OpenMed/multicare-articles huggingface dataset:
Case report: Histoplasmosis presenting as asymptomatic hypercalcemia detected on routine laboratory testing in a pediatric kidney transplant recipient
Authors: Elizabeth Spiwak, Shrea Goswami, Sara E Lay, Corina Nailescu
Journal: Front Pediatr (2023)
Keywords: acute kidney injury (aki), histoplasmosis, hypercalcemia, kidney transplant, pediatric, pulmonary nodules
MeSH terms: Case Reports

Among all infections occurring in pediatric kidney transplant recipients, approximately 1%-5% are fungal. Most fungal infections occur in the first 6 months following kidney transplantation. We present the case of a 15-year-old boy with a history of a kidney transplant 4 years ago, who was found to have asymptomatic moderate hypercalcemia on routine laboratory testing, along with an acute deterioration of his kidney function markers. The cause of his acute kidney injury was likely related to hypercalcemia. An extensive workup for hypercalcemia revealed infection with Histoplasma capsulatum (histoplasmosis) with multiple pulmonary nodules. Hypercalcemia that was initially refractory to medical management resolved after initiating the antifungal treatment. Fungal granulomatous infections such as histoplasmosis should be considered in the differential diagnosis of hypercalcemia in an asymptomatic pediatric kidney transplant recipient.
Governance of Assisted Living in Singapore: Lessons for Aging Countries
Authors: Si Ying Tan, Luting Poh, Jeremy Lim
Journal: Front Public Health (2022)
Keywords: age-friendly environment, assisted living, case study, governance, long-term care, regulation
MeSH terms: Assisted Living Facilities, Research Support, Non-U.S. Gov't, Aged, Aging, Humans, Singapore, Workforce

A global trend toward aging populations means that the challenge of providing adequate long-term care to older people looms large in many countries. In Singapore, a public discourse revolving around the expansion of assisted living to create age-friendly environments in long-term care has emerged. This study examines Singapore's experience in developing regulations for assisted living by documenting the different levels of regulation in place and by identifying the regulatory gaps remaining to govern assisted living. Anchoring in a conceptual framework on the governance of assisted living, different regulatory components of assisted living at the micro-, meso-, and macro-levels are analyzed. Using a case study method, primary and secondary data examining the experiences of governing and implementing assisted living in Singapore were collected. Analysis was conducted using a thematic analysis approach. Micro- and some macro-level regulations, which include admission assessment, staffing, and infrastructural requirements for assisted living, are maturing and evolving, while meso-level regulations, such as operational management, the monitoring framework, and stipulations for training requirements for staff, remain a work-in-progress in Singapore. The regulations for assisted living are currently primarily guided by soft laws, such as practice guidelines; the government has committed toward enacting permanent regulations for all long-term care facilities with the phased implementation of the Health Care Services Act from 2021 to 2023. We conclude that assisted living, despite the early stage of its development in Singapore, is a viable care model that should be expanded to meet the rising demand for care on the part of a majority of older people, who fall in the middle of the care continuum (that is, they can neither live independently nor need complete institutionalization). We also propose five policy recommendations for all aging countries to strengthen the governance of assisted living in long-term care. These include establishing (i) clear provisions on care quality assessment and the redress of grievance, (ii) minimum standards of care, (iii) differential regulations for assisted living, (iv) routine care assessment, and, (v) applying technology in assisted living facilities to address a shortage of care workers.
Technical note: MRI lymphangiography of the lower limb in secondary lymphedema
Authors: Ravindra B Kamble, Roshan Shetty, N Diwakar, G Madhusudan
Journal: Indian J Radiol Imaging (2011)
Keywords: gadopentetate, mri, lymphangiography, lymphedema
MeSH terms: Case Reports

We would like to describe a case of MRI lymphangiography of the left leg, performed by subcutaneous injection of gadopentetate in the foot, followed by serial acquisitions of images, in a 52-year-old female, who presented to us with progressive leg swelling following total hysterectomy and radiation therapy. Successful demonstration of lymphatic channels, along with faint visualization of the venous system, was achieved. This technique allows excellent visualization of lymphatic channels.
Acute gastric dilatation: a transient cause of hepatic portal venous gas-case report and review of the literature
Authors: Satya B Allaparthi, Curuchi P Anand
Journal: Case Rep Gastrointest Med (2013)

