OpenMed/multicare-articles huggingface dataset:
"Primary care is primary care": Use of Normalization Process Theory to explore the implementation of primary care services for transgender individuals in Ontario
Authors: Erin Ziegler, Ruta Valaitis, Jennifer Yost, Nancy Carter, Cathy Risdon
Journal: PLoS One (2019)
MeSH terms: Fee-for-Service Plans / organization & administration, Physicians, Primary Care / organization & administration, Primary Health Care / organization & administration, Public Health / methods, Transgender Persons / psychology, Transsexualism / therapy, Research Support, Non-U.S. Gov't, Adult, Family Health / ethics, Fee-for-Service Plans / ethics, Female, Humans, Male, Ontario, Physicians, Primary Care / ethics, Public Health / ethics, Qualitative Research, Transgender Persons / statistics & numerical data, Transsexualism / psychology, Waiting Lists

Background:
In Ontario, Canada, healthcare for transgender individuals is accessed through primary care; however, there are a limited number of practitioners providing transgender care, and patients are often on waiting lists and/or traveling great distances to receive care. Understanding how primary care is implemented and delivered to transgender individuals is key to improving access and eliminating healthcare barriers. The purpose of this study is to understand how the implementation of primary care services for transgender individuals compares across various models of primary care delivery in Ontario.
Methods:
A qualitative, exploratory, multiple-case study guided by Normalization Process Theory (NPT) was used to compare transgender care delivery and implementation across three primary care models. Three cases known to provide transgender primary care and represent different primary care models in Ontario, Canada (i.e., family health team, community health centre, fee-for service physician) were explored. The NoMAD survey, a tool to measure implementation processes, and qualitative interviews with primary care practitioners and allied healthcare staff were administered.
Results:
Using the NPT framework to guide analysis, key themes emerged about successful implementation of primary care services for transgender individuals. These themes include creating a safe space for patients, identifying gaps in services, understanding practitioners' roles, and the need for more training and education in transgender care for practitioners.
Conclusions:
Primary care services for transgender individuals can and should be delivered in all models of primary care. Training and awareness for healthcare practitioners are needed to develop capacity in providing primary care to transgender individuals. A greater number of practitioners and organizations are needed to take on this work, embedding and normalizing transgender care into routine practice to address barriers to access and improve quality of care for transgender individuals.
Primitive Neuroectodermal Tumor of the Pancreas: A Case Report and Review of the Literature
Authors: Uirá Teixeira, Marcos Goldoni, Michelle Unterleider, João Diedrich, Diogo Balbinot, Pablo Rodrigues, Rodolfo Monteiro, Daniel Gomes, José Sampaio, Paulo Fontes, Fábio Waechter
Journal: Case Rep Surg (2015)

Primitive neuroectodermal tumors (PNETs) are presented as rare malignant neoplasms. In unusual cases, those neoplasms may arise in solid organs containing neuroendocrine cells, such as the pancreas. Herein the case of a 28-year-old patient that underwent gastroduodenopancreatectomy after the diagnosis of a huge mass (PNET) located in both head and body of the pancreas is reported. This is the 19th case of pancreatic PNET reported in literature.
Diffusion-Weighted Imaging Findings of Ischemic Spinal Injury in a Chondrodystrophic Dog With Fibrocartilaginous Embolism
Authors: Taesik Yun, Kang-Il Lee, Yoonhoi Koo, Hakhyun Kim, Dongwoo Chang, Chulhyun Lee, Mhan-Pyo Yang, Byeong-Teck Kang
Journal: Front Vet Sci (2020)
Keywords: apparent diffusion coefficient, diffusion-weighted imaging, dog, fibrocartilaginous embolism, high-field mri
MeSH terms: Case Reports

