OpenMed/multicare-articles huggingface dataset:
Case Report: Four cases of cardiac sarcoidosis in patients with inherited cardiomyopathy-a phenotypic overlap, co-existence of two rare cardiomyopathies or a second-hit disease
Authors: Hans Ebbinghaus, Laura Ueberham, Daniela Husser-Bollmann, Andreas Bollmann, Ulrich Laufs, Borislav Dinov
Journal: Front Cardiovasc Med (2023)
Keywords: cardiac sarcoidosis, conduction disease, familial cardiomyopathy, non-ischemic cardiomyopathy, ventricular tachyarrhythmias
MeSH terms: Case Reports

Cardiac sarcoidosis (CS), a rare condition characterized by non-caseating granulomas, can manifest with symptoms such as atrioventricular block and ventricular tachycardia (VT), as well as mimic inherited cardiomyopathies. A 48-year-old male presented with recurrent VT. The initial 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) scan showed uptake of the mediastinal lymph node. Cardiovascular magnetic resonance (CMR) demonstrated intramyocardial fibrosis. The follow-up 18FDG-PET scan revealed the presence of tracer uptake in the left ventricular (LV) septum, suggesting the likelihood of CS. Genetic testing identified a pathogenic LMNA variant. A 47-year-old female presented with complaints of palpitations and syncope. An Ajmaline provocation test confirmed Brugada syndrome (BrS). CMR revealed signs of cardiac inflammation. An endomyocardial biopsy (EMB) confirmed the diagnosis of cardiac sarcoidosis. Polymorphic VT was induced during an electrophysiological study, and an implantable cardioverter-defibrillator (ICD) was implanted. A 58-year-old woman presented with sustained VT with a prior diagnosis of hypertrophic cardiomyopathy (HCM). A genetic work-up identified the presence of a heterozygous MYBC3 variant of unknown significance (VUS). CMR revealed late gadolinium enhancement (LGE), while the 18FDG-PET scan demonstrated LV tracer uptake. The immunosuppressive therapy was adjusted, and no further VTs were observed. A 28-year-old male athlete with right ventricular dilatation and syncope experienced a cardiac arrest during training. Genetic testing identified a pathogenic mutation in PKP2. The autopsy has confirmed the presence of ACM and a distinctive extracardiac sarcoidosis. Cardiac sarcoidosis and inherited cardiomyopathies may interact in several different ways, altering the clinical presentation. Overlapping pathologies are frequently overlooked. Delayed or incomplete diagnosis risks inadequate treatment. Thus, genetic testing and endomyocardial biopsies should be recommended to obtain a clear diagnosis.
A case of intraductal papillary neoplasm of the bile duct suspected to be of peribiliary glands origin
Authors: Takuya Ogiso, Hirotaka Suzuki, Hiroshi Matsubara, Takehito Naito, Masahiro Yamada, Hideko Yamamoto, Shun Hattori, Taro Aoba, Yoshifumi Arai, Fumihiro Urano
Journal: DEN Open (2024)
Keywords: bile duct, intraductal papillary neoplasm of the bile duct, mucobilia, peribiliary glands, peroral cholangioscopy
MeSH terms: Case Reports

Peribiliary glands are complex lobular structures containing mucus and serous glands, distributed along the extrahepatic and intrahepatic bile ducts. In this report, we describe a case of intraductal papillary neoplasm of the bile duct suspected to be of peribiliary glands origin. The patient was an 80-year-old man who was referred to our hospital for a hepatic mass. On further examination, a 38 × 34 mm cystic lesion with papillary growth was found in S1/4. Because the lesion was extensively bordered by both hepatic ducts and the connection was unclear, it was difficult to determine the extent of hepatic resection. To confirm the location, a peroral cholangioscopy was performed. The connection with the cyst was detected in the right hepatic duct and a villous tumor mucosa protruded through the conduit lumen. Since we found that the lesion communicated with the right hepatic duct, a right hepatectomy was subsequently performed. The postoperative pathological diagnosis was an intraductal papillary neoplasm of the blie duct with associated invasive carcinoma. The postoperative course was good, and the patient experienced no recurrence.
Nurseped: educational technology for safety in the management of intravenous antibiotics in pediatrics
Authors: Amanda Paiva Bernardes Alves, Natália Del' Angelo Aredes, George Oliveira Silva, Faétila Dos Santos Oliveira, Luciana Mara Monti Fonseca, Laiane Medeiros Ribeiro
Journal: Rev Lat Am Enfermagem (2023)
MeSH terms: Anti-Bacterial Agents / administration & dosage, Anti-Bacterial Agents / therapeutic use, Child Health, Educational Technology, Infections / drug therapy, Infections / nursing, Patient Safety, Review, Validation Study, Administration, Intravenous, Child, Feedback, Hospitalization, Humans, Surveys and Questionnaires, Anti-Bacterial Agents