Gastric pneumatosis (GP) and hepatic portal venous gas (HPVG) have typically been thought of as an ominous radiological sign associated with a grave prognosis, and the observation of HPVG on plain abdominal radiography, ultrasonography, or computed tomography is viewed as a significant finding. It is often associated with severe or potentially lethal conditions warranting urgent diagnosis and possible surgical intervention. Early studies of HPVG based on plain abdominal radiography found an associated mortality rate of 75% primarily due to ischemic bowel. However, modern abdominal computed tomography (CT) has resulted in the detection of HPVG in an increased proportion of nonfatal and benign conditions. We report a nonfatal case of HPVG in a patient with Noonan's syndrome due to acute gastric dilatation in the setting of gastric outlet obstruction caused by a congenital band that is extremely rare in adults.
The Utility of the Oncotype DX Test for Breast Cancer Patients in an Australian Multidisciplinary Setting
Authors: Joseph Do Woong Choi, T Michael D Hughes, Gavin Marx, John Boyages, Josie Rutovitz, Csilla Hasovits, Andrew Parasyn, Senarath Edirimanne, Nicholas K Ngui
Journal: Breast J (2022)
MeSH terms: Breast Neoplasms / drug therapy, Breast Neoplasms / genetics, Breast Neoplasms / pathology, Australia, Female, Gene Expression Profiling / methods, Humans, Neoplasm Recurrence, Local / pathology, Prognosis, Receptors, Estrogen / genetics, Retrospective Studies, Receptors, Estrogen

Introduction:
The Oncotype DX test is a genomic assay that generates a Recurrence Score (RS) predicting the 10-year risk of recurrence and response to adjuvant chemotherapy in ER+/HER2- breast cancer patients. The aims were to determine breast cancer distant recurrence and correlate with adjuvant chemoendocrine prescribing patterns based on the Oncotype DX recurrence score.
Methods:
We conducted a retrospective single-institution case series of 71 patients who had Oncotype DX assay testing after definitive surgery between 2012 and 2016. Both node-positive and node-negative patients were included. Patients were divided into Oncotype DX low risk (RS < 11) (n = 10, 14%), intermediate risk (RS 11-25) (n = 45, 63%), and high risk (RS > 25) (n = 16, 23%). Median follow-up was 6.1 years (range 4-8.9 years). Adjuvant treatment regimens and oncological outcomes were determined. Results. Mean age at diagnosis was 56 years (range, 33-77). Invasive ductal carcinoma (IDC) accounted for the majority (87%), with most tumors measuring between 10-20 mm (52%). 48% of the cohort were node positive. 15 of 16 high-risk patients (94%) received chemotherapy. 96% of intermediate-risk patients received endocrine therapy alone, one patient received chemoendocrine therapy (2%), and one declined systemic therapy (2%). In the low-risk group, 100% received endocrine therapy only. The high-risk group had the lowest mean ER% (P < 0.05), greatest mean mitotic rate (P < 0.05), and greatest proportion of Ki67% > 14. Five patients developed distant recurrence (7%): three from the intermediate-risk group (7%), one from the low-risk group (10%), and one from the high-risk group (6%).
Conclusion:
This is the first Australian study reporting the experience with medium-term recurrence outcomes of using the Oncotype DX assay in breast cancer. Chemotherapy was rarely given for patients with low-to-intermediate RS and always offered in high RS. This pattern of prescribing was associated with low rates of distant recurrence. National funding models should be considered.
Periaortic Abscess following DeBakey Type-1 Aortic Dissection Repair with Dacron Graft-Early Diagnosis and Management
Authors: Rishi Raj, Dileep Unnikrishnan, Aasems Jacob, Kumar Ashish, Amulya Prakash, Ajay Shah
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

