following the seminar (paired t test p < .001). Learner satisfaction data revealed a positive response to the seminar: Learners felt more confident managing pain and highly recommended the seminar's continuation in the future.
Discussion:
Initial data from this seminar suggest a need for and benefit of targeted pain education for senior medical students. Seminar materials can easily be adapted for learners in other departments or in early graduate medical education.