OpenMed/multicare-articles huggingface dataset:
Case report: Effectiveness of brexpiprazole and esketamine/ketamine combination: A novel therapeutic strategy in five cases of treatment-resistant depression
Authors: Lai Fong Chan, Luke Sy-Cherng Woon, Nuur Asyikin Mohd Shukor, Choon Leng Eu, Nurazah Ismail, Song Jie Chin, Nik Ruzyanei Nik Jaafar, Azlin Baharudin
Journal: Front Psychiatry (2022)
Keywords: brexpiprazole, effectiveness, esketamine, ketamine, treatment-resistant depression
MeSH terms: Case Reports

A significant proportion of patients with treatment-resistant depression do not attain functional recovery despite administration of multiple steps of pharmacotherapeutic strategies. This highlights the elusiveness of meeting unmet needs in existing pharmacotherapies for treatment-resistant depression. There is accumulating evidence that antidepressant agents involving the glutamatergic system such as brexpiprazole and esketamine/ketamine have more rapid onset of action and potentially improved effectiveness as an augmentation therapy in treatment-resistant depression. This case series aimed to report five complex cases of unipolar and bipolar treatment-resistant depression where conventional treatment strategies were inadequate in managing high risk suicidal behavior and achieving functional recovery. We discussed further the possible synergistic mechanisms of the novel combination strategy of brexpiprazole and esketamine/ketamine, clinical and patient factors that influenced treatment response, challenges with this combination strategy and implications for future practice and research.
Cecal Perforation Induced by Migrated Biliary Stent as a Rare Complication of ERCP: A Case Report and Literature Review
Authors: Arash Mohammadi Tofigh, Hamed Tahmasbi, Majid Iranshahi, Alireza Haghbin Toutounchi, Hojatolah Khoshnoudi, Seyed Pedram Kouchak Hosseini
Journal: Case Rep Surg (2023)
MeSH terms: Case Reports

Introduction and Importance. Endoscopic retrograde cholangiopancreatography (ERCP) is a non-surgical method utilized to manage biliary tract obstruction, but the complication of biliary stent migration occurs in 5-10% of patients. Though migrated stents are commonly passed through the gastrointestinal tract without harm, intestinal perforation is a rare but severe complication, affecting less than 1% of cases. Case Presentation. We report a case of a 65-year-old woman who presented to the emergency department with symptoms of abdominal pain, nausea, and loss of appetite. According to clinical examination and evidence, the patient underwent surgery with high suspicion of appendicitis, which unexpectedly uncovered a perforated cecum with a protruding biliary stent. Clinical Discussion. Our report describes a unique and unexpected finding of cecal perforation caused by a migrated biliary stent in a patient. We also conducted a review of current literature on ERCP complications, including risk factors for stent migration, relevant statistics, and appropriate interventions. Conclusion. Surgeons should be aware of the risk of stent migration and complications in patients with a history of ERCP. Removal of migrated biliary stents is recommended, regardless of the presence of complications. Additional assessments for alternative diagnoses are recommended for older patients with abdominal pain complaints. Flexible plastic stents should be used for patients at risk of stent passage.
Congenital Vitelline Band Causing Intestinal Obstruction in an Adult with a Double Inferior Vena Cava
Authors: Mihiri Wettasinghe, Kumari Pussepitiya, Bandula Samarasinghe, Nuwan Wickramasinghe
Journal: Case Rep Radiol (2016)