A 9-year-old, intact male Shih Tzu dog presented with systemic weakness and peracute onset of tetraplegia. Tetraplegia with lower motor neuron signs was noted upon neurological examination. Diseases that cause acute flaccid tetraparesis, such as acute fulminating myasthenia gravis, polyradiculoneuritis, tick paralysis, and botulism, were ruled out based on the medical history, normal electrophysiological tests, and non-response to the neostigmine challenging test. Initial 0.3-Tesla (T) magnetic resonance imaging (MRI) findings included sharply demarcated intramedullary lesions at the C3-C6 level, mainly involving gray matter, which appeared hypo- to iso- intense on T1-weighted images (WIs), and hyperintense on T2-WIs and fluid-attenuated inversion recovery images. There was no enhancement on post-contrast T1-WIs. Neutrophilic pleocytosis was observed in the cerebrospinal fluid analysis. No clinical responses were observed for the treatment of non-infectious myelitis with an immunosuppressive dosage of prednisolone. A follow-up 3-T MRI 6 days later demonstrated hyperintensity on diffusion-WI (DWI) and a decreased apparent diffusion coefficient (ADC) value (0.54 × 10-3 mm2/s) of the spinal lesions. Through histological examination, a fibrocartilaginous embolism was definitively confirmed. This is the first report to describe an ischemic spinal injury visualized by DWI and ADC mapping with high-field MRI in a chondrodystrophic dog diagnosed with a fibrocartilaginous embolism.
Traumatic-event headaches
Authors: David C Haas
Journal: BMC Neurol (2004)
MeSH terms: Headache / etiology, Wounds and Injuries / complications, Case Reports, Comparative Study, Adult, Chronic Disease, Craniocerebral Trauma / complications, Female, Humans, Male, Middle Aged, Whiplash Injuries / complications, Wounds and Injuries / classification

Background:
Chronic headaches from head trauma and whiplash injury are well-known and common, but chronic headaches from other sorts of physical traumas are not recognized.
Methods:
Specific information was obtained from the medical records of 15 consecutive patients with chronic headaches related to physically injurious traumatic events that did not include either head trauma or whiplash injury. The events and the physical injuries produced by them were noted. The headaches' development, characteristics, duration, frequency, and accompaniments were recorded, as were the patients' use of pain-alleviative drugs. From this latter information, the headaches were classified by the diagnostic criteria of the International Headache Society as though they were naturally-occurring headaches. The presence of other post-traumatic symptoms and litigation were also recorded.
Results:
The intervals between the events and the onset of the headaches resembled those between head traumas or whiplash injuries and their subsequent headaches. The headaches themselves were, as a group, similar to those after head trauma and whiplash injury. Thirteen of the patients had chronic tension-type headache, two had migraine. The sustained bodily injuries were trivial or unidentifiable in nine patients. Fabrication of symptoms for financial remuneration was not evident in these patients of whom seven were not even seeking payments of any kind.
Conclusions:
This study suggests that these hitherto unrecognized post-traumatic headaches constitute a class of headaches characterized by a relation to traumatic events affecting the body but not including head or whiplash traumas. The bodily injuries per se can be discounted as the cause of the headaches. So can fabrication of symptoms for financial remuneration. Altered mental states, not systematically evaluated here, were a possible cause of the headaches. The overall resemblance of these headaches to the headaches after head or whiplash traumas implies that these latter two headache types may likewise not be products of structural injuries.
Hemodynamic Response to Massive Bleeding in a Patient with Congenital Insensitivity to Pain with Anhidrosis
Authors: Yuki Sugiyama, Sayako Gotoh, Masatoshi Urasawa, Mikito Kawamata, Koichi Nakajima
Journal: Case Rep Anesthesiol (2018)
MeSH terms: Case Reports

A patient with congenital insensitivity to pain with anhidrosis (CIPA) underwent revision of total hip arthroplasty under general anesthesia with only propofol. During surgery, neither elevation of stress hormones nor hemodynamic changes associated with pain occurred; however, when blood was rapidly lost, compensatory tachycardia was observed. Although patients with CIPA are complicated with autonomic disturbance due to dysfunction of postganglionic sympathetic fibers, this compensatory response indicated that the adrenal glands in patients with CIPA secrete catecholamine as part of a compensatory response during bleeding under general anesthesia.
Myxedema Coma and Acute Hepatopathy in a Dog with Severe Atherosclerosis
Authors: Leah C Giralico, Rebecca Makii, Betsy A Pray, Valerie J Parker
Journal: Case Rep Vet Med (2021)
MeSH terms: Case Reports

A 9-year-old male intact mixed-breed dog was presented to The Ohio State University Veterinary Medical Center for evaluation of two days' duration of weakness, lethargy, inappetence, and one episode of vomiting the day of presentation. On presentation, the dog was depressed and tetraparetic. He was noted to be icteric and dehydrated. Obesity and truncal alopecia with a "rat tail" appearance were observed. Diagnostic testing revealed evidence of an acute hepatopathy and peritonitis. Given the dog's neurologic status, physical examination abnormalities, including a "tragic facial expression", and hyperlipidemia, there was concern for possible myxedema coma. A thyroid panel was consistent with hypothyroidism. The dog experienced respiratory arrest prior to initiation of therapy, and an autopsy confirmed the presence of subacute necrotizing cholangiohepatitis, marked atherosclerosis, and severe thyroid atrophy. These clinical and pathologic changes were supportive of myxedema coma.
Case Report: A Novel EIF2B3 Pathogenic Variant in Central Nervous System Hypomyelination/Vanishing White Matter
Authors: Parith Wongkittichote, Soe Soe Mar, Robert C McKinstry, Hoanh Nguyen
Journal: Front Genet (2022)
Keywords: eif2b3, ataxia, childhood ataxia with central nervous system hypomyelination/vanishing white matter, developmental regression, leukodystrophy
MeSH terms: Case Reports

