OpenMed/multicare-articles huggingface dataset:
Playing to live: outcome evaluation of a community-based psychosocial expressive arts program for children during the Liberian Ebola epidemic
Authors: C A Decosimo, J Hanson, M Quinn, P Badu, E G Smith
Journal: Glob Ment Health (Camb) (2019)
Keywords: art therapy, ebola, liberia, mhpss, expressive therapies

Background:
This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results.
Methods:
There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis of variance (ANOVA) were used to analyse pre- and post-psychological stress symptoms (PSS) for samples from both groups.
Results:
Separately, treatment group 1 (TG1) and treatment group 2's (TG2) paired t test yielded significant results (p < 0.001) for the decrease of PSS. The mixed-model ANOVA found that there were significant differences in total pre- and post-test PSS and a significant difference in PSS means over time.
Conclusions:
Results indicated that there was a statistically significant decrease in reported symptoms in both treatment groups pre- to post-intervention and a significant difference in total symptoms over time. However, the findings do not indicate that the longer programming was statistically different compared to the shorter programming. The study presented had gaps in data, largely due to limits in research during the crisis. However, this paper provides a unique case study for challenges that can be faced for project evaluation in emergency settings.
Tirofiban-Induced Thrombocytopenia Occurring with Crohn's Disease
Authors: Toni Ibrahim, Fady El Karak, Assem Araji, Elie El Rassy
Journal: Case Rep Cardiol (2016)

A 69-year-old man, with severe refractory Crohn's disease, presented with acute coronary syndrome that required angioplasty. He developed severe tirofiban-induced thrombocytopenia (TIT) heralded by type I allergic reaction that required steroids and a combination of antihistamine H1 and antihistamine H2 for symptomatic management. The thrombocytopenia spontaneously resolved uneventfully in 48 hours thereafter. This case report suggests a possible association between TIT and inflammatory bowel disease. Therefore, strict monitoring of the platelet count is required in patients who develop allergic reactions to tirofiban.
Cyberknife Radiosurgery and Concurrent Intrathecal Chemotherapy for Leptomeningeal Metastases: Case Report of Prolonged Survival of a HER-2+ Breast Cancer Patient Status-Post Craniospinal Irradiation
Authors: Gregory Lekovic, Doniel Drazin, Albert C Mak, Marc S Schwartz
Journal: Cureus (2016)
Keywords: breast cancer, cyberknife radiosurgery, intrathecal chemotherapy, leptomeningeal disease, leptomeningeal metastases, neurooncology, neurosurgery, radiation, stereotactic radiosurgery
MeSH terms: Case Reports

Leptomeningeal disease (LMD) from breast cancer is usually a rapidly fatal condition, with median overall survival reported to be 15 weeks. Conventional treatment for LMD includes craniospinal irradiation and intrathecal (IT) methotrexate. However, the role of stereotactic radiation for leptomeningeal disease remains poorly defined. This case report describes our experience using Cyberknife radiosurgery to treat a 49-year-old female with HER-2+ breast cancer and focal/nodular leptomeningeal metastases that were refractory to craniospinal irradiation and concurrent IT chemotherapy. This combined approach--i.e., craniospinal irradiation, IT chemotherapy, and Cyberknife Radiosurgery for local, recurrent metastases--resulted in survival of 46 months with controlled disease. Based on our experience with this patient, we believe further consideration of radiosurgery for LMD is warranted.
Case Report: The effect of intravenous and oral antibiotics on the gut microbiome and breath volatile organic compounds over one year
Authors: Farah Shahi, Sarah Forrester, Kelly Redeker, James P J Chong, Gavin Barlow
Journal: Wellcome Open Res (2022)
Keywords: antibiotics, antimicrobials, breath metabolites, microbiome, resistance, volatile organic compounds
MeSH terms: Case Reports