Introduction. Vitelline artery remnants are rare causes of intra-abdominal bands leading to bowel obstruction. These bands may be associated with Meckel's diverticulum. Double inferior vena cava (IVC) is a rare presentation and is usually identified incidentally. Case Presentation. A sixty-year-old male presented with progressive vomiting for five days and he was clinically diagnosed with intestinal obstruction. Plain X-ray abdomen showed evidence of small bowel obstruction. CT scan of the abdomen revealed dilated small bowel loops with a small outpouching in the distal ileum with a band like structure attached to it. In the CT, left sided patent IVC draining into the left renal vein was identified. Left external iliac vein was in continuity with the left IVC. Left internal iliac vein was draining into the right IVC. Exploratory laparotomy revealed a Meckel's diverticulum with a band identified as the vitelline remnant attached to its apex and inserting at the anterior abdominal wall near the umbilicus. Discussion. Meckel's diverticulum with vitelline bands, although rare, should be borne in mind in adult patients with intestinal obstruction. Identification of this anomaly can be difficult in imaging studies. Presence of double IVC should be mentioned in the imaging findings to prevent possible catastrophic complications during surgery.
Bladder Urothelial Carcinoma in a Child: Case Report and Review of Literature
Authors: Marian Hanae Oda, Danilo Vicente Dos Santos, Adria Karina Farias, Leilane de Oliveira, Bruno Pinheiro Falcão, Nicholas J Ahn, Antônio Carlos Amarante, Graziele Moraes Losso, Andre Ivan Bradley Dos Santos Dias, Miguel Angelo Agulham, Camila Girardi Fachin
Journal: Front Pediatr (2019)
Keywords: braf, kras, children, macroscopic hematuria, urothelial carcinoma
MeSH terms: Case Reports

Bladder urothelial carcinoma (UC) it is the fifth most prevalent carcinoma in humans, nevertheless in children and young adults it's very rare. It usually occurs in older adults. Literature on UC in pediatric population is limited and important information (risk factors, follow-up protocols, etc.) are poorly defined. We present an 11-year-old boy with a painful macroscopic hematuria. Ultrasound revealed a heterogeneous intravesical mass without extravesical extension, which was confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). The first biopsy was compatible with urothelial papilloma. After 1 year, he returned with a bigger mass. Transurethral resection of the bladder (TURB) was performed and immunohistochemistry showed low-grade papillary UC with a high-grade component, with tumor free margin. Tumor had mutations in the BRAF and KRAS genes. Two and a half years after the resection the patient has no recurrence. Less than 1% of bladder UC occur in the first two decades of life. Gross hematuria is a common symptom. Ultrasound is generally the first diagnostic tool. MRI is also helpful, but cystoscopy allows definitive diagnosis. Transurethral resection of the bladder (TURB) is the standard treatment, with good results and low recurrence rate, and it was the treatment of choice for our patient, that remains free of disease. The BRAF and KRAS gene mutations were never described before in pediatric UC. There are only few cases in literature of pediatric UC that present a tumor genetic profile; therefore, our case report adds more information to this very rare disease in children.
Duodenal Lipoma As Upper Gastrointestinal Bleeding Presentation: Case Report and Review of the Literature
Authors: Mohammed I Mousa, Sara S Al Ghamdi, Ahmad A Alsolmi, Ahmed F Fakhri
Journal: Cureus (2023)
Keywords: duodenal lipoma, endoscopic resection of duodenal lipoma, melena, non-variceal upper gastrointestinal bleeding, piecemeal
MeSH terms: Case Reports

Duodenal lipomas (DLs) are rare benign nonepithelial tumors that account for 4% of all gastrointestinal (GI) lipomas. DLs can occur in any part of the duodenum but most commonly arise in the second part of the duodenum. They are usually asymptomatic and discovered incidentally but may present with GI hemorrhage, bowel obstruction, or abdominal pain and discomfort. The diagnostic modalities can be based on radiological studies and endoscopy with the aid of endoscopic ultrasound (EUS). DLs can be managed either endoscopically or surgically. We report a case of symptomatic DL presenting with upper GI hemorrhage along with a review of the literature. We report a case of a 49-year-old female patient who presented with a one-week history of abdominal pain and melena. Upper endoscopy revealed a single, large pedunculated polyp with an ulcerated tip in the first part of the duodenum. EUS confirmed features suggestive of a lipoma, including an intense homogeneous hyperechoic mass originating from the submucosa. The patient underwent endoscopic resection, with excellent recovery. The rare occurrence of DLs requires a high index of suspicion and radiological endoscopic assessment to rule out invasion into the deeper layers. Endoscopic management is associated with good outcomes and a decreased risk of surgical complications.
What happens when a whole-school health promotion research trial ends? a case study of the SEHER program in India
Authors: Sachin Shinde, Monika Raniti, Amit Sharma, Susan M Sawyer
Journal: Front Psychiatry (2023)
Keywords: adolescents, education, mental health, schools, sustainability, whole-school intervention