Leukodystrophies are a group of heterogeneous disorders affecting brain myelin. Among those, childhood ataxia with central nervous system hypomyelination/vanishing white matter (CACH/VWM) is one of the more common inherited leukodystrophies. Pathogenic variants in one of the genes encoding five subunits of EIF2B are associated with CACH/VWM. Herein, we presented a case of CACH/VWM who developed ataxia following a minor head injury. Brain magnetic resonance imaging showed extensive white matter signal abnormality. Diagnosis of CACH/VWM was confirmed by the presence of compound heterozygous variants in EIF2B3: the previously known pathogenic variant c c.260C>T (p.Ala87Val) and the novel variant c.673C>T (p.Arg225Trp). Based on the American College of Medical Genetics (ACMG) recommendations, we classified p.Arg225Trp as likely pathogenic. We report a novel variant in a patient with CACH/VWM and highlight the importance of genetic testing in patients with leukodystrophies.
Augmenting Function for Infarction from Infection: Impella 2.5 for Ischemic Cardiogenic Shock Complicating Sepsis
Authors: Praveen George, Mukta C Srivastava, Jonathan Ludmir, Robert M Reed, Semhar Z Tewelde, Anuj Gupta, Michael T McCurdy
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Cardiac dysfunction is a common complication of sepsis in individuals with preexisting coronary disease and portends a poor prognosis when progressing to ischemic cardiogenic shock. In this setting, maximal medical therapy in isolation is often inadequate to maintain cardiac output for patients who are poor candidates for immediate revascularization. Furthermore, the use of vasopressors and inotropes increases myocardial demand and may lead to further injury. Percutaneous ventricular assist devices provide a viable option for management of severe shock with multiorgan failure. The Impella is one of several novel mechanical support systems that can effectively augment cardiac output while reducing myocardial demand and serve as a bridge to recovery from severe hemodynamic compromise. This case report describes the successful utilization of the Impella 2.5 in a patient with baseline profound anemia and coronary artery disease (CAD) presenting in combined distributive and cardiogenic shock associated with a type 2 myocardial infarction complicating sepsis.
Tuboovarian Abscess due to Colonic Diverticulitis in a Virgin Patient with Morbid Obesity: A Case Report
Authors: Zafer Selçuk Tuncer, Gokhan Boyraz, Senem Özge Yücel, Ilker Selçuk, Aslıhan Yazicioğlu
Journal: Case Rep Med (2012)

Since tuboovarian abscess is almost always a complication of pelvic inflammatory disease, it is rarely observed in virgins. A 30-year-old virgin patient presented with pelvic pain, fever, and vaginal spotting for the previous three weeks. Her abdominopelvic computed tomography scan revealed bilateral multiseptated cystic masses with prominent air-fluid levels suggesting tuboovarian abscesses. The sigmoid colon was lying between two tuboovarian masses, and its borders could not be distinguished from the ovaries. The patient was presumed to have bilateral tuboovarian abscesses which developed as a complication of the sigmoid diverticulitis. She was administered intravenous antibiotic therapy followed by percutaneous drainage under ultrasonographic guidance. She was discharged on the twenty second day with prominent clinical and radiological improvement. Diverticulitis may be a reason for development of tuboovarian abscess in a virgin patient. Early recognition of the condition with percutaneous drainage in addition to antibiotic therapy helps to have an uncomplicated recovery.
Acute Muscle Trauma due to Overexercise in an Otherwise Healthy Patient with Cystic Fibrosis
Authors: Henning Neubauer, Clemens Wirth, Katharina Ruf, Helge Hebestreit, Meinrad Beer
Journal: Case Rep Pediatr (2012)
MeSH terms: Case Reports