Objective:
to develop and validate the content of a serious game on the safe management of intravenous medications in pediatrics.
Method:
methodological study for the development and content validation of an educational technology. The cases and challenges of the serious game were developed based on a literature review and validated by 11 nurses with training and experience in the area. Content validity and agreement indices were adopted to analyze agreement and internal consistency (minimum of 0.8).
Results:
the content is based on the main antibiotics used in the clinical management of infections in hospitalized children and patient safety. Absolute agreement was obtained in 60 of the 61 items evaluated, and the minimum obtained was 0.82 in the content validation index and 0.80 in agreement. Adjustments were suggested by experts in the response statement for a specific case and implemented to improve the quality of the technology content.
Conclusion:
the content of the serious game Nurseped was validated by nurse experts in child health regarding clinical cases, question statements and multiple-choice answers, in addition to feedback that presents the user with an evidence-based answer after getting the challenge right or wrong.
Case Report: Shewanella algae, a rare cause of osteosynthesis-associated infection
Authors: Sofiane Masmoudi, Mohamed Ali Khlif, Hajer Battikh, Meriam Zribi, Maher Barsaoui, Khaled Zitouna
Journal: F1000Res (2024)
Keywords: hematogenous, infection, osteosynthesis, osteosynthesis-associated infection, shewanella
MeSH terms: Gram-Negative Bacterial Infections / drug therapy, Gram-Negative Bacterial Infections / microbiology, Shewanella, Case Reports, Adolescent, Anti-Bacterial Agents / therapeutic use, Fracture Fixation, Internal / adverse effects, Humans, Male, Anti-Bacterial Agents, Shewanella algae

Shewanella is an emerging human pathogen. It mostly causes skin and soft tissue infections. Osteosynthesis-associated infection involving Shewanella are rare and in most cases are secondary to direct contamination following open fractures in aquatic environments. Here, we present a rare case of hematogenous osteosynthesis-associated infection involving Shewanella algae affecting an 18-year-old patient who was operated on for 12 th thoracic vertebrae and 4th lumbar vertebrae fractures occurring in an aquatic environment. We performed surgical debridement with subsequent double course parenteral antibiotherapy that was then adapted to bacteria sensitivities for three weeks. After a follow-up of six months, the patient had no signs of recurrent infection. The presence of infected dermabrasions and the concordance between germs isolated in operative samples and in blood cultures presumes that the contamination was hematogenous.
A Stent Misplaced in the Septal Perforating Artery: Right Ventricular Fistula, Interventricular Septal Hematoma, and Right Ventricular Outflow Tract Obstruction
Authors: Melik Demir, Murat Gök, Muhammet Gürdoğan, Osman Kula, Fethi Emre Ustabaşıoğlu, Kenan Yalta
Journal: Arq Bras Cardiol (2023)
MeSH terms: Fistula, Percutaneous Coronary Intervention, Ventricular Outflow Obstruction, Right, Case Reports, Coronary Vessels, Hematoma / diagnostic imaging, Hematoma / etiology, Humans, Stents / adverse effects

Coronary-cameral fistulas, though mostly regarded as congenital entities, have also been encountered as complications of major traumas and percutaneous coronary interventions (PCIs).1 On the other hand, interventricular septal (IVS) hematoma might potentially arise mostly during retrograde chronic total occlusion (CTO) interventions and has a benign course in this context.2 Herein, we describe a challenging PCI complication (and its management strategy) presenting with IVS hematoma, right ventricular fistula, and right ventricular outflow tract (RVOT) obstruction due to a misimplanted coronary stent in the septal perforating artery (SPA).
Long-term, repeated doses of intravenous autologous mesenchymal stem cells for a patient with Parkinson's disease: a case report
Authors: Ridhima Vij, Alan Prossin, Mallika Tripathy, Hosu Kim, Hyeonggeun Park, Thanh Cheng, Djamchid Lotfi, Donna Chang
Journal: Front Neurol (2023)
Keywords: parkinson's disease, adipose derived, autologous, case report, mesenchymal stem cells
MeSH terms: Case Reports