Background:
Health promotion interventions that are developed and evaluated by researchers and other external providers are at risk of not being sustained beyond the initial implementation period. When delivered by a lay school health worker, the SEHER study of a whole-school health promotion intervention in Bihar, India was found to be feasible, acceptable and effective in improving school climate and student health behaviors. The objective of this case study is to describe the decision-making processes, barriers, and enablers to continuing the SEHER intervention following its official closure.
Methods:
For this exploratory qualitative case study, data were collected from four government-run secondary schools, two of which continued SEHER and two of which discontinued it after official closure. Thirteen school staff were interviewed, and 100 girls and boys (aged 15-18 years old) participated in eight focus groups discussing their experiences of the process of continuing the intervention (or discontinuing) following its official closure. Thematic analysis was conducted in NVivo 12 using grounded theory.
Results:
No school sustained the intervention as originally delivered in the research trial. In two schools, the intervention was adapted by selecting sustainable components, whereas in two others it was discontinued altogether. We identified four interrelated themes that explained the complex decision-making process, barriers, and enablers related to program continuation: (1) understanding of the intervention philosophy among school staff; (2) school capabilities to continue with intervention activities; (3) school attitudes and motivation about implementing the intervention, and; (4) the education policy environment and governance structures. Suggestions for overcoming barriers included adequate resource allocation; training, supervision, and support from external providers and the Ministry of Education; and formal government approval to continue the intervention.
Conclusion:
Sustaining this whole-school health promotion intervention in low-resource school settings in India depended on individual, school and government factors as well as external support. These findings suggest that health interventions will not necessarily become embedded in a school's operations merely because they are designed as a whole-school approach or because they are effective. Research should identify the resources and processes required to balance planning for future sustainability while awaiting trial results about an intervention's effectiveness.
A case series of dermatomyositis following SARS-CoV-2 vaccination
Authors: Airiss R Chan, Jan Willem Cohen Tervaert, Desiree Redmond, Elaine Yacyshyn, Giovanni Ferrara, Peter M Hwang, Mohamed Osman, Robert Gniadecki
Journal: Front Med (Lausanne) (2022)
Keywords: sars-cov-2, tlr7, dermatomyositis, exacerbation, molecular mimicry, vaccine

Background/objective:
The most significant adverse events following SARS-CoV-2 vaccination are myocarditis and pericarditis. Myositis and dermatomyositis have been reported following SARS-CoV-2 infection, but vaccine-induced dermatomyositis (DM) has not been reported. Our case series aimed to characterize new onset dermatomyositis or disease-related flares following SARS-CoV-2 vaccination.
Materials and methods:
A total of 53 patients from our institution with a new or pre-existing diagnosis of DM were recruited and consented. Phone interviews were conducted to obtain vaccination status and symptoms following vaccination. Electronic medical records were reviewed to extract age, sex, autoantibody profiles, comorbidities, immunomodulatory therapies, creatine kinase (CK) values, and SARS-CoV-2 vaccination dates from the provincial vaccination registry. For patients who reported disease flares, records were reviewed for the onset and nature of symptoms, extent of organ involvement and changes in immunomodulation.
Results:
On average, patients received 2.62 vaccine doses (range 1-3 doses). A total of 3 of 51 patients (5.88%) experienced dermatomyositis symptoms following vaccination. Two patients were newly diagnosed with dermatomyositis, one requiring hospitalization. Reported symptom onset following vaccination ranged from 1 to 30 days. Of note, all of these patients had normal CK values, even though there was muscle biopsy-confirmed myositis in one patient. Eight patients in the cohort (15.1%) had asymptomatic CK elevation (<1.5 X ULN).
Conclusion:
New onset dermatomyositis or flare up of pre-existing dermatomyositis may be a rare complication in SARS-CoV-2 vaccination although no studies can support a true correlation. Several pathophysiologic mechanisms are proposed.
Glomus tumors with malignant features of the extremities: a case series
Authors: Taylor R Wood, Jonathan B McHugh, Geoffrey W Siegel
Journal: Clin Sarcoma Res (2020)
Keywords: case series, glomus tumor, glomus tumor with uncertain malignant potential, malignant glomus tumor, tertiary sarcoma center