A 71-year-old male with history of DeBakey type-1 aortic dissection and repair with dacron graft three months prior to presentation was brought to the emergency room with complaints of high-grade fevers, chills, and shortness of breath. Chest X-ray revealed right lower lobe infiltrates and widened superior mediastinum. A follow-up CT chest with contrast showed fluid collection around the aortic graft. He was started on intravenous broad-spectrum antibiotics, and a TEE was done for further evaluation of periaortic fluid collection which showed findings to suggest periaortic abscess. The patient underwent surgical drainage of the abscess and was found to have an abscess around the surgical aortic graft which was drained followed by two weeks of antibiotic treatment. The patient was discharged to a rehabilitation facility and remained asymptomatic at three-month follow-up appointment. Type-1 aortic dissection is a medical emergency requiring acute surgical intervention, and despite significant advancements in diagnosis and management, the immediate and long-term complications remain high leading to increased risk of mortality. Our patient developed spontaneous periaortic abscess three months postoperatively requiring intensive antibiotic therapy along with surgical drainage. Our case emphasizes the importance of early diagnosis and management of late complications of periaortic abscess in patients with aortic dissection repair.
Case Report: Anesthetic Management and Electrical Cardiometry as Intensive Hemodynamic Monitoring During Cheiloplasty in an Infant With Enzyme-Replaced Pompe Disease and Preserved Preoperative Cardiac Function
Authors: Meng-Chen Liu, Ming-Tse Wang, Philip Kuo-Ting Chen, Dau-Ming Niu, Yu-Hsuan Fan Chiang, Ming-Hui Hsieh, Hsiao-Chien Tsai
Journal: Front Pediatr (2021)
Keywords: pompe disease, anesthesia, cardiomyopathy, hypotonia, impedance cardiography, pulse wave analysis
MeSH terms: Case Reports

Introduction: Pompe disease is caused by deficiency of the lysosomal enzyme acid α-glucosidase, which results in cardiac and muscular complications that can jeopardize perioperative outcomes. We report a 4-month-old infant with Pompe disease receiving cheiloplasty under general anesthesia with the aid of peripheral nerve blocks and intensive hemodynamic monitoring. Case Description: This case report describes a 4-month-old full-term Taiwanese female infant who presented with left unilateral cleft lip and palate in the prenatal examination. She was diagnosed with infantile-onset Pompe disease after acidic α-glucosidase (GAA) gene sequencing. She also received enzyme replacement therapy (ERT) 15 days after birth and regular ERT every other week. Cheiloplasty was performed under general anesthesia uneventfully, and peripheral nerve blocks were adopted for analgesia. Intensive hemodynamic monitoring using electrical cardiometry technology (ICON®) and pulse contour analysis (FloTrac system) were applied during the operation. No adverse effects were observed, and the wound healed well. Therefore, the patient was discharged 4 days after surgery. Conclusion: With the availability of ERT, severe organ dysfunction in infantile-onset Pompe disease patients is no longer common. However, moderate cardiac depression can still occur while increasing inspiratory pressure and deepening the anesthesia level despite a normal preoperative echocardiogram report. Therefore, careful, gradual titration is desirable. Furthermore, electrical cardiometry can detect hemodynamic changes more instantaneously and reliably than pulse contour analysis. In addition, we suggest taking advantage of the peripheral nerve block as a part of balanced anesthesia to alleviate the cardiac suppression caused by general anesthesia.
A Case of Hyper IgD and Periodic Fever Syndrome in Japan
Authors: Hisashi Kawashima, Akiyoshi Hoshi, Hiroaki Ioi, Chiako Ishii, Satoshi Sato, Yasuyo Kashiwagi, Kouji Takekuma, Akinori Hoshika
Journal: Clin Med Case Rep (2008)
Keywords: igd, pfapa, mevalonate kinase, periodic fever
MeSH terms: Case Reports

We report a four-year-old Japanese girl with hyper IgD and periodic fever syndrome. There is a first report of hyper IgD syndrome (HIDS) of which the genomic study was done in Japan. In this report a girl complained of periodic fever and abdominal symptoms accompanied with high levels of mevalonic acid in urine and serum. She has been well controlled by non-steroidal anti-inflammatory drugs (NSAIDs) for 3 years.
Case Report: Cryptococcal meningitis in an apparently immunocompetent patient in Nepal - challenges in diagnosis and treatment
Authors: Ashish Jha, Sudeep Adhikari, Keshav Raj Sigdel, Buddhi Paudyal, Buddha Basnyat, Gyan Kayastha, Sumita Pradhan, Ujjwol Risal, Jiwan Poudel
Journal: Wellcome Open Res (2019)
Keywords: cryptococcal meningitis, immunocompetent patient, liposomal amphotericin b
MeSH terms: Case Reports