Parkinson's disease (PD) is a neurodegenerative disease that involves the loss of dopaminergic neurons in the substantia nigra pars compacta of the basal ganglia. Clinically, patient presentation involves a combination of motor and non-motor symptoms characterized by progressive worsening over time and significant decreases in overall quality-of-life. Despite there being no fully restorative cure for PD, Mesenchymal Stem Cell (MSC) therapy offers promising therapeutic potential. Here, we report a case of a 77-year-old female, living with idiopathic Parkinson's Disease for over 17 years. The patient received multiple infusions of autologous Hope Biosciences adipose-derived MSCs (HB-adMSCs). A total of 26 infusion treatments of HB-adMSCs were administered over the course of ~2 years that resulted in marked improvements in her typical Parkinsonian symptoms, as demonstrated by the decreases in her UPDRS (Unified Parkinson's Disease Rating Scale) scores. Changes in clinical scores mirrored concurrent changes in regional brain metabolism as quantified by FDG-PET (Fluorodeoxyglucose-Positron Emission Tomography), compared to baseline. Long-term, multiple infusions of HB-adMSCs were safely tolerated by the patient without any serious adverse events. Further research is needed to evaluate the safety and efficacy of HB-adMSC therapy for the treatment of PD patients.
Case report: Successful anesthesia management of noncardiac surgery in a patient with single atrium
Authors: Hong Cao, Mengmeng Jiang, Zhao Zhuang, Shoushi Wang, Qianqian Cao
Journal: Front Pharmacol (2024)
Keywords: case report, epidural anesthesia, pulmonary hypertension, single atrium, transthoracic echocardiography
MeSH terms: Case Reports

Background:
Single atrium is very rare congenital cardiac anomaly in adults. The prognosis of patients with single atrium is very poor, with 50% of patients dying owing to cardiopulmonary complications in childhood. Herein, we focused on anesthesia management for noncardiac surgery in patients with single atrium.
Case presentation:
A 58-year-old male with a history of bilateral varicocele underwent laparotomy for high-position ligation of the spermatic vein. The patient also had a history of single atrium, atrial fibrillation, chronic heart failure, pulmonary hypertension (PH), and complete right bundle branch block (CRBBB). Given the significant complications associated with general anesthesia in patients with PH, we preferred to use low-dose epidural anesthesia for this patient. Transthoracic echocardiography was used to assess cardiac function before and during surgery and guide perioperative fluid therapy. To limit the stress response, we used a regional nerve block for reducing postoperative pain. Furthermore, we used norepinephrine to appropriately increase the systemic vascular resistance in response to the reduction of systemic vascular resistance caused by epidural anesthesia.
Conclusion:
Low-dose epidural anesthesia can be safely used in patients with single atrium and PH. The use of perioperative transthoracic echocardiography is helpful in guiding fluid therapy and effectively assessing the cardiac structure and function of patients. Prophylactic administration of norepinephrine before epidural injection may make it easier to maintain the patient's BP.
A Case of Spontaneous Coronary Artery Dissection
Authors: Connor Rougelot, Micah Pippin
Journal: Cureus (2024)
Keywords: acute coronary syndrome (acs), atypical spontaneous coronary artery dissection, coronary artery dissection (cad), spontaneous coronary dissection, st elevations
MeSH terms: Case Reports

Spontaneous coronary artery dissection (SCAD) is the development of an intramural hematoma that causes a false lumen to form, leading to occlusion and ischemia. It is a rare but separate pathologic cause of acute coronary syndrome, more commonly occurring in females and often associated with underlying vascular conditions. Definitive diagnosis requires invasive coronary angiography. Management is similar to that of myocardial infarction caused by atherosclerosis; however, the majority of SCADs are managed conservatively, as stenting often leads to worse outcomes. Diagnostic and management strategies are primarily based on consensus, with minimal randomized control trials or prospective analyses available to guide patient care.
Extra-pontine Myelinolysis After Rapid Correction of Hyponatremia Responding to Levodopa
Authors: Jagannath Dhadwad, Anish Chitnis
Journal: Cureus (2024)
Keywords: extra-pontine myelinolysis (epm), hypovolemic hyponatremia, oral levodopa, osmotic demyelination syndrome (ods), secondary parkinsonism
MeSH terms: Case Reports

