OpenMed/multicare-articles huggingface dataset:
Safety of intravenous anakinra in COVID-19 with evidence of hyperinflammation, a case series
Authors: Kristina E N Clark, Oliver Collas, Helen Lachmann, Animesh Singh, Jim Buckley, Sanjay Bhagani
Journal: Rheumatol Adv Pract (2020)
Keywords: covid-19, anakinra, haemophagocytic lymphohistiocytosis, hyperinflammation

Objectives:
Anakinra is a selective IL-1 inhibitor, which has been used in the context of secondary haemophagocytic lymphohistiocytosis. Although usually given in the s.c. form, previous anecdotal reports have emphasized its utility when given i.v. Our aim is to report our experience on the beneficial effects of anakinra i.v. in patients with SARS-CoV-2 and evidence of hyperinflammation.
Methods:
We report four patients with severe COVID-19 infection requiring intensive care admission and ventilatory support.
Results:
All four patients showed evidence of deterioration, with hyperferritinaemia and increasing oxygen requirements and with superadded bacterial infections. Upon commencement of anakinra i.v., there was subsequent improvement in the patients clinically, with reduction in ventilatory support and inotropic support, and biochemically, with rapid improvement in inflammatory markers.
Conclusion:
Anakinra is safe to use i.v. in patients with COVID-19 and evidence of superadded bacterial infection. Although its utility has not been confirmed in a randomized trial, current research in the COVID-19 pandemic aims to establish the utility of immunosuppression, including IL-1 blockade, on the outcomes of patients with moderate to severe disease. Our case series supports its use in patients with severe, life-threatening COVID-19 and evidence of hyperinflammation.
A Rare Etiology of Abnormally Large Gastric Folds: Menetrier's Disease
Authors: Muhammad Umar Kamal, Hassan Tariq, Vaniza Mehak, Sara Azam, Kishore Kumar, Masooma Niazi, Anil Dev
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Menetrier's disease (MD) is described as hypertrophied giant gastric folds causing hypoproteinemia due to protein losing gastropathy and is associated with higher risk of gastric adenocarcinoma. We present a case of a 58-year-old male who presented to our clinic with Melena and endoscopic work up showed enlarged gastric folds and erythematous mucosa in the antrum and three nonbleeding angioectasias in the duodenum. Mucosa biopsies were negative for H. pylori infection. He underwent polypectomy which showed fundic gland polyps. After 1½ years, EGD was repeated for abnormal computerized tomography of abdomen which showed enlarged gastric folds and biopsy revealed gastric fundic mucosa with foveolar hyperplasia, dilated fundic glands, and chronic gastritis. Stomach biopsy results were consistent with MD. Our patient had progressive disease in one and half years. It is important to follow patient with large gastric folds regular as they can develop MD over time which has increased risk of gastric adenocarcinoma.
Surgical outcome of collateral ligament injury with metacarpal head fracture in a near amputation after power saw injury: Case report
Authors: Wongthawat Liawrungrueang
Journal: Int J Surg Case Rep (2019)
Keywords: collateral ligament injury, near amputation, power saw injury

Introduction:
The incidence of thumb amputation is high in developing and industrialized countries. A power saw injury is very traumatic to the soft tissue and neurovascular system, and thus difficult for orthopedic and plastic surgeons to treat.
Presentation of case:
A 41 year old male injured his right hand with a power saw. The poor condition of the soft tissue and collateral ligament damage to the head of the metacarpal fracture meant that near amputation was a possibility. The patient received adequate antibiotic and was taken to the operating room for fixation with convergent screws system, repaired and reconstructed collateral ligament complex. At 3 month follow up, author saw the union of the intraarticular fracture and the metacarpophalangeal joint (MCP). The patient was followed up at 1 year, the sensory and function was full recovered. The patient was extremely satisfied with this treatment and can now work normally again.
Discussion:
The collateral ligament complex injury with metacarpal head fracture in a near amputation after power saw injury; it is a very unstable injury. In this case, author performed an early adequate intravenous antibiotics in the emergency room and was taken to the operating room for repair and reconstruction. Neurological status and hand function were recovered that patient was extremely satisfied in this surgical planning.
Conclusion:
The power saw injury is a severe injury which requires special attention for treatment. Furthermore, the early reparation, reconstruction and fixation with screws in a convergent system is the treatment of choice in this condition.
Cannabis Contaminants Limit Pharmacological Use of Cannabidiol
Authors: Zackary Montoya, Matthieu Conroy, Brian D Vanden Heuvel, Christopher S Pauli, Sang-Hyuck Park
Journal: Front Pharmacol (2020)
Keywords: cannabidiol, cannabis, cannabis contaminants, hemp, phytocannabinoids
MeSH terms: Review