A 50 year old woman from Nepal had clinical features suggestive of meningitis. Cerebrospinal fluid (CSF) analysis was normal except for the presence of cryptococcal antigen. The inclusion of test for Cryptococcus in the CSF helped in making the diagnosis of cryptococcal meningitis in our patient who was apparently immunocompetent. Treatment with liposomal amphotericin B could not be started on time due to financial constraints. The patient had a stroke and further deteriorated. Liposomal amphotericin B is stocked by the government of Nepal for free supply to patients with visceral leishmaniasis, but the policy does not allow the drug to be dispensed for other infections. The family members of our patient acquired the drug within a few days from a government center using their political connections and following administering the treatment the patient improved. This case demonstrates the utility of considering cryptococcal meningitis as a differential diagnosis, and including tests for Cryptococcus when dealing with immunocompetent patients presenting with meningitis. It also demonstrates the effects of the sociopolitical situation on health care delivery in low- and middle-income countries (LMICs) such as Nepal.
A new technique for Asian nasal tip shaping: "twin tower" folding ear cartilage transplantation
Authors: Long Zhang, Jiang-Wen Wang, Jun Ding, Xi Zhang, Xi-Mei Wang, Zhan-Zhao Zhang, Run-Ze Yu
Journal: Case Reports Plast Surg Hand Surg (2022)
Keywords: auricular cartilage, rhinoplasty, septal extension graft, three-dimensional anthropometric analysis
MeSH terms: Case Reports

Rhinoplasty focuses on the establishment of the structural support of nasal cartilage and the shaping of the nasal tip. The purpose of this study was to explore the application of "double tower" folding ear cartilage transplantation for nasal tip shaping in rhinoplasty.
Uterocutaneous Fistula after a C-Section in a Patient with Second Trimester Fetal Demise and Chorioamnionitis
Authors: Déborah Wernly, Valérie Besse, Daniela Huber
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Uterocutaneous fistulae are very rare entities with only about 120 cases reported in the literature. They are mostly described after a C-section or other pelvic surgery. We hereby describe a uterocutaneous fistula in a 41-year-old patient 5 months after a C-section because of a chorioamnionitis and a 22-week fetal demise. One month after the C-section, she underwent a diagnostic hysteroscopy to exclude postoperative intrauterine adhesions. Afterwards, she complained of pelvic pain, persistent metrorrhagia, and significant weight loss during 2 months. She consulted the emergency unit several times, and lastly endometritis was diagnosed. She was treated with antibiotic therapy for 7 days, without significant clinical improvement. She presented at our institution 48 hours after a carbuncle had appeared in her right iliac fossa. A uterocutaneous fistula was diagnosed on the CT scan. The patient received IV antibiotic therapy and underwent a total hysterectomy with bilateral salpingectomy by laparotomy, as she did not want a conservative surgery. The clinical postoperative evolution was favorable. Symptoms of UCF can be very unspecific. To avoid medical wandering and improve the patient's care, UCF should be in the differential diagnostic of abdominal pain after a pelvic surgery. Moreover, in patients with previous C-section and infectious perioperative status, the risk of PID or pelvic abscess must be careful evaluated before intrauterine diagnostic or therapeutic procedures.
Lymphoepithelial Carcinoma Originated from the Sinonasal Cavity: Case Report and Literature Review
Authors: Hassan Alhazzani, Saleh Alabood, Ahmed Alhussien, Sahar Alsadah, Abdulrahman Alghulikah, Shuaa Asiri, Ibrahim Alarifi
Journal: Case Rep Otolaryngol (2023)
MeSH terms: Case Reports

Background:
Sinonasal lymphoepithelial carcinoma (SNLEC) is a rare neoplasm, representing less than 1% of all types of carcinomas and approximately 3% of head and neck tumors. It can affect the nasopharynx due to the rich lymphoid tissue present in this region. Clinical SNLEC presentation varies, ranging from asymptomatic to nonspecific sinonasal symptoms. We report a case of SNLEC and review the literature for SNLEC presentation, diagnosis, management options, and outcomes. Case Presentation. A 38-year-old male, medically free, presented to the emergency department complaining of nasal obstruction, right facial numbness, persistent right-sided headache, intermittent orbital pain, and a history of on/off epistaxis. Imaging showed a destructive mass in the right sphenoid sinus extending to different sinuses and infratemporal fossa. Biopsy confirmed the diagnosis of SNLEC, with immunohistochemistry being positive for Epstein-Barr virus (EBV) and CK8/18. Induction chemotherapy was started with three cycles of cisplatin and gemcitabine, followed by concurrent chemoradiation therapy.
Conclusion:
SNLEC is rare, with limited reported cases from around the world. It is mostly seen in adults between their fifth and seventh decades with male predominance. SNLEC is diagnosed using imaging, immunohistochemistry, and EBV testing given its strong association with EBV. Owing to the limited cases, there is no standard approach to treating SNLEC. However, most cases managed with radiation and with and without other modalities showed an excellent response in terms of tumor nonrecurrence.
The sword of Damocles for the splenectomised: death by OPSI
Authors: Christian Georg Blumentrath, Nils Ewald, Jasmina Petridou, Uwe Werner, Barbara Hogan
Journal: Ger Med Sci (2016)
Keywords: overwhelming post-splenectomy infection (opsi), post-splenectomy vaccination, prevention of opsi, purpura fulminans, septic shock
MeSH terms: Pneumococcal Infections / etiology, Postoperative Complications / etiology, Sepsis / etiology, Splenectomy / adverse effects, Streptococcus pneumoniae, Case Reports, Aged, Fatal Outcome, Female, Humans