Background:
Antimicrobial resistance (AMR) is a global concern and better understanding of the gut microbiome, a known 'amplifier' of AMR, may allow future clinicians to tailor therapy to minimise this risk and offer a personalised medicine approach. To examine the gut microbiome, patients are required to provide faecal samples; more convenient and cheaper solutions need to be found.
Methods:
As part of a pilot study looking at how routes of administration affect the gut microbiome in NHS patients undergoing routine clinical management for infections, we hypothesised that effects on the gut microbiome varied with the route and metabolism of antibiotic used, and these changes may be reflected in breath metabolites. We present a case report of a patient with an unusual clinical history, alongside breath metabolite and gut microbiome data taken before, during and after antibiotic therapy over a period of one year.
Results:
We noted a shift in the dominant Bacteroides strain in the patient's gut microbiome between pre- and post-therapy samples, along with an alteration in the composition of breath metabolites.
Conclusions:
This study provides a framework for similar future work and highlights the need for further research on the relationships between changes in microbial gut communities and antimicrobial exposure, patient clinical status, and the metabolites of human breath.
Does treating obesity stabilize chronic kidney disease?
Authors: Sujata Agnani, Vidula T Vachharajani, Rohit Gupta, Naveen K Atray, Tushar J Vachharajani
Journal: BMC Nephrol (2005)
MeSH terms: Bariatric Surgery, Gastric Bypass, Kidney / physiopathology, Kidney Failure, Chronic / complications, Kidney Failure, Chronic / physiopathology, Obesity, Morbid / complications, Obesity, Morbid / surgery, Case Reports, Adult, Creatine / blood, Humans, Kidney Failure, Chronic / blood, Male, Obesity, Morbid / pathology, Postoperative Period, Time Factors, Weight Loss, Creatine

Background:
Obesity is a growing health issue in the Western world. Obesity, as part of the metabolic syndrome adds to the morbidity and mortality. The incidence of diabetes and hypertension, two primary etiological factors for chronic renal failure, is significantly higher with obesity. We report a case with morbid obesity whose renal function was stabilized with aggressive management of his obesity.
Case report:
A 43-year old morbidly obese Caucasian male was referred for evaluation of his chronic renal failure. He had been hypertensive with well controlled blood pressure with a body mass index of 46 and a baseline serum creatinine of 4.3 mg/dl (estimated glomerular filtration rate of 16 ml/min). He had failed all conservative attempts at weight reduction and hence was referred for a gastric by-pass surgery. Following the bariatric surgery he had approximately 90 lbs. weight loss over 8-months and his serum creatinine stabilized to 4.0 mg/dl.
Conclusion:
Obesity appears to be an independent risk factor for renal failure. Targeting obesity is beneficial not only for better control of hypertension and diabetes, but also possibly helps stabilization of chronic kidney failure.
Management of bronchial secretions with Free Aspire in children with cerebral palsy: impact on clinical outcomes and healthcare resources
Authors: Giancarlo Garuti, Elisa Verucchi, Isabella Fanelli, Michele Giovannini, Joao Carlos Winck, Mirco Lusuardi
Journal: Ital J Pediatr (2016)
MeSH terms: Cerebral Palsy / complications, Sputum, Suction / instrumentation, Observational Study, Child, Child, Preschool, Disease Management, Female, Humans, Male, Treatment Outcome

