OpenMed/multicare-articles huggingface dataset:
BRAF L485-P490 deletion mutant metastatic melanoma sensitive to BRAF and MEK inhibition: A case report and literature review
Authors: Simeng Zhang, Zichang Yang, Yu Cheng, Xiaoyu Guo, Chang Liu, Shuo Wang, Lingyun Zhang
Journal: Front Pharmacol (2023)
Keywords: braf in-frame deletion mutation, case report, dabrafenib, metastatic melanoma, trametinib
MeSH terms: Case Reports

Background: The combination therapy of BRAF inhibitors (BRAFis) and MEK inhibitors (MEKis) has been approved as a first-line treatment for metastatic melanoma with BRAF V600 mutants. Recently, BRAF mutations have been divided into three subtypes based on biochemical and signaling characteristics. Unlike V600 mutants that show class I BRAF mutations, evidence of the effects of using BRAF inhibitors and MEK inhibitors in patients with non-V600 BRAF mutations remains unclear. The exploration of effective therapy for non-V600 BRAF mutations in melanoma has thus attracted much interest. Case presentation: We reported a case of a 64-year-old female metastatic melanoma patient with a novel BRAF p.L485-P490 deletion mutation. The patient received anti-PD1 agent pembrolizumab (100 mg) therapy as the first-line treatment for two cycles, which was terminated due to an intolerable adverse effect. Considering the p.L485-P490 deletion mutation signal as an active dimer which is akin to a class II BRAF mutation, the patient underwent dabrafenib and trametinib combination therapy as a second-line treatment. After two cycles of combination treatment, the patient achieved a partial response confirmed by radiological examinations. At the last follow-up date, the patient had obtained over 18 months of progression-free survival, and the treatment was well tolerated. Conclusion: The combination therapy of dabrafenib and trametinib has been proven to be an effective method as a later-line therapy for metastatic melanoma patients with class II BRAF in-frame deletion mutations.
Research in child and adolescent psychiatry in India
Authors: Priyavadan Chandrakant Shastri, Jay P Shastri, Dimple Shastri
Journal: Indian J Psychiatry (2010)
Keywords: child, adolescent, case reports, mental health, mental illness, original articles, review articles

The primary source for this annotation on child and adolescent psychiatry is Indian Journal of Psychiatry. Articles covering various dimensions of child and adolescent mental health were searched from its electronic data base to discuss relevant articles. Literature was mainly in the form of original research articles, review articles, case reports, editorials, orations and presidential address.
Understanding creative teaching in twenty-first century learning among Islamic education teachers during the COVID-19 pandemic
Authors: Hafizhah Zulkifli, Ab Halim Tamuri, Nor Alniza Azman
Journal: Front Psychol (2022)
Keywords: covid-19, creative teaching, education, teacher, twenty-first century learning

Education during the COVID-19 pandemic required teachers to be creative because students might not be able to complete education in a normal way. However, Islamic education teachers seem to lack the skills and attitudes required for twenty-first century learning, including creative teaching. The purpose of this study is to explore if Islamic education teachers were able to teach creatively by responding to twenty-first century learning during the pandemic. A qualitative methodology was adopted using a case study design. The sample consisted of four Islamic education teachers from Putrajaya schools. Our findings illustrated that there were six themes that emerged as elements of creative teaching in twenty-first century learning. These were: student-centered learning, twenty-first century teaching, creative inspirations, creative strategies, creative activities, and alternative evaluation. This study found Islamic education teachers to be creative in teaching and it demonstrated the professional development of Islamic education teachers.
Case report: Androgen-secreting adrenocortical tumors in eight cats
Authors: Caylen G Erger, Allison L Gerras, Alan J Conley, Chen Gilor, Karah Burns DeMarle, Kent R Refsal, Jamie M Fleming, Dodd G Sledge, Daniel K Langlois
Journal: Front Vet Sci (2023)
Keywords: adrenal, aggression, androstenedione, behavior, periuria, testosterone
MeSH terms: Case Reports