The overwhelming post splenectomy infection (OPSI) in splenectomised patients is a rare but severe infection mostly caused by encapsulated bacteria. We analyse the case of a 65-year-old female patient who was presented with clinical and laboratory findings indicating gastroenteritis. Two years years before admission, the patient underwent a splenectomy for a two stage splenic rupture following resuscitation for pulmonary embolism. Immunisation of the patient was complete and timely. As a result of the unspecific clinical presentation, there was a delay in administration of antibiotics. However, administration of antibiotics induced a fulminant shock. The patient died 4 hours after attending the hospital due to a pneumococcal sepsis. The discussion highlights epidemiological and pathophysiological aspects and potential prevention strategies in the international context. Vaccination failed in our patient as the isolated pneumococcal strain (serogroup: 12F) is usually covered by the 23-valent pneumococcal polysaccharide vaccination (Pneumovax(®)). The case reported here indicates that there may be a potential benefit of prophylactic antibiotic treatment within the first 3 years after splenectomy for patients above the age of 65 years. Awareness of OPSI (prevention strategies, symptoms and treatment) among patients and their treating physicians is crucial for the improvement of prognosis. We partly address these issues in a standard operating procedure for the assessment of splenectomised patients in our departments of emergency medicine.
A Novel Biallelic STING1 Gene Variant Causing SAVI in Two Siblings
Authors: Malak Ali Alghamdi, Jaazeel Mulla, Narjes Saheb Sharif-Askari, Francisco J Guzmán-Vega, Stefan T Arold, Mervat Abd-Alwahed, Nasser Alharbi, Tarek Kashour, Rabih Halwani
Journal: Front Immunol (2021)
Keywords: jak inhibitor, savi, sting-associated vasculopathy of infancy, sting1, cutaneous vasculopathy, interferonopathies, pulmonary inflammation
MeSH terms: Alleles, Genetic Diseases, Inborn / immunology, Homozygote, Membrane Proteins / genetics, Mutation, Missense, Siblings, Vascular Diseases / genetics, Case Reports, Research Support, Non-U.S. Gov't, Adolescent, Amino Acid Substitution, Child, Exome Sequencing, Female, Genetic Diseases, Inborn / drug therapy, Genetic Diseases, Inborn / genetics, Genetic Diseases, Inborn / pathology, Humans, Inflammation / drug therapy, Inflammation / genetics, Inflammation / immunology, Inflammation / pathology, Janus Kinase 1 / antagonists & inhibitors, Janus Kinase 1 / genetics, Janus Kinase 1 / immunology, Male, Membrane Proteins / immunology, Nitriles, Pyrazoles / administration & dosage, Pyrimidines, Vascular Diseases / drug therapy, Vascular Diseases / immunology, Vascular Diseases / pathology, Membrane Proteins, Nitriles, Pyrazoles, Pyrimidines, STING1 protein, human, ruxolitinib, JAK1 protein, human, Janus Kinase 1

STING-associated vasculopathy of infantile-onset (SAVI) is one of the newly identified types of interferonopathies. SAVI is caused by heterozygous gain-of-function mutations in the STING1. We herein report for the first time a homozygous variant in the STING1 gene in two siblings that resulted in constitutive activation of STING gene and the SAVI phenotype. Exome sequencing revealed a novel homozygous NM_198282.3: c.841C>T; p.(Arg281Trp) variant in exon 7 of the STING1 gene. The variant segregated in the family to be homozygous in all affected and either heterozygous or wild type in all healthy. Computational structural analysis of the mutants revealed changes in the STING protein structure/function. Elevated serum beta-interferon levels were observed in the patients compared to the control family members. Treatment with Janus kinase inhibitor (JAK-I) Ruxolitinib suppressed the inflammatory process, decreased beta-interferon levels, and stopped the progression of the disease.