Cystic fibrosis (CF) is one of the most common inherited diseases and is caused by mutations in the CFTR gene. Although the pulmonary and gastrointestinal manifestations of the disease remain in the focus of treatment, recent studies have shown expression of the CFTR gene product in skeletal muscle cells and observed altered intramuscular Ca(2+) release dynamics in CFTR-deficient animal models. Physical exercise is beneficial for maintaining fitness and well-being in CF patients and constitutes one aspect of modern multimodal treatment, which has considerably increased life span and reduced morbidity. We report on a case of acute muscle trauma resulting from excessive dumbbell exercise in a young adult with cystic fibrosis and describe clinical, laboratory and imaging characteristics of acute exercise-induced muscle injury.
Stomach carcinoma presenting with a synchronous liver cancer: a case report and literature review
Authors: Yong Wang, Xiao-Ting Wu
Journal: Case Rep Gastrointest Med (2014)

Multiple primary malignant neoplasms are two or more malignancies in an individual without any relationship between the tumors. Multiple primary malignancies are relatively rare but have increased in recent decades. Two cancers are commonly observed among those with multiple primary malignancies, but two malignancies of stomach and liver are relatively rare to be reported. Mechanisms of the tumors were unclear; we described a patient who had stomach carcinoma presenting with a synchronous liver cancer and investigated his family history; we suggest that family history may be a key risk factor and early detection for additional primary malignancies should be needed for patients who had specific cancer history in their pedigree. Early diagnosis may be the key risk factor affecting prognosis.
Retroperitoneal Paraganglioma-Induced Cardiogenic Shock Rescued by Preoperative Arterial Embolization
Authors: N Houari, S Touzani, H Salhi, M-Y Alaoui Lamrani, K Ibnmajdoub, H El Ouahabi, A El Bouazzaoui, B Boukatta, M Maâroufi, K Maazaz, N Kanjaa
Journal: Case Rep Crit Care (2018)
MeSH terms: Case Reports

Background:
Catecholamine-induced cardiogenic shock is a rare manifestation of paragangliomas. The high mortality rate of this condition makes the immediate, multidisciplinary approach mandatory.
Case report:
We report a case of an 18-year-old woman with a retroperitoneal secreting paraganglioma, complicated with a cardiogenic shock and an acute adrenergic myocarditis, requiring hemodynamic support and emergency arterial embolization prior to surgical excision, with a favorable outcome.
Conclusion:
Paraganglioma-induced myocarditis is rare but can be dramatic. Management requires appropriate and immediate hemodynamic support. Embolization may be an alternative to stabilize the patient prior to surgery.
Case Report: Hyperinflammatory Status in an Immunocompromised Child With a Highly Sustained Viral Load of SARS-CoV-2
Authors: Matias Moragas, Sandra Gomez, María Florencia Fernández, Marcelo Dario Golemba, Marcela Palladino, Daniela Borgnia, Silvina Ruvinsky, Lidia Fraquelli, Ana Buchovsky, Rosa Bologna, Andrea Mangano
Journal: Front Med (Lausanne) (2021)
Keywords: covid-19, sars-cov-2, hyperinflammatory status, immunocompromised state, pediatrics, viral load
MeSH terms: Case Reports

Coronavirus disease 2019 (COVID-19) is spreading throughout the world. Limited data are available for the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load (VL) in immunocompromised pediatric patients. Here, we report the clinical characteristics and the dynamics of SARS-CoV-2 VL of a pediatric patient with acute myeloid leukemia who developed a hyperinflammatory status mimicked MIS-C. The clinical course was characterized by the late onset of fever, GI symptoms, rash, and respiratory distress, including oxygen requirement with sustained VL of SARS-CoV-2 around 7 log10 RNA copies/mL for 6 weeks. It is important to note that the hyperinflammatory status developed early at the third week of hospitalization-in a context of high VL and immunocompromised status. All these characteristics make this clinical case unique. On the other hand, while many reports have characterized the dynamics of SARS-CoV-2 VL in adults and immunocompetent hosts, it remains unreported in pediatrics-even less in immunosuppressed children.
Clostridium septicum Aortitis and Cecal Adenocarcinoma
Authors: Brian Moseley, Nicola W Mwirigi, Juan Bowen
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Clostridium septicum aortitis is a rare infection that is highly associated with underlying malignancy. We present a case of an 82-year-old male diagnosed with both C. septicum aortitis and a high-grade cecal tubulovillous adenoma. The patient was offered aortic resection; however, he opted for only suppressive antibiotic therapy and a right hemicolectomy with ileocolonic anastomosis. He ultimately passed away 75 days following admission. The authors report on the connection between C. septicum aortitis and malignancy. The authors also discuss the need for prompt treatment with antibiotics once the infection is identified and the consideration of aortic resection given the risk of aneurysmal change with aortic dissection or rupture.
Case Report: Identification of Potential Prognosis-Related TP53 Mutation and BCL6-LPP Fusion in Primary Pituitary Lymphoma by Next Generation Sequencing: Two Cases
Authors: Yi Zhang, Liyuan Ma, Jie Liu, Huijuan Zhu, Lin Lu, Kan Deng, Wenbin Ma, Hui Pan, Renzhi Wang, Yong Yao
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: bcl6, tp53, diffuse large b cell lymphoma, high-dose methotrexate, next generating sequencing, primary pituitary lymphoma
MeSH terms: Cytoskeletal Proteins / genetics, LIM Domain Proteins / genetics, Lymphoma, Large B-Cell, Diffuse / pathology, Mutation, Pituitary Neoplasms / pathology, Proto-Oncogene Proteins c-bcl-6 / genetics, Tumor Suppressor Protein p53 / genetics, Case Reports, Research Support, Non-U.S. Gov't, Aged, Female, High-Throughput Nucleotide Sequencing, Humans, Lymphoma, Large B-Cell, Diffuse / cerebrospinal fluid, Lymphoma, Large B-Cell, Diffuse / genetics, Male, Middle Aged, Pituitary Neoplasms / cerebrospinal fluid, Pituitary Neoplasms / genetics, Prognosis, BCL6 protein, human, Cytoskeletal Proteins, LIM Domain Proteins, LPP protein, human, Proto-Oncogene Proteins c-bcl-6, TP53 protein, human, Tumor Suppressor Protein p53