Background:
Malignant glomus tumors are exceedingly rare, however they can be locally aggressive and have the potential to metastasize. There is limited information available in the literature regarding treatment and outcomes, therefore we present a case series of 5 patients with glomus tumors with malignant features confined to the extremities that have presented to our tertiary sarcoma center within the last 20 years. This is the largest case series of its kind in the malignant glomus tumor literature, to our knowledge.
Methods:
We performed a retrospective chart review of all patients with histologically confirmed glomus tumors with malignant features in the extremities found within the University of Michigan EMERSE database since January 1st, 2000.
Results:
Five patients met our inclusion and exclusion criteria. Three patients were diagnosed with malignant glomus tumors, one patient with glomus tumor with uncertain malignant potential, and the last patient with malignant glomus tumor with leiomyosarcomatous features. Males and females were equally represented. Age range was 9-49 years at time of first presentation. All patients underwent an initial surgical resection. Three of the five patients (60%) underwent initial resection at an outside hospital prior to referral to tertiary sarcoma center, and all three required re-resection. One of these patients had local tumor recurrence after a planned positive margin resection and radiotherapy. Another patient had distant metastasis after a positive margin surgical resection and a short course of radiotherapy. All patients are still alive according to their medical record with the average time from initial treatment to last follow up of 59.2 months.
Conclusions:
Our study supports the current literature that wide-local resection with the goal of negative margins is still the current gold standard treatment for glomus tumors with malignant features. Studies with larger cohorts are necessary before recommending for or against radiotherapy or chemotherapy. Early biopsy and referral to a tertiary sarcoma center prior to surgical resection may help reduce the re-resection rate and potential seeding of the tumor in these patients, thereby improving outcomes.
Base of Skull Metastatic Adenocarcinoma from the Breast 23 Years after the Primary Diagnosis
Authors: Iylia Ajmal Othman, Farah Dayana Zahedi, Salina Husain
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Breast cancer metastases to the base of the skull with concomitant infiltration into the paranasal sinuses and nasopharynx are exceptionally rare with only small numbers of reported literatures. Greenberg et al. in 1981 described five clinical syndromes with regards to the base of skull metastases and the clinical presentation of each syndrome related to its anatomical location. Often, metastases to the base of the skull remain asymptomatic until the lesion has increased to a considerable size causing bony destruction and impingement to the surrounding structures. When involving the paranasal sinuses or nasopharynx, the most common presenting symptoms mimic those of rhinosinusitis and, hence, may delay the accurate diagnosis. We are reporting a case of base of skull metastasis from breast carcinoma, 23 years after the primary diagnosis. To the best of our knowledge, our case is the first case to report latent metastasis of more than 20 years.
Treatment of Community-Acquired Pneumonia: A Case Report and Current Treatment Dilemmas
Authors: Glenn Harnett
Journal: Case Rep Emerg Med (2017)
MeSH terms: Case Reports

Resistance to macrolides is rising in the USA and warrants careful consideration when confronted with a patient with suspected pneumonia in the urgent care clinic. This case study exemplifies the potentially serious consequences of treatment failure following prescription of a macrolide for community-acquired bacterial pneumonia. Furthermore, the consequential treatment dilemmas currently faced by physicians are briefly discussed.
A Young, Immunocompetent Woman with Small Bowel and Hepatic Mucormycosis Successfully Treated with Aggressive Surgical Debridements and Antifungal Therapy
Authors: Daniel Vikum, Ingvild Nordøy, Cecilie Torp Andersen, Børre Fevang, Pål Dag Line, Finn Kristian Kolrud, Pål Aukrust, Trond Buanes
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

A 24-year-old woman with coeliac disease and transient neutropenia developed mucormycosis with extensive involvement of the liver and small intestine. She was successfully treated with aggressive surgical debridements and long-term antifungal therapy with liposomal amphotericin B and posaconazole.
Dermatofibrosarcoma protuberans: A case report of a rare, bulky tumor that was managed with surgical therapy
Authors: Ahmet Yılmaz, Erol Cenesizoglu, Ertuğrul Eğilmez, Safa Onel, Mehdi Muştu, Ahmet Cennet
Journal: Int J Shoulder Surg (2009)
Keywords: dermatofibrosarcoma protuberans, soft tissue tumor, surgical therapy
MeSH terms: Case Reports