For nearly a century, Cannabis has been stigmatized and criminalized across the globe, but in recent years, there has been a growing interest in Cannabis due to the therapeutic potential of phytocannabinoids. With this emerging interest in Cannabis, concerns have arisen about the possible contaminations of hemp with pesticides, heavy metals, microbial pathogens, and carcinogenic compounds during the cultivation, manufacturing, and packaging processes. This is of particular concern for those turning to Cannabis for medicinal purposes, especially those with compromised immune systems. This review aims to provide types of contaminants and examples of Cannabis contamination using case studies that elucidate the medical consequences consumers risk when using adulterated Cannabis products. Thus, it is imperative to develop universal standards for cultivation and testing of products to protect those who consume Cannabis.
Pneumoretroperitoneum with subcutaneous emphysema after a post colonoscopy colonic perforation
Authors: Sahned Jaafar, Suy Sen Hung Fong, Abdul Waheed, Subhasis Misra, Keyur Chavda
Journal: Int J Surg Case Rep (2019)
Keywords: colonic perforation, colonoscopy, intraperitoneal perforation, retroperitoneal perforation

Introduction:
Colonoscopy is considered as one of the most common performed procedures for both diagnostic and therapeutic purposes. Serious complication after colonoscopy could occurs like bleeding or perforation. Majority of the perforations are intraperitoneal, while extraperitoneal perforations are very rare and it may cause pneumoretroperitoneum, pneumomediastinum, pneumothorax and subcutaneous emphysema.
Presentation of the case:
A case report was described of 80-year-old female who underwent a diagnostic colonoscopy for recurrent abdominal pain who presented with severe abdominal pain and tenderness with CT findings of pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema. The patient successfully treated surgically with laparoscopic Hartman procedure.
Discussion:
Colonic perforation is rare complication of colonoscopy that can manifest intraperitoneal, extraperitoneal or a combination of both. Patient risk factors include advance age, female sex, diverticulosis, previous abdominal surgery and pre-existing colonic strictures. Technical risk factors includes excessive shearing forces during endoscopic insertion, dilation, biopsy and using electrocautery. Majority of the intraperitoneal perforation warrant a surgical intervention whereas isolated extraperitoneal perforation may be managed conservatively.
Conclusion:
Combined intraperitoneal and extraperitoneal colonic perforation are rare presentations following diagnostic colonoscopy and often difficult to diagnose based on the clinical manifestation only. Understanding the manifestation of extraperitoneal perforation will help to properly identify the condition and preventing morbidity and mortality in these patients.
Prolonged Treatment Response to Pembrolizumab in a Patient with Pretreated Metastatic Colon Cancer and Lynch Syndrome
Authors: Matthew Keating, Lisa Giscombe, Toufic Tannous, Kevan Hartshorn
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

Pembrolizumab and other immunotherapies now play a prominent role in the treatment of metastatic colon cancer. Clinicians have achieved significant response rates even in heavily pretreated patients, particularly those with mismatched repair deficiencies. The endpoint of pembrolizumab treatment for patients who enjoy a strong response remains unclear. Herein, we present the case of a 33-year-old man with pretreated metastatic colon cancer and a prolonged treatment response of over three years to single-agent pembrolizumab even after treatment discontinuation in July 2018. Prior to pembrolizumab, he was found to have lung and liver metastases despite multiple lines of chemotherapy. With pembrolizumab, there was a persistent downtrend in CEA level and uptrend in weight. After nearly three years of pembrolizumab treatment from October 2015 through July 2018, PET scan showed no FDG-avid disease, and further treatment was placed on hold. He remains under surveillance, with CT scan in February 2019 again showing no evidence of local or metastatic disease. In patients whose treatment duration and disease course are not defined by toxicities/progressive disease but rather by sustained treatment responses, we propose that immunotherapy treatment duration be guided by close monitoring of CEA levels, weight, and clinical exams in addition to traditional imaging.
Patient-specific modeling of right coronary circulation vulnerability post-liver transplant in Alagille's syndrome
Authors: Miguel Silva Vieira, Christopher J Arthurs, Tarique Hussain, Reza Razavi, Carlos Alberto Figueroa
Journal: PLoS One (2018)
MeSH terms: Alagille Syndrome / physiopathology, Heart / physiopathology, Myocardial Ischemia / physiopathology, Patient-Specific Modeling, Case Reports, Research Support, Non-U.S. Gov't, Alagille Syndrome / diagnosis, Alagille Syndrome / diagnostic imaging, Cardiac Output, Catheterization, Child, Coronary Circulation / physiology, Coronary Vessels / diagnostic imaging, Coronary Vessels / physiopathology, Echocardiography, Stress, Heart / diagnostic imaging, Humans, Liver Transplantation / adverse effects, Male, Models, Cardiovascular, Myocardial Ischemia / diagnosis, Myocardial Ischemia / diagnostic imaging, Myocardial Reperfusion / adverse effects, Regional Blood Flow / physiology

