OpenMed/multicare-articles huggingface dataset:
Expansion of Human Papillomavirus-Specific T Cells in Periphery and Cervix in a Therapeutic Vaccine Recipient Whose Cervical High-Grade Squamous Intraepithelial Lesion Regressed
Authors: Takeo Shibata, Sumit Shah, Teresa Evans, Hannah Coleman, Benjamin J Lieblong, Horace J Spencer, Charles M Quick, Toshiyuki Sasagawa, Owen W Stephens, Erich Peterson, Donald Johann Jr, Yong-Chen Lu, Mayumi Nakagawa
Journal: Front Immunol (2021)
Keywords: t cell receptor, cervical intraepithelial neoplasia, clonal expansion, human papillomavirus, therapeutic vaccine
MeSH terms: Cancer Vaccines / therapeutic use, Human papillomavirus 16 / immunology, Lymphocytes, Tumor-Infiltrating / drug effects, Papillomavirus Vaccines / therapeutic use, Squamous Intraepithelial Lesions / drug therapy, T-Lymphocytes / drug effects, Uterine Cervical Neoplasms / drug therapy, Case Reports, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Adult, Cell Proliferation / drug effects, Cells, Cultured, Clinical Trials, Phase I as Topic, Female, Genes, T-Cell Receptor, High-Throughput Nucleotide Sequencing, Host-Pathogen Interactions, Humans, Lymphocyte Activation / drug effects, Lymphocytes, Tumor-Infiltrating / immunology, Lymphocytes, Tumor-Infiltrating / virology, Neoplasm Grading, RNA-Seq, Remission Induction, Squamous Intraepithelial Lesions / immunology, Squamous Intraepithelial Lesions / pathology, Squamous Intraepithelial Lesions / virology, T-Lymphocytes / immunology, T-Lymphocytes / virology, Time Factors, Treatment Outcome, Uterine Cervical Neoplasms / immunology, Uterine Cervical Neoplasms / pathology, Uterine Cervical Neoplasms / virology, Cancer Vaccines, Papillomavirus Vaccines

Advances in high-throughput sequencing have revolutionized the manner with which we can study T cell responses. We describe a woman who received a human papillomavirus (HPV) therapeutic vaccine called PepCan, and experienced complete resolution of her cervical high-grade squamous intraepithelial lesion. By performing bulk T cell receptor (TCR) β deep sequencing of peripheral blood mononuclear cells before and after 4 vaccinations, 70 putatively vaccine-specific clonotypes were identified for being significantly increased using a beta-binomial model. In order to verify the vaccine-specificity of these clonotypes, T cells with specificity to a region, HPV 16 E6 91-115, previously identified to be vaccine-induced using an interferon-γ enzyme-linked immunospot assay, were sorted and analyzed using single-cell RNA-seq and TCR sequencing. HPV specificity in 60 of the 70 clonotypes identified to be vaccine-specific was demonstrated. TCR β bulk sequencing of the cervical liquid-based cytology samples and cervical formalin-fixed paraffin-embedded samples before and after 4 vaccinations demonstrated the presence of these HPV-specific T cells in the cervix. Combining traditional and cutting-edge immunomonitoring techniques enabled us to demonstrate expansion of HPV-antigen specific T cells not only in the periphery but also in the cervix. Such an approach should be useful as a novel approach to assess vaccine-specific responses in various anatomical areas.
Spontaneous Nosocomial Pseudomonas aeruginosa Meningitis Presenting as Trismus
Authors: C J Parr, J Wheeler, A Sharma, C Smith
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

We describe the case of a 78-year-old female receiving adjuvant postsurgical chemotherapy for colon adenocarcinoma who spontaneously developed nosocomial Pseudomonas meningitis causing severe trismus. The patient was initially admitted for ileus, developing neck stiffness and trismus on the thirteenth day of admission. Cerebrospinal fluid grew pansensitive Pseudomonas aeruginosa. Magnetic resonance imaging of the brain was consistent with bilateral subacute infarcts secondary to meningitis. The patient responded well to 21 days of broad spectrum antimicrobial therapy modified to ceftazidime alone following speciation and sensitivity. Outpatient follow-up at 46 days revealed normal maximal mouth opening with the ability to chew and tolerate a full diet. Trismus is a motor disturbance of the trigeminal nerve with difficulty in opening the mouth. Infectious etiologies commonly described include tetanus, odontogenic infections, or deep neck space infections. This is the first reported case of simultaneous nosocomial Pseudomonas meningitis and trismus in a patient with no history of neurosurgery or lumbar spinal manipulation.
COVID-19 myocarditis: a case report
Authors: Patrícia Yokoo, Eduardo Kaiser Ururahy Nunes Fonseca, Roberto Sasdelli Neto, Walther Yoshiharu Ishikawa, Murilo Marques Almeida Silva, Elaine Yanata, Rodrigo Caruso Chate, Antonio Carlos Bacelar Nunes Filho, Marcelo Bettega, João Ricardo Cordeiro Fernandes, Flávio Tarasoutchi, Gilberto Szarf
Journal: Einstein (Sao Paulo) (2020)
MeSH terms: Coronavirus Infections / complications, Myocarditis / virology, Pneumonia, Viral / complications, Case Reports, Betacoronavirus, COVID-19, Coronavirus Infections / diagnosis, Humans, Magnetic Resonance Imaging, Male, Myocarditis / diagnostic imaging, Pandemics, Pneumonia, Viral / diagnosis, SARS-CoV-2