Urine marking, aggression, and other behavioral concerns are common reasons for cat owners to seek veterinary care. Empiric treatment for lower urinary tract disease or primary behavior disorders are commonly pursued, especially in those cases with normal routine laboratory evaluations. Herein, we report the clinicopathologic findings in eight sexually altered cats that were diagnosed with androgen-secreting adrenocortical tumors. Nearly all cats (n = 7) initially were evaluated for inappropriate urination and pungent urine, with additional behavioral concerns including aggression (n = 3) and excess vocalization (n = 4) commonly reported. Penile barbs (n = 5) were identified in all five male cats, and an enlarged clitoris was observed in one female cat. Testing of serum androgen concentrations revealed abnormally high androstenedione (n = 1) or testosterone (n = 7) concentrations. In the five cases with available adrenal tissue, histopathologic evaluation identified either an adrenocortical adenoma (n = 3) or adrenocortical carcinoma (n = 2). Hormonal abnormalities resolved and clinical signs improved in the four cats that underwent surgical adrenalectomy, with each of these cats surviving >1 year. However, clinical signs were minimally impacted with medical treatments, including one cat in which trilostane treatment failed to improve clinical signs or testosterone concentrations. This collection of cases underscores the importance of a detailed physical examination as well as the consideration of endocrine disturbances in cats undergoing evaluation for inappropriate urination or aggression. Furthermore, this report adds to the growing body of evidence that sex-hormone secreting adrenal tumors in cats may be an under-recognized syndrome.
Primary hepatic lymphoma of MALT type mimicking hepatic adenoma treated by hepatectomy: a case report and literature review
Authors: Ren-Long Wang, Jia Wang, Yong-Sheng Li, Yuan Wang, Qiong Su
Journal: Front Surg (2023)
Keywords: case report, hepatectomy, mucosal-associated lymphoid tissue, non-hodgkin lymphoma, primary hepatic lymphoma
MeSH terms: Case Reports

Background:
Primary hepatic lymphoma (PHL) is a rare malignant tumor. Extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT) is an indolent lymphoma occurring at extranodal sites. The stomach is the most common organ affected by MALT lymphoma, whereas liver-related lymphoma is rarely reported. Its atypical clinical presentation often delays the diagnosis. Owing to the rarity of PHL, identifying its optimal treatment still remains a challenge. Herein, we report a case of PHL of the MALT type mimicking hepatic adenoma that was treated by hepatectomy without chemotherapy and review the scarce literature. Our findings suggest that surgery is an alternative approach to cure patients with localized hepatic lymphoma.
Case summary:
A 55-year-old woman was admitted to our hospital because of upper abdominal discomfort, and a liver lesion was detected by computed tomography. She did not have nausea, fever, fatigue, jaundice, weakness, night sweats, or weight loss before admission. And her previous medical history was unremarkable. There were no positive signs on physical examination. Based on her preoperative examination including magnetic resonance imaging, the liver lesion was suspected to be a hepatic adenoma; however, the possibility of it being a malignancy like hepatocellular carcinoma was not excluded. Therefore, a decision of resection of the lesion was made. During the operation, hepatectomy of segment 4b and cholecystectomy were performed. The patient recovered well; however, after postoperative pathological examination, the lesion was diagnosed as a hepatic lymphoma of MALT type. The patient was reluctant to undergo chemotherapy or radiotherapy. At 18-month follow-up, no significant recurrence was observed, indicating that the treatment had a curative effect.
Conclusion:
Notably, primary hepatic lymphoma of MALT type is a rare, low-grade B-cell malignancy. Making an accurate preoperative diagnosis of this disease is usually difficult, and liver biopsy is an appropriate avenue to improve the diagnostic accuracy. In patients with a localized tumor lesion, hepatectomy followed by chemotherapy or radiotherapy should be considered to achieve better outcomes. Although this study describes an unusual type of hepatic lymphoma mimicking a benign tumor, it has its inherent limitations. More clinical studies are required to establish guidelines for the diagnosis and treatment of this rare disease.
Late Onset Postpartum Eclampsia: It is Really Never Too Late-A Case of Eclampsia 8 Weeks after Delivery
Authors: Jens Minnerup, Ilka Kleffner, Heike Wersching, Julian Zimmermann, Wolf-Rüdiger Schäbitz, Thomas Niederstadt, Rainer Dziewas
Journal: Stroke Res Treat (2010)
MeSH terms: Case Reports