We report a case of this rare tumor and describe the surgical approach that we adopted and the clinical outcome; we also report his condition at 24 months' follow-up. Although treatment was with radical surgery, sufficient shoulder function could be obtained in our patient. We also describe the interesting MR findings of this tumor which correlated well with the histopathologic findings.
Risk assessment of gastric cancer associated with asbestosis: a case report
Authors: Soo-Hong Park, Dong-Mug Kang, Bon-Hak Koo, Young-Ki Kim, Jong-Eun Kim
Journal: Ann Occup Environ Med (2015)
Keywords: asbestos, asbestosis, gastric cancer, risk assessment, spinning, textile
MeSH terms: Case Reports

Background:
The International Agency for Research on Cancer classifies asbestos as belonging to Carcinogen Group 2A for gastric cancer. We herein report a case of gastric cancer associated with asbestosis and describe the work-related and risk assessments of asbestos exposure for gastric cancer.
Case presentation:
The 66-year-old male patient in our case worked in asbestos spinning factories. His level of cumulated asbestos fiber exposure was estimated to be 38.0-71.0 f-yr/cc. Thus, the Excess Life Cancer Risk for lung cancer associated with asbestos exposure was 9,648×10(-5), almost 9,600 times the value recommended by the United States of America Environmental Protection Agency (1 × 10(-5)). The relative risk of developing lung cancer for this patient was more than 25 f-yr/cc, a well-known criterion for doubling the risk of lung cancer.
Conclusion:
The patient's exposure to high-dose asbestos was sufficient to increase his risk of gastric cancer because as the risk of lung cancer increased, the risk of gastric cancer was due to increase as well. Therefore, occupational asbestos fiber exposure might be associated with gastric cancer in this case.
Derivative chromosomes involving 5p large rearranged segments went unnoticed with the use of conventional cytogenetics
Authors: Emiy Yokoyama, Victoria Del Castillo, Silvia Sánchez, Sandra Ramos, Bertha Molina, Leda Torres, María José Navarro, Silvia Avila, José Luis Castrillo, Benilde García-De Teresa, Bárbara Asch, Sara Frías
Journal: Mol Cytogenet (2018)
Keywords: 10p15 duplication, 5p deletion, 9p22 duplication, congenital malformations, derivate chromosomes, intellectual disability, translocations
MeSH terms: Case Reports

Background:
In countries where comparative genomic hybridization arrays (aCGH) and next generation sequencing are not widely available due to accessibility and economic constraints, conventional 400-500-band karyotyping is the first-line choice for the etiological diagnosis of patients with congenital malformations and intellectual disability. Conventional karyotype analysis can rule out chromosomal alterations greater than 10 Mb. However, some large structural abnormalities, such as derivative chromosomes, may go undetected when the analysis is performed at less than a 550-band resolution and the size and banding pattern of the interchanged segments are similar. Derivatives frequently originate from inter-chromosomal exchanges and sometimes are inherited from a parent who carries a reciprocal translocation.
Case presentation:
We present two cases with derivative chromosomes involving a 9.1 Mb 5p deletion/14.8 Mb 10p duplication in the first patient and a 19.9 Mb 5p deletion/ 18.5 Mb 9p duplication in the second patient. These long chromosomal imbalances were ascertained by aCGH but not by conventional cytogenetics. Both patients presented with a deletion of the Cri du chat syndrome region and a duplication of another genomic region. Each patient had a unique clinical picture, and although they presented some features of Cri du chat syndrome, the phenotype did not conclusively point towards this diagnosis, although a chromosomopathy was suspected.
Conclusions:
These cases highlight the fundamental role of the clinical suspicion in guiding the approach for the etiological diagnosis of patients. Molecular cytogenetics techniques, such as aCGH, should be considered when the clinician suspects the presence of a chromosomal imbalance in spite of a normal karyotype.