A male patient with flu-like symptoms and tomography and laboratory diagnosis of severe acute respiratory syndrome. He developed acute cardiac dysfunction during admission and was submitted to a cardiac magnetic resonance imaging examination, which confirmed acute myocarditis, indicating cardiac involvement by coronavirus disease 2019. A review and discussion about coronavirus disease 2019-related cardiac manifestations are reported, focusing on the imaging findings to make diagnosis.
Higher than recommend dosage of sublingual isosorbide dinitrate for treating angina pectoris: a case report and review of the literature
Authors: Hong-Yan Cao, Hai-di Wu, Zi-Kai Song, Ming-Long Tang, Shuo Yang, Yang Liu, Ling Qin
Journal: Pan Afr Med J (2021)
Keywords: nitrates, angina pectoris, case report, isosorbide dinitrate, nitric oxide
MeSH terms: Angina Pectoris / drug therapy, Isosorbide Dinitrate / administration & dosage, Vasodilator Agents / administration & dosage, Case Reports, Review, Adult, Chest Pain / etiology, Coronary Angiography, Dose-Response Relationship, Drug, Humans, Isosorbide Dinitrate / adverse effects, Male, Treatment Outcome, Vasodilator Agents / adverse effects, Vasodilator Agents, Isosorbide Dinitrate

Nitrates primarily cause arterial and venous vasodilation effects, which increases coronary artery blood supply, and decreases cardiac preload and afterload by enhancing nitric oxide (NO) levels. The dosage of nitrates used for angina pectoris widely differs among individuals, and therapeutic resistance and tolerance gradually occur. Increasing doses of nitrates are needed to abolish ischemia chest pain onset in patients with angina pectoris, and to obtain satisfactory therapeutic effects. Here, we report the case of a 37-year-old male who was hospitalized six times, from September 2013 to April 2018, with recurrent angina pectoris. Although the patient was implanted with stents, he still presented with chest pain associated with physical efforts. Diagnosis with acute myocardial infarction was based on his ST-segment changes on electrocardiogram (ECG), elevated troponin-T level and coronary angiography. After the stents were implanted, his chest pain had no relief. Following three times of coronary angiography revealed that distal and small branch vessels still had stenosis, but was not required to revascularization. Due to serious headache resulted from sublingual or oral nitroglycerin; he had to take sublingual isosorbide dinitrate, from 20 mg to 150 mg each time, to obtain rapid relief from angina pectoris without doctor's consent. Followed up to April 2019, the patient has continued to take 100-150 mg sublingual isosorbide dinitrate for angina pectoris onset triggered by physical efforts, and has obtained remarkable relief within a few minutes, without blood pressure decrease and other side effects. Higher than recommend dosage of sublingual isosorbide dinitrate might establish better efficacy for angina pectoris in rarely patient.
Subcapsular Renal Hematoma in Simultaneous Pancreas Kidney Transplantation
Authors: Daniele Cappellani, Chiara Terrenzio, Elena Gianetti, Walter Baronti, Valerio Borrelli, Lorella Marselli, Fabio Vistoli, Alessandro Campatelli, Ugo Boggi, Piero Marchetti
Journal: Case Rep Transplant (2020)
MeSH terms: Case Reports