Introduction. Eclampsia is the combination of preeclampsia and seizures. Approximately one-half of all cases of eclampsia occur postpartum. Thereby late onset postpartum eclampsia is defined by its onset more than 48 hours after delivery. Summary of Case. We report a postpartum eclampsia occurring 8 weeks after delivery, which is the latest onset ever described. The course was complicated by an intracerebral hemorrhage (ICH). Conclusion. A late onset postpartum eclampsia even several weeks after delivery should be considered as possible diagnosis, since early treatment initiation with magnesium sulphate and antihypertensive medication prevents severe complications and reduces mortality.
Management of Intracanal Separated File Fragment in a Four-Rooted Mandibular Third Molar
Authors: Benoy Jacob, Anjaneyulu K, Aishwarya Ranganath, Riluwan Siddique
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

The success of endodontic therapy is attributed to complete arbitration of the bound entities concealed within the complexity and absolute disinfection of the root canal system, thus, deeming it mandatory to effectively negotiate and overcome the challenges posed by obstruction, either iatrogenic or anatomic. To achieve this, considerable depth of knowledge and expertise with reference to variations in root canal morphology and clinical mishap management is substantially as important as developing fine observation skills in conjunction with an appropriate armamentarium and a keen sense of determination, thereby enhancing one's clinical acumen by several folds. In the present case, following rubber dam isolation, the temporary restoration was removed, and the remaining carious dentin was excavated. Endodontic access cavity was refined and explored with a DG-16 probe, following which three separate canal orifices were identified in the pulp chamber floor (mesiobuccal, mesiolingual, and distal). On further observation under a surgical operating microscope and continuous exploration with the DG-16 probe, a fourth canal was found in the mesial aspect of the tooth (middle mesial). With instrumentation, it was confirmed that a fractured object was indeed present at the apical third of the mesiolingual root of tooth 38. Bypassing of the fractured fragment was initiated with a size 10 SS K-file coupled with copious irrigation with 3% sodium hypochlorite. In the present case report, four distinct canals comprising 3 mesial and 1 distal canal were recognized, and the fractured instrument in one of the canals was bypassed successfully.
Giant coronary artery aneurysm with a thrombus secondary to Kawasaki disease
Authors: Sushant Patil, Salil Shirodkar, Robin J Pinto, Bharat Dalvi
Journal: Ann Pediatr Cardiol (2008)
Keywords: coronary artery thrombus, kawasaki's disease, giant aneurysm
MeSH terms: Case Reports

Although coronary artery aneurysms occur in Kawasaki disease, giant aneurysms are rare. We report a very large coronary artery aneurysm, measuring 25 mm and involving left anterior descending artery, in a 2-year-old child with Kawasaki disease. The challenges in management of such a patient have been highlighted.
Rapid onset renal deterioration in an adult with silent ureteropelvic junction obstruction
Authors: Nicholas J Hellenthal, Sasha A Thomas, Roger K Low
Journal: Indian J Urol (2009)
Keywords: adult, renal function, ureteral obstruction
MeSH terms: Case Reports

We report a case of a rapid renal deterioration due to ureteropelvic junction obstruction (UPJO) in an asymptomatic woman with prior normal diuretic renography. This case illustrates "silent" renal obstruction and the inability of diuretic renography in detecting significant renal obstruction. This case may favor close surveillance of any adult patient with potential UPJO, especially those with underlying renal disease or solitary kidney.
Successful Treatment of Clostridium difficile Bacteremia with Aortic Mycotic Aneurysm in a Patient with Prior Endovascular Aortic Aneurysm Repair
Authors: Kairav Shah, Rebecca Brauch, Kartikeya Cherabuddi
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