Objectives:
Cardiac output (CO) response to dobutamine can identify Alagille's syndrome (ALGS) patients at higher risk of cardiovascular complications during liver transplantation. We propose a novel patient-specific computational methodology to estimate the coronary autoregulatory responses during different hemodynamic conditions, including those experienced in a post-reperfusion syndrome (PRS), to aid cardiac risk-assessment.
Material and methods:
Data (pressure, flow, strain and ventricular volumes) from a 6-year-old ALGS patient undergoing catheter/dobutamine stress MRI (DSMRI) were used to parameterize a closed-loop coupled-multidomain (3D-0D) approach consisting of image-derived vascular models of pulmonary and systemic circulations and a series of 0D-lumped parameter networks (LPN) of the heart chambers and the distal arterial and venous circulations. A coronary microcirculation control model (CMCM) was designed to adjust the coronary resistance to match coronary blood flow (and thus oxygen delivery) with MVO2 requirements during Rest, Stress and a virtual PRS condition.
Results:
In all three simulated conditions, diastolic dominated right coronary artery (RCA) flow was observed, due to high right ventricle (RV) afterload. Despite a measured 45% increase in CO, impaired coronary flow reserve (CFR) (~1.4) at Stress was estimated by the CMCM. During modeled PRS, a marked vasodilatory response was insufficient to match RV myocardial oxygen requirements. Such exhaustion of the RCA autoregulatory response was not anticipated by the DSMRI study.
Conclusion:
Impaired CFR undetected by DSMRI resulted in predicted myocardial ischemia in a computational model of PRS. This computational framework may identify ALGS patients at higher risk of complications during liver transplantation due to impaired coronary microvascular responses.
Black Seed Oil, Bentonite Clay, and Probiotics: A Comprehensive Holistic Cure for Clostridium difficile Infection in a 2-Year-Old Female Child
Authors: Emily Littman, Nicole Winningham, Tana B Carson, Ivette M Hidalgo
Journal: Case Rep Infect Dis (2022)
MeSH terms: Case Reports

There has been a rise in antibiotic resistance in secondary conditions such as Clostridium difficile (C. difficile) due to overuse of antibiotics. Oral antibiotics are used to treat C. difficile, which further disrupts the intestinal flora resulting in unwanted side effects. Naturopathic treatments often have fewer side effects and lower secondary infection risk than pharmaceutical interventions making them ideal for pediatric use. This case report describes the effective treatment of a pediatric clinical case of C. difficile using naturopathic and complementary alternative medicines (CAMs) including black seed oil (Nigella sativa), bentonite clay, and probiotics. A healthy two-year-old patient presented to a pediatrician with symptoms of, and subsequently confirmed, C. difficile after having been recently hospitalized and treated for a gluteal abscess and cellulitis using clindamycin, vancomycin, and piperacillin/tazobactam. Through a shared decision-making process, the patient's mother and providers developed a treatment plan for the C. difficile infection (CDI), which included black seed oil, bentonite clay, and Lactobacillus probiotics. No C. difficile was detected via stool immunoassay after 4 days of combined CAM therapy. Our results underscore the need for additional research regarding the effectiveness of naturopathic CAMs including black seed oil, bentonite clay, and probiotics as alternatives to antibiotic treatment of CDI in children.
Budd-Chiari Syndrome Caused by TIPS Malposition: A Case Report
Authors: A S Katkar, Anderson H Kuo, S Calle, K Gangadhar, K Chintapalli
Journal: Case Rep Med (2014)