Subcapsular renal hematoma (SRH) is a challenging condition, which may jeopardize kidney function or constitute a life-threatening event. This is particularly true in single-kidney patients, such as kidney-transplant recipients. SRH may exert an excessive pressure on the surrounding parenchyma, thus resulting in hypoperfusion and ischemia, with high risk of acute kidney failure and graft loss. Moreover, SRH may precede an overt renal rupture with subsequent hemorrhage and hemodynamic instability. The indication to an interventional management for this condition is still a matter of debate, with some authors advocating the high possibilities of spontaneous resolution and others advocating the high-risk of graft loss and even internal bleeding in case of overt renal rupture. Herein, we report the case of a 51-year-old simultaneous pancreas-kidney transplantation recipient who presented a SRH following a mild trauma. The therapeutic choices were carefully balanced on the specific case, and the conservative management proved successful.
The active management of impending cephalopelvic disproportion in nulliparous women at term: a case series
Authors: James M Nicholson, Lisa C Kellar
Journal: J Pregnancy (2010)
MeSH terms: Cephalopelvic Disproportion / therapy, Labor, Induced, Case Reports, Adolescent, Adult, Delivery, Obstetric, Female, Fetal Development, Gestational Age, Humans, Parity, Pregnancy, Pregnancy, High-Risk, Risk Factors, Ultrasonography, Prenatal, Vacuum Extraction, Obstetrical

Background:
The Active Management of Risk in Pregnancy at Term (AMOR-IPAT) protocol has been associated in several studies with significant reductions of group cesarean delivery rate. Present within each of these studies were nulliparous women with risk factors for cephalopelvic disproportion. Risk factors for cephalopelvic disproportion in nulliparous women are especially important because they represent the precursors for the most common indication for primary cesarean delivery.
Cases:
Three examples of exposure of urban nulliparous women to the AMOR-IPAT protocol are presented. Each woman's risk factor profile for Cephalopelvic Disproportion (CPD) was used to estimate her Upper Limit of Optimal Time of Vaginal Delivery for CPD (UL-OTDcpd). Labor management and clinical outcomes for each case are presented. A simple table summarizing induction rates and birth outcome rates of exposed versus nonexposed nulliparous women is also presented.
Conclusion:
Because the mode of delivery of the first birth substantially impacts birth options in later pregnancies, the impact of AMOR-IPAT on nulliparous patients is particularly important. Determining the UL-OTDcpd in nulliparous patients, and carefully inducing each patient who has not entered labor by her UL-OTDcpd, may be an effective way of lowering rates of cesarean delivery in nulliparous women.
Management of the Knee Extension Deficit after Acute Trauma
Authors: Thiago Alvim do Amaral, David Sadigursky
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

A 25-year-old man initially presented with right knee extension deficit after an acute trauma, caused by a condition known as arthrogenic muscle inhibition. This should not be confused with a mechanical block caused by intra-articular pathology. The loss of knee extension, even if minimal, is disabling and leads to worse results after knee surgical treatment. Therefore, it is necessary to recognize and diagnose arthrogenic muscle inhibition to ensure the best treatment for patients with this condition. In this case report, the patient was managed with a rehabilitation technique resulting in an effective functional gain of the quadriceps and full restoration of knee extension.
ABO incompatible liver transplantation as a bridge to treat HELLP syndrome
Authors: Kathleen Connor, Raymond A Rubin, Roshan Shrestha, Mark Johnson, Marty Sellers, Brad Butler
Journal: Gastroenterol Res Pract (2009)
MeSH terms: Case Reports

The following is a case report of a primiparous woman who developed fulminant liver failure in the setting of HELLP syndrome complicated by hepatic rupture. It is unique in that a timely ABO compatible liver donor was unavailable, necessitating the transplantation of an ABO incompatible organ. Despite aggressive therapy, severe reperfusion injury and humoral rejection dictated retransplantation with an ABO compatible organ on postoperative day 15, resulting in rapid clinical recovery.
Reimplantation of an anomalous coronary artery arising from the pulmonary artery
Authors: Andrea Quarti, Alessandro D'Alfonso, Massimo Colaneri, Alessandra Baldinelli, Maria Grazia Bettuzzi, Marco Pozzi
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