Osmotic demyelinating disease of the central nervous system has two variants: central pontine myelinolysis and extra-pontine myelinolysis (EPM). Up to 10% of cases of osmotic demyelination syndrome are associated with EPM, which mostly affects the thalamus and basal ganglia. It is commonly associated with the rapid correction of hyponatremia. An elderly woman in her 60s presented with complaints of acute gastroenteritis and giddiness and visited the emergency ward. On examination, she was conscious and oriented to time but disoriented to place and person and had slurring of speech with signs of dehydration. Her serum sodium levels were 100 meq/L, and her brain MRI was normal. After shifting her to the intensive care unit, she was treated with 200 ml of 3% NaCl bolus to correct her hyponatremia. On day three, she began developing rigidity in both lower limbs, which progressed to the upper limbs with hyperreflexia and mutism. A brain MRI was done, which showed subtle hyperintensities in the caudate lobe with no other new findings. Her serum aldosterone and cortisol were on the lower side of the normal range. Treatment of tablet levodopa-carbidopa (100/25) combination thrice a day (TDS) led to an improvement in her health condition.
A case report of IgG4-related hepatic inflammatory pseudotumor in a 3-year old boy
Authors: Qian Wan, Zhongjin Xu, Xiaohui Liu, Zhuqiang Wu, Qingmei Zhong, Chongjun Wu
Journal: Front Immunol (2024)
Keywords: igg4-related disease, child, hepatic inflammatory pseudotumor, liver biopsy, steroid
MeSH terms: Granuloma, Plasma Cell / diagnosis, Granuloma, Plasma Cell / drug therapy, Granuloma, Plasma Cell / immunology, Immunoglobulin G / blood, Immunoglobulin G / immunology, Immunoglobulin G4-Related Disease / diagnosis, Case Reports, Biopsy, Child, Preschool, Diagnosis, Differential, Humans, Immunosuppressive Agents / therapeutic use, Liver / diagnostic imaging, Liver / immunology, Liver / pathology, Liver Diseases / diagnosis, Liver Diseases / immunology, Male, Tomography, X-Ray Computed

Background:
Hepatic Inflammatory Pseudotumor (IPT) is an infrequent condition often masquerading as a malignant tumor, resulting in misdiagnosis and unnecessary surgical resection. The emerging concept of IgG4-related diseases (IgG4-RD) has gained widespread recognition, encompassing entities like IgG4-related hepatic IPT. Clinically and radiologically, corticosteroids and immunosuppressive therapies have proven effective in managing this condition.
Case presentation:
A 3-year-old Chinese boy presented to the clinic with an 11-month history of anemia, fever of unknown origin, and a tender hepatic mass. Blood examinations revealed chronic anemia (Hb: 6.4 g/L, MCV: 68.6 fl, MCH: 19.5 pg, reticulocytes: 1.7%) accompanied by an inflammatory reaction and an elevated serum IgG4 level (1542.2 mg/L). Abdominal contrast-enhanced computed tomography unveiled a 7.6 cm low-density mass in the right lateral lobe, while magnetic resonance imaging demonstrated slight hypointensity on T1-weighted images and slight hyperintensity on T2-weighted images, prompting suspicion of hepatic malignancy. A subsequent liver biopsy revealed a mass characterized by fibrous stroma and dense lymphoplasmacytic infiltration. Immunohistochemical analysis confirmed the presence of IgG4-positive plasma cells, leading to the diagnosis of IgG4-related hepatic IPT. Swift resolution occurred upon initiation of corticosteroid and mycophenolate mofetil therapies.
Conclusion:
This study underscores the diagnostic approach to hepatic IPT, utilizing histopathology, immunostaining, imaging, serology, organ involvement, and therapeutic response. Early histological examination plays a pivotal role in clinical guidance, averting misdiagnosis as a liver tumor and unnecessary surgical interventions.
The Effect of Double Carbapenem Regimen in the Management of Carbapenem-Resistant Klebsiella pneumoniae Infections: A Report of Five Cases
Authors: Radhika Soanker, Lakshmi Vemu, Sukanya Vimala, Padmaja Kanne, Venu M Thumma, Gayatri Chavala
Journal: Cureus (2024)
Keywords: difficult to treat pathogens, extensively-drug resistant, k pneumoniae producing carbapenemase, metallo beta-lactamase, pan-drug resistant
MeSH terms: Case Reports