The clinical spectrum of Clostridium difficile infection can range from benign gastrointestinal colonization to mild diarrhea and life threatening conditions such as pseudomembranous colitis and toxic megacolon. Extraintestinal manifestations of C. difficile are rare. Here, we report a patient with a history of an endovascular aortic aneurysm repair (EVAR) presenting with an endovascular leak complicated by C. difficile bacteremia and a mycotic aneurysm. He was successfully treated with an explant of the EVAR, an aorto-left renal bypass, and aorto-bi-iliac bypass graft placement along with a six-week duration of intravenous vancomycin and oral metronidazole.
Subdural and cerebellar hematomas which developed after spinal surgery: a case report and review of the literature
Authors: Ufuk Utku, Sibel Güler, Erol Yalnız, Ercüment Unlü
Journal: Case Rep Neurol Med (2013)

Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2 mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings.
Noonan syndrome caused by RIT1 gene mutation: A case report and literature review
Authors: Ping Zha, Ying Kong, Lili Wang, Yujuan Wang, Qing Qing, Liying Dai
Journal: Front Pediatr (2022)
Keywords: noonan syndrome, rit1, clinical phenotype, hypertrophic cardiomyopathy, variant locus
MeSH terms: Case Reports

Objective:
Noonan syndrome (NS), an autosomal dominant disease known as a RASopathy, is caused by germline mutations in mitogen-activated protein kinase pathway genes. A RIT1 gene mutation has been found to cause NS. The present study summarizes RIT1 gene mutation sites and associated clinical phenotypes.
Methods:
We retrospectively analyzed the clinical characteristics of a case of NS caused by RIT1 mutation in our hospital, and searched the PubMed database, China National Knowledge Infrastructure (CNKI) database and Wanfang database with the keywords Noonan syndrome and RIT1. Studies published between May 1, 2014 and July 1, 2021 were retrieved. By reviewing the abstracts and full text of the studies, we screened NS cases associated with RIT1 mutation in children 0-18 years of age. The clinical characteristics of these cases were summarized.
Results:
A total of 41 cases were analyzed, including 13 boys and 28 girls. There were 14 premature cases. The age at diagnosis was 4 days to 18 years, and 10 cases were diagnosed at 0-1 years of age. Common amino acid substitution positions included 57 (13/41), 95 (7/41), 82 (8/41), and 90 (4/41). A total of 63.63% cases had abnormal prenatal examination results, manifesting mainly as fetal neck edema, polyhydramnios and cardiac malformation. With respect to abnormal conditions after birth, 70-80% of patients had typical developmental malformations of the face, neck and thorax; 19/35 patients had abnormal lymphatic development; and a portion of patients had short stature and motor development disorders. A total of 87.80% (36/41) patients had cardiac dysplasia, among which hypertrophic cardiomyopathy (HCM) accounted for 58.53%. A total of 84.62% of patients carrying the p.A57G mutation had HCM, but no HCM was found in patients with the p.G95A mutation. A total of 34.15% of patients had pulmonary artery or pulmonary valve stenosis (PVS). In patients with the p.M90I mutation, 75% had PVS. Patients with concurrent HCM and PVS accounted for 19.51 and 48.78% of patients had supraventricular tachycardia.
Conclusion:
A RIT1 gene mutation causing NS was associated with a high rate of abnormal prenatal examination findings. Most patients had typical NS craniofacial deformities, and some have short stature and motor development disorders. The cardiac deformity rate was high, and HCM was common. Some patients had supraventricular arrhythmias. Heart abnormalities showed high heterogeneity, given the various mutation loci.
A Rare Adrenal Incidentaloma That Mimics Adrenocortical Carcinoma
Authors: Kedar Lavingia, Ramyar Torabi, Samuel W Kim, Marybeth S Hughes, Eric C Feliberti, Roger R Perry
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Objective:
We present a case of an adrenal hemangioma, an uncommon cause of an adrenal mass, and review the clinical presentation, work-up, and management of adrenal incidentalomas.
Background:
A 64-year-old male was found to have a right adrenal incidentaloma during work-up for elevated liver transaminase levels, later found to be from hepatitis C. The mass was suspicious for adrenocortical carcinoma on CT imaging. Biochemical evaluation revealed no evidence of function. He underwent an open right adrenalectomy. The mass was found to be an adrenal hemangioma on histopathologic analysis.
Methods:
This is a case report with pertinent review of the diagnosis and management of adrenal incidentalomas.
Results:
Adrenal hemangiomas are rare, benign, nonfunctional tumors typically found during imaging for other reasons. As illustrated by this case, they appear similar to adrenocortical carcinoma on CT imaging. The diagnosis is usually not made prior to surgical resection.
Conclusion:
Adrenal hemangioma is a rare nonfunctional adrenal incidentaloma that displays atypical features on CT imaging. The suspicion for adrenocortical carcinoma usually prompts adrenalectomy.
Philadelphia chromosome positive AML arising from JAK2-positive myelofibrosis
Authors: Marte Karen Brattås, Kyrre Lilleeng, Randi Hovland, Ingvild Jenssen Lægreid, Marta Vorland, Friedemann Leh, Øystein Bruserud, Bjørn Tore Gjertsen, Håkon Reikvam
Journal: Biomark Res (2018)
Keywords: aml, clonal evolution, jak2, philadelphia chromosome, primary myelofibrosis
MeSH terms: Case Reports