A case of anomalous origin of the left coronary artery from the pulmonary artery in a patient with the origin of the coronary opposite to the aorta is reported. Between many surgical options we conclude to reestablish a double coronary system reconnecting the coronary through a conduit created with a pulmonary wall baffle and an autologous pericardial patch.
Impaired Vitamin D Signaling in T Cells From a Family With Hereditary Vitamin D Resistant Rickets
Authors: Fatima A H Al-Jaberi, Martin Kongsbak-Wismann, Alejandro Aguayo-Orozco, Nicolai Krogh, Terkild B Buus, Daniel V Lopez, Anna K O Rode, Eva Gravesen, Klaus Olgaard, Søren Brunak, Anders Woetmann, Niels Ødum, Charlotte M Bonefeld, Carsten Geisler
Journal: Front Immunol (2021)
Keywords: hvdrr, t cells, vitamin a, vitamin d, vitamin d receptor
MeSH terms: Familial Hypophosphatemic Rickets / metabolism, Receptors, Calcitriol / genetics, T-Lymphocytes / metabolism, Vitamin D / genetics, Case Reports, Research Support, Non-U.S. Gov't, Child, Family, Female, Heterozygote, Homozygote, Humans, Male, Mutation, Receptors, Calcitriol / metabolism, Up-Regulation, Vitamin D / metabolism, Vitamin D3 24-Hydroxylase / metabolism, Receptors, Calcitriol, VDR protein, human, Vitamin D, CYP24A1 protein, human, Vitamin D3 24-Hydroxylase

The active form of vitamin D, 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), mediates its immunomodulatory effects by binding to the vitamin D receptor (VDR). Here, we describe a new point mutation in the DNA-binding domain of the VDR and its consequences for 1,25(OH)2D3 signaling in T cells from heterozygous and homozygous carriers of the mutation. The mutation did not affect the overall structure or the ability of the VDR to bind 1,25(OH)2D3 and the retinoid X receptor. However, the subcellular localization of the VDR was strongly affected and the transcriptional activity was abolished by the mutation. In heterozygous carriers of the mutation, 1,25(OH)2D3-induced gene regulation was reduced by ~ 50% indicating that the expression level of wild-type VDR determines 1,25(OH)2D3 responsiveness in T cells. We show that vitamin D-mediated suppression of vitamin A-induced gene regulation depends on an intact ability of the VDR to bind DNA. Furthermore, we demonstrate that vitamin A inhibits 1,25(OH)2D3-induced translocation of the VDR to the nucleus and 1,25(OH)2D3-induced up-regulation of CYP24A1. Taken together, this study unravels novel aspects of vitamin D signaling and function of the VDR in human T cells.
Taking the Lead: A Case Report of a Leiomyoma Causing Duodeno-Duodenal Intussusception and Review of Literature
Authors: Louis F Chai, Philip M Batista, Harish Lavu
Journal: Case Rep Pancreat Cancer (2016)
Keywords: duodeno-duodenal intussusception, gastrointestinal bleed, leiomyoma
MeSH terms: Case Reports

Background: Duodenal masses are rare entities and symptomatic presentation generally is due to abdominal pain or the presence of gastrointestinal bleeding. A number of published case reports in the literature have detailed various neoplasms that have caused an intussusception isolated to the duodenum. This is a particularly unusual phenomenon due to the location and fixation of this portion of the proximal small bowel to the retroperitoneum. We present here a case of duodeno-duodenal intussusception secondary to a leiomyoma. Case: A 65-year-old Caucasian male presented with intermittent bloody stools and syncope over a 9-month period secondary to a duodenal leiomyoma causing intussusception, which was treated through a pancreaticoduodenectomy. Conclusion: Intussusception of the duodenum is an uncommon entity and the diagnosis of a leiomyoma should be considered in the setting of a potential mass in the small intestine.
A Rare Occurrence of Three Primary Malignancies of the Rectum, Breast, and Kidney in the Same Patient: A Case Report and Review of the Literature
Authors: Umesh Jayarajah, Oshan Basnayake, Pradeep Wijerathne, Jayan Jayasinghe, Dharmabandhu N Samarasekera, Sanjeewa Seneviratne
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

An increasing number of patients with multiple primary cancers are encountered due to improved cancer detection, widespread cancer screening, and better cancer treatment. Here, we report such a patient without a family history of malignancies or a known genetic predisposition developing three primary malignancies of the rectum, breast, and kidney. A 63-year-old female who underwent an anterior resection for rectal cancer was detected to have an elevated carcinoembryonic antigen (CEA) level during a routine follow-up, 8 years after the initial surgery. Clinical examination revealed a left breast lump which was confirmed as invasive ductal carcinoma (pT3 pN0 cM0). Imaging and colonoscopy excluded a local recurrence. However, a right renal lesion suggestive of a renal cell carcinoma was detected (pT1a). She underwent left mastectomy with a sentinel lymph node biopsy and a right partial nephrectomy with a curative intent. Postoperatively, CEA levels declined to normal limits. Management of multiple primary malignancies poses a major challenge. A multidisciplinary approach and tailored decision-making for the individual patient help with the optimum outcome.
A Case of Violent Suicide Attempt in a Context of Myxedema Psychosis following Radioiodine Treatment in a Patient with Graves' Disease
Authors: Louise Todorov, Amel Ait Boudaoud, Rachel Pascal de Raykeer, Alina Radu, Khadija Lahlou-Laforêt, Frédéric Limosin, Cédric Lemogne, Sébastien Czernichow
Journal: Case Rep Psychiatry (2019)
MeSH terms: Case Reports