The treatment of infections caused by carbapenem-resistant organisms is challenging. Carbapenems in combination with vaborbactam and relebactam are recommended to treat infections caused by extensively drug-resistant organisms including carbapenemase-producing isolates, while ceftazidime-avibactam plus aztreonam, or cefiderocol is recommended for infections caused by New Delhi metallo beta-lactamase (NDM)-producing Enterobacteriaceae. As, in India, except for ceftazidime-avibactam and aztreonam, the other drugs are not approved for marketing, in this case report, the role of a double carbapenem regimen (ertapenem plus meropenem) in the treatment of carbapenem-resistant Klebsiella pneumoniae infections has been presented. In one case, the in vitro effect of the double carbapenem regimen on pan drug-resistant (PDR) K. pneumoniae isolates from a blood culture specimen of a critically ill patient using a time-kill study is presented. In this case, only a double carbapenem regimen with 2 MIC (minimum inhibitory concentration) meropenem + 2 MIC ertapenem demonstrated bactericidal activity by inhibition of bacterial growth of PDR K. pneumoniae isolate, at four and eight hours, which was sustained till 24 hours. However, while 2 MIC meropenem + 2 MIC colistin inhibited bacterial growth at four hours and eight hours, bacterial regrowth occurred by 24 hours. In addition, four cases of critically ill patients with infections caused by carbapenem-resistant Enterobacteriaceae are presented in whom a double carbapenem regimen was recommended for treatment. Of these four cases, a complete clinical cure was observed in three cases, and a microbiological cure in the fourth case. As the double carbapenem regimen demonstrated effect in an in vitro time-kill study in the first case and on clinical outcomes in three out of the latter four cases, it appears to be a life-saving, salvage therapy in infections caused by carbapenem-resistant K. pneumoniae in India.
Vasculitis, an Early Unusual Presentation of Rheumatoid Arthritis: A Case Report
Authors: Ashutosh Kashyap, Biraj Pokhrel, Aaraju Bhatta, Savita Aryal, Shambhu Khanal
Journal: Cureus (2024)
Keywords: corticosteroids, gangrene, rheumatoid arthritis, rheumatoid vasculitis, vasculitis
MeSH terms: Case Reports

Rheumatoid arthritis (RA) is a chronic inflammatory disease, with rheumatoid vasculitis (RV) being its most threatening complication. We report a case of a 70-year-old female presenting with gangrene of the tips of fingers and toes early in the course of RA, which is a rare manifestation. The skin is the most commonly affected organ in RV, followed by the peripheral nerves. However, almost every organ system can get implicated. The management of RV is mostly empirical, with high-dose glucocorticoids and cyclophosphamide. Early diagnosis and optimum management are essential in preventing severe complications of the disease.
Case report: Diagnostic challenge: a new multiple sclerosis "relapse" leading to the diagnosis of anaplastic astrocytoma
Authors: Martina Petrášová, Iva Šrotová, Jan Kolčava, Pavel Štourač, Ludmila Hynková, Miloš Keřkovský, Hana Pikulová, Eduard Neuman, Leoš Kren, Eva Vlčková
Journal: Front Neurol (2024)
Keywords: astrocytoma, case report, magnetic resonance imaging, multiple sclerosis, positron-emission tomography
MeSH terms: Case Reports

Cerebral tumors and multiple sclerosis (MS) can show overlapping clinical and magnetic resonance imaging (MRI) features and even occur concurrently. Due to the emergence of new symptoms, not usually MS related, an MRI was conducted in a 29-year-old woman with relapsing-remitting MS and showed a significant size progression of a parieto-occipital lesion, with mild clinical correlates, such as blurred vision, difficulty in speaking, and headache. Contrast-enhanced MRI and fluorothymidine positron-emission tomography (PET) did not point toward neoplasm, a lesion biopsy, however, showed astrocytoma, which was confirmed as grade III astrocytoma after the radical resection of the tumor. In the case of an atypical lesion, a tumor should be considered in patients with MS. A small fraction of high-grade gliomas show no enhancement on MRI and no hypermetabolism on PET. Biopsy proved to be the essential step in a successful diagnostic workup. To the best of our knowledge, this is the first case of anaplastic astrocytoma with these radiological features reported in a patient with MS.