Background:
A feature of myeloproliferative neoplasia is transforming to more aggressive and malignant myeloid neoplasia, including acute myeloid leukemia. Different pathogenesis mechanisms participate in transformation, including transformation of existing potential preleukemic clones, since JAK2-mutant myeloproliferative neoplasms often transform to JAK2 wild-type acute myeloid leukemia.
Case presentation:
Here, we present an 80 year old man with a JAK2-V617F mutant primary myelofibrosis. After 10 months the disease transform into a Philadelphia chromosome positive acute myeloid leukemia, detecting the cytogenetic aberration; t(9;22)(q34;q22) encoding the rare BCR-ABL1 fusion gene; e6a2. The patient had treatment response to tyrosine kinases, illustrating the potential benefits of such approach in treating these patients subset.
Conclusion:
The case illustrates the potential of leukemic transformation to Philadelphia chromosome positive myeloid malignancies from potential existing preleukemic clones, and the awareness of such an evolution among patients with myeloproliferative neoplasms. Tyrosine kinases have potential effect also in patients presenting without chronic myeloid leukemia and with rare BCR-ABL1 fusion transcripts, and should probably be a part of the treatment approach.
Pterygoid Hamular Bursitis: A Possible Link to Craniofacial Pain
Authors: Sameep S Shetty, Premalatha Shetty, Prit Kiran Shah, Jayanth Nambiar, Nancy Agarwal
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

A striking feature of the skull base is the pterygoid hamulus known for its bizarre morphology and biomechanical location. Pterygoid hamular bursitis is an inflammation of bursae located between the tendon, muscle, and bony prominences. The minimal objective finding in an apparently normal orofacial apparatus and dependence on the subjective symptoms experienced by the patient with widespread referral pattern often perplexes the clinician. Bursitis should be considered in the differential diagnosis of craniofacial neuralgia, temporomandibular joint dysfunction, and chronic craniofacial pain. Clinical signs and symptoms of this intriguing entity are diverse and multifaceted that can sometimes demand services of clinicians across various specialties considering the anatomic density of the region. Care must be taken to avoid delay, misdiagnosis, and overtreatment.
B12 Deficiency and Clinical Presentation in the Setting of Nitric Oxide Use
Authors: Donald Mario Robert Harker, Bridget Martinez, Burton J Tabaac
Journal: Case Rep Neurol Med (2021)
MeSH terms: Case Reports

B12 deficiency can arise symptomatically from an array of varying pathologies including frank deficiency from strict vegan diets. Other high-risk contributing pathological conditions include chronic alcoholism, autoimmune disease, and chronic gastrointestinal inflammatory disorders, and it is also seen in those with a history of gastric surgery. Additionally, the elderly are at an increased risk as are patients prescribed certain medications. Uncommonly suspected causes of B12 deficiency include the abuse of recreational nitrous oxide (NO) given its interference with cobalt oxidation. Here, we report two cases of hypovitaminosis B12 in association with NO abuse in an effort to highlight an increasingly dangerous trend with recreational use. Importantly, we aim to increase visibility of this malady given that improperly diagnosed neurologic deterioration following NO anesthesia has been shown to become irreversible and may even result in death.