Introduction:
Hypothyroidism has been associated with mood disorders but some cases of acute psychosis have also been reported. However, less attention has been paid to suicidal behavior in these patients.
Case report:
We report a case of suicide attempt by self-stabbing in a 43-year-old woman without past psychiatric history, four months after radioiodine therapy for Graves' disease. On clinical examination remarkable signs of myxedema were found and blood investigations showed hypothyroidism with an extremely high thyroid stimulating hormone (TSH) level (152 mUI/L; reference range 0.20-5.10). The patient presented delirium symptoms at the time of self-stabbing, which was associated with persecutory delusions and auditory harm command hallucinations. A rapid physical and psychiatric improvement was observed after the initiation of an oral thyroid replacement therapy without relapse after early discontinuation of the antipsychotic treatment.
Discussion:
The most distinctive feature of our case is that the violent suicide attempt could be attributed to the myxedema psychosis. Suicide may result from several factors, including psychosocial stressors, psychiatric symptoms, and hormonal disturbance. This unique presentation should remind clinicians to systematically consider ordering additional tests in patients with atypical psychiatric presentation, even when serious behavioral disorders (such as violent suicide attempts) are present and may result in premature transfer to psychiatric units.
Idiopathic acute myocarditis during treatment for controlled human malaria infection: a case report
Authors: Maurits P A van Meer, Guido J H Bastiaens, Mohamed Boulaksil, Quirijn de Mast, Anusha Gunasekera, Stephen L Hoffman, Gheorghe Pop, André J A M van der Ven, Robert W Sauerwein
Journal: Malar J (2014)
MeSH terms: Malaria, Falciparum / drug therapy, Myocarditis / etiology, Myocarditis / physiopathology, Case Reports, Research Support, Non-U.S. Gov't, Antimalarials / therapeutic use, Atovaquone / therapeutic use, Drug Combinations, Humans, Magnetic Resonance Imaging, Malaria, Falciparum / parasitology, Male, Plasmodium falciparum / isolation & purification, Proguanil / therapeutic use, Troponin T / blood, Young Adult, Antimalarials, Drug Combinations, Troponin T, atovaquone, proguanil drug combination, Proguanil, Atovaquone

A 23-year-old healthy male volunteer took part in a clinical trial in which the volunteer took chloroquine chemoprophylaxis and received three intradermal doses at four-week intervals of aseptic, purified Plasmodium falciparum sporozoites to induce protective immunity against malaria. Fifty-nine days after the last administration of sporozoites and 32 days after the last dose of chloroquine the volunteer underwent controlled human malaria infection (CHMI) by the bites of five P. falciparum-infected mosquitoes. Eleven days post-CHMI a thick blood smear was positive (6 P. falciparum/μL blood) and treatment was initiated with atovaquone/proguanil (Malarone®). On the second day of treatment, day 12 post-CHMI, troponin T, a marker for cardiac tissue damage, began to rise above normal, and reached a maximum of 1,115 ng/L (upper range of normal = 14 ng/L) on day 16 post-CHMI. The volunteer had one ~20 minute episode of retrosternal chest pain and heavy feeling in his left arm on day 14 post-CHMI. ECG at the time revealed minor repolarization disturbances, and cardiac MRI demonstrated focal areas of subepicardial and midwall delayed enhancement of the left ventricle with some oedema and hypokinesia. A diagnosis of myocarditis was made. Troponin T levels were normal within 16 days and the volunteer recovered without clinical sequelae. Follow-up cardiac MRI at almost five months showed normal function of both ventricles and disappearance of oedema. Delayed enhancement of subepicardial and midwall regions decreased, but was still present. With the exception of a throat swab that was positive for rhinovirus on day 14 post-CHMI, no other tests for potential aetiologies of the myocarditis were positive. A number of possible aetiological factors may explain or have contributed to this case of myocarditis including, i) P. falciparum infection, ii) rhinovirus infection, iii) unidentified pathogens, iv) hyper-immunization (the volunteer received six travel vaccines between the last immunization and the CHMI), v) atovaquone/proguanil treatment, or vi) a combination of these factors. Definitive aetiology and pathophysiological mechanism for the myocarditis have not been established.