Background:
Primary pituitary lymphoma (PPL) is an extremely rare disease with poor prognosis. Although PPL has been shown to be different from classical primary central nervous system lymphoma because of the embryological origin of structures, individual and precise treatment of PPL remains unknown.
Methods:
A 61-year-old man and a 65-year-old woman both diagnosed with primary pituitary diffuse large B cell lymphoma underwent genetic analysis of cerebrospinal fluid and tumor tissue by next generation sequencing.
Results:
In the first case, partial remission was achieved following R²-MTX chemotherapy. In the other case with TP53 mutation and BCL6-LPP fusion, disease progressed although different chemotherapy regimens were given.
Conclusion:
The gene mutation of TP53 and BCL6 may be identified as a marker responsible for prognostic difference in patients with PPL. Genetic analysis may provide a novel approach for precise management and prognosis prediction.
Superselective embolisation for control of intractable epistaxis from maxillary artery injury
Authors: P Singam, J Thanabalan, Z Mohammed
Journal: Biomed Imaging Interv J (2011)
Keywords: epistaxis, head trauma, maxillary artery injury
MeSH terms: Case Reports

Traumatic intractable epistaxis following fractures of the facial and base of skull rarely may be life-threatening. Common sites of injury are the internal carotid and maxillary artery. When conventional methods of arresting haemorrhage fail, the choices are then an open arterial ligation or superselective embolisation. This paper presents a patient with life-threatening epistaxis from a Le Fort type II fracture. Angiography revealed a maxillary artery injury in which superselective embolisation was performed and the haemorrhage was successfully arrested. A literature review of this technique is discussed, including its advantages and the relationship of the internal maxillary artery to facial fractures.
A case of Warthin-like papillary thyroid carcinoma with diffuse sclerosing stroma and a novel RET mutation: a new entity or a combined tumour?
Authors: Fausto Maffini, Daniele Lorenzini, Daniela Lepanto, Elvio De Fiori, Caterina Fumagalli, Alessandra Rappa, Marta Tagliabue, Massimo Barberis
Journal: Ecancermedicalscience (2019)
Keywords: braf, ret, mutation, pathology, thyroid carcinoma
MeSH terms: Case Reports

Activating mutations of the RET gene have been described for both papillary (chromosomal rearrangement) and medullary (missense mutations) thyroid carcinomas. Here, we describe a case of a Warthin-like variant of papillary thyroid carcinoma displaying some morphological aspects that mimic the diffuse sclerosing variant. The tumour harboured BRAF V600E mutation and a novel germline point mutation in the RET gene, with unknown clinical and pathological meaning.
Closure Of Thoracic Wall Defect Using Breast Implant Capsule Tissue As A Rotation Flap - A Case Report
Authors: Michael Josiassen, Madeline T Kudibal, Christina Gramkow, Stig-Frederik Trojahn Kølle
Journal: Case Reports Plast Surg Hand Surg (2018)
Keywords: thoracic flap, iatrogen pneumothorax
MeSH terms: Case Reports

A 70-year old woman underwent thoracic surgery resulting in rupture of a silicone implant. During re-implantation at a later time an iatrogenic thoracic wall defect was discovered. In order to complete re-implantation the defect was closed using a rotation flap constructed from capsular tissue from the previous silicone implant.