Budd-Chiari syndrome refers to hepatic pathology secondary to diminished venous outflow, most commonly associated with venothrombotic disease. Clinically, patients with Budd-Chiari present with hepatomegaly, ascites, abdominal distension, and pain. On imaging, Budd-Chiari syndrome is hallmarked by occluded IVC and or hepatic veins, caudate lobe enlargement, heterogeneous liver enhancement, intrahepatic collaterals, and hypervascular nodules. Etiopathological factors for Budd-Chiari syndrome include several systemic thrombotic and nonthrombotic conditions that can cause venous outflow obstruction at hepatic veins and/or IVC. While the transjugular intrahepatic portosystemic shunt (TIPS) is used as a treatment option for Budd-Chiari syndrome, Budd-Chiari syndrome is not a well-known complication of TIPS procedure. We report a case of Budd-Chiari syndrome that occurred in a transplanted cirrhotic liver from malpositioned proximal portion of the TIPS in IVC causing occlusion of the ostia of hepatic veins which was subsequently diagnosed on contrast-enhanced CT.
Urosepsis Causing Gastric Ischemia: A Rare but Deadly Complication
Authors: Vijay Jarodiya, Chirag Kher, Sangeetha Nanthabalan, Gunjan Shah
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

A 70-year-old male presented with abdominal pain and altered mental status. He was found to have sepsis secondary to a urinary tract infection with imaging showing hepatic portal venous gas and gastric pneumatosis. Esophagogastroduodenoscopy revealed gastric ischemia extending to the midbody with necrosis and biopsies confirming ischemia. The patient was treated conservatively with intermittent nasogastric tube suctioning, acid suppression therapy and broad-spectrum antibiotics. The patient improved clinically and repeat imaging and EGD showed resolution of the ischemia. The patient's diet was advanced and he was discharged to a long-term acute care facility. Gastric ischemia is a rare condition caused by local or diffuse vascular insufficiency. Management is either surgical or conservative with acid suppression, nasogastric tube suctioning and broad-spectrum antibiotics. Gastric ischemia is often diagnosed late and can have complications such as gastric perforation which carries high morbidity and mortality.
Intestinal Tuberculosis Presenting with Gastrointestinal Bleeding in Patient on Warfarin Therapy
Authors: Werimo Pascal Kuka, Joe Rakiro, Joseph Gatheru, Felix Riunga, Allan Rajula
Journal: Case Rep Gastrointest Med (2022)
MeSH terms: Case Reports

Background:
Intestinal tuberculosis (ITB) constitutes less than 5% of overall cases of extrapulmonary disease and mostly affects the ileocecal region. The presentation and radiologic findings in enteric tuberculosis can mimic Crohn's disease (CD). Case Presentation. We present a case report of an African woman who presented to a Kenyan hospital with lower gastrointestinal bleeding while on anticoagulation for valvular atrial fibrillation, and was diagnosed with intestinal tuberculosis after colonoscopy, biopsy, and positive staining for tuberculous bacilli.
Conclusion:
Intestinal tuberculosis causing gastrointestinal bleeding is rare but should be suspected in patients living in TB endemic regions.
Endovascular repair with extracorporeal membrane oxygenation as a rescue strategy for aortobronchial fistula: a case report
Authors: Kyosuke Takahashi, Misa Kajitani, Takaaki Kamada, Wataru Takayama, Yoshiro Kobayashi
Journal: JA Clin Rep (2017)
Keywords: aortobronchial fistula, endovascular repair, extracorporeal membrane oxygenation, massive hemoptysis, thoracic aortic aneurysm

Aortobronchial fistula (ABF) is a rare and potentially lethal complication of thoracic aortic replacement surgery. Currently, thoracic endovascular aortic repair (TEVAR) has emerged as a less invasive alternative to open surgery for ABF to facilitate prompt hemostasis. However, there are no published reports of TEVAR for ABF, particularly for presentation with life-threatening respiratory failure from massive hemoptysis. A 48-year-old male patient, who had recently undergone aortic root and arch replacement due to aortic dissection, was transferred to the emergency department with massive hemoptysis and severe dyspnea. A single-lumen endotracheal tube was immediately placed in the right main bronchus to protect the nonbleeding lung from spillage of blood. Chest computed tomography (CT) showed leakage of contrast material from the distal anastomosis of the aortic graft and consolidated lung tissue adjacent to the leakage. He was diagnosed with an ABF following aortic arch replacement, and an emergency TEVAR was performed. After adequate hemostasis, severe hypercapnia remained uncorrected despite the maximum ventilatory support. Thus, venovenous extracorporeal membrane oxygenation (VV ECMO) was immediately initiated, and severe respiratory acidosis improved dramatically. Furthermore, VV ECMO facilitated prompt bronchoscopic washout of the remaining blood clot without any danger of respiratory collapse and was weaned off successfully after 5 days as ventilation improved. This case demonstrates that emergency TEVAR in combination with VV ECMO can be a rescue strategy for massive hemoptysis from an ABF.
Management of Neuraxial Analgesia in a Parturient with Factor XIII Deficiency: A Case Report and Proposed Management Algorithm
Authors: David B Carroll, Conrad Myler, Natthapol Songdej, Khaled Sedeek, Dmitri Bezinover
Journal: Case Rep Anesthesiol (2020)
MeSH terms: Case Reports

Factor XIII (FXIII) deficiency is a rare coagulation defect that can be associated with significant bleeding. A 28-year-old pregnant woman, with a history of hemorrhagic stroke secondary to severe congenital FXIII deficiency, presented in active labor requesting an epidural. Factor XIII levels had been monitored throughout her pregnancy and treated with intermittent factor XIII infusions to maintain factor levels above 30% of normal. After careful multidisciplinary peripartum evaluation and FXIII replacement, neuraxial analgesia was performed without complication. Neuraxial analgesia can be performed without complication in patients with FXIII deficiency if FXIII levels are carefully managed and no other coagulopathy exists.
What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?
Authors: Zeev Blumenfeld
Journal: Front Endocrinol (Lausanne) (2020)
Keywords: coh, ivf/art, pof, poi, poor responders
MeSH terms: Drug Resistance / physiology, Infertility, Female / therapy, Ovulation Induction / methods, Review, Female, Fertilization in Vitro / methods, Humans, Infertility, Female / diagnosis, Infertility, Female / etiology, Ovarian Reserve / physiology, Pregnancy, Pregnancy Rate, Primary Ovarian Insufficiency / complications, Primary Ovarian Insufficiency / therapy, Treatment Failure

The infertile patients with aging ovaries-also sometimes referred to as impending premature ovarian insufficiency (POI), impending premature ovarian failure (POF), or poor ovarian responders (POR), constitute a significant and increasing bulk of the patients appealing to IVF/ART. Different causes have been cited in the literature, among the identified etiologies, including chromosomal and genetic etiology, metabolic, enzymatic, iatrogenic, toxic, autoimmune, and infectious causes. Although the most successful and ultimate treatment of POI/POF/POR patients is egg donation (ED), many, if not most, of these infertile women are reluctant to consent to ED upon the initial diagnostic interview, requesting alternative solutions despite the low odds for success. Despite anecdotal case reports, no unequivocal treatment proved to be successful for these patients in prospective randomized controlled trials. Nevertheless, the addition of growth hormone (GH) to ovarian stimulation in POR with GH deficiency may improve the results of controlled ovarian hyperstimulation (COH) and the IVF success. In patients with autoimmune etiology for POR/POI, the combination of glucocorticosteroids, pituitary-ovarian suppression, and COH may be successful in achieving the desired conception.
Multidisciplinary Approach to Hepatic Metastases of Intracranial Hemangiopericytoma: A Case Report and Review of the Literature
Authors: Dimitrios K Manatakis, Spiridon G Delis, Nikolaos Ptohis, Penelope Korkolopoulou, Christos Dervenis
Journal: Case Rep Oncol Med (2015)

Hemangiopericytoma is a rare primary tumor originating from Zimmerman's pericytes, with significant metastatic potential. Hepatic metastatic disease requires an aggressive approach by a multidisciplinary team of dedicated oncology specialists, to prolong survival in selected patients. We report on a patient with recurrent hepatic metastases of grade II intracranial hemangiopericytoma 5 years after initial treatment, managed by a stepwise combination of liver resection, radiofrequency ablation, and transarterial embolization. Although metastatic disease implies hematogenous dissemination, long-term survival after liver resection has been reported and major hepatectomies are justified in patients with adequate local control. Liver resections combined with transarterial embolization are highly recommended, due to hypervascularity of the tumor.