Background:
Management of secretions in children with cerebral palsy is often problematic due to severe deformation of the rib cage, impaired cough, and patients'inability to collaborate with chest physiotherapy. Assessing the effectiveness of different methods and techniques of secretion clearance is hampered by the lack of direct outcome measures and by limited patient cooperation. This observational study was planned to evaluate the efficacy of Free Aspire, a device that utilizes a special method to remove secretions from the bronchial tree in hypersecretive patients.
Case presentation:
Cerebral palsy patients were selected who had experienced more than 3 episodes of respiratory exacerbations in the latest year despite therapeutic optimization (including bronchial clearance techniques) and who had received at least one antibiotic course or underwent at least one access to the Emergency Room (ER) or admission to hospital in the 6 months prior to the study. Patients with congestive heart failure or contraindications for Free Aspire were excluded. We prospectively enrolled 8 patients (mean age 8.25 ± 6.11 years) who had been using in the past techniques for clearance secretions different from Free Aspire. The treatment with Free Aspire consisted of at least two 20-min sessions per day. The observational study period was 18 months. In the 6 months prior to start the treatment (T0), patients had a mean number of 4.0 ± 2.23 visits from the primary care pediatrician (PCP), spent 14 ± 20 days in hospital, and received antibiotics for 35 ± 17 days. After the first 6 months of treatment (T1), they had 1.7 ± 0.73 PCP visits, no days spent in hospital, and 9.75 ± 10.4 days of antibiotic therapy. At 12 months of treatment (T2), PCP visits were 1.7 ± 0.70, days in hospital 1.12 ± 0.3, and days of antibiotics 10.25 ± 10. At 18 months of treatment (T3) no hospitalizations had occurred, PCP visits were 0.25 ± 0.70, and days of antibiotic therapy 4.8 ± 12.62. The technique proved to be safe and well tolerated.
Conclusion:
Our findings show that Free Aspire for bronchial secretion clearance in cerebral palsy patients with limited capacity to collaborate is safe and effective in reducing the impact of respiratory exacerbations in terms of number of PCP visits, days spent in hospital, and days of antibiotic therapy; its regular use maintains this effect in time.
NUS1 and Epilepsy-myoclonus-ataxia Syndrome: An Under-recognized Entity?
Authors: Giulietta M Riboldi, Edoardo Monfrini, Christine Stahl, Steven J Frucht
Journal: Tremor Other Hyperkinet Mov (N Y) (2022)
Keywords: nus1, ataxia, genetics, myoclonus, myoclonus epilepsy, myoclonus-ataxia
MeSH terms: Cerebellar Ataxia / genetics, Epilepsies, Myoclonic, Epilepsy / complications, Epilepsy / genetics, Intellectual Disability / genetics, Myoclonus / genetics, Case Reports, Ataxia / genetics, Humans, Receptors, Cell Surface, NUS1 protein, human, Receptors, Cell Surface

Background:
Variants of the NUS1 gene have recently been linked to a spectrum of phenotypes including epilepsy, cerebellar ataxia, cortical myoclonus and intellectual disability (ID), and primary congenital defects of glycosylation.
Case report:
We report a case of myoclonus epilepsy, mild cerebellar ataxia, and ID due to a new de-novo NUS1 missense variant (c.868C>T, p.R290C), and review the current literature of NUS1-associated clinical phenotypes.
Discussion:
Pathogenic variants of NUS1 are found in a rapidly growing number of cases diagnosed with myoclonus epilepsy and/or myoclonus-ataxia syndrome. NUS1 should be included in the genetic screening of undiagnosed forms of myoclonus, myoclonus-ataxia, and progressive myoclonus epilepsies.
Segmental Orthodontics for the Correction of Cross Bites
Authors: Anirudh Agarwal, Rinku Mathur
Journal: Int J Clin Pediatr Dent (2011)
Keywords: 2 × 4 appliance, anterior and posterior cross bite, lingual button with cross elastics
MeSH terms: Case Reports

Cross bite is a condition where one or more teeth may be abnormally malposed buccally or lingually or labially with reference to the opposing tooth or teeth. Cross bite correction is highly recommended as this kind of malocclusion do not diminish with age. Uncorrected cross bite may lead to abnormal wear of lower anteriors and cuspal interference, mandibular shift resulting in mandibular asymmetry and temporomandibular joint dysfunction syndrome. There are several methods for treating this type of malocclusion. In this article, segmental orthodontics has been highlighted by using 2 × 4 appliance therapy and lingual button with cross elastics. This appliance offers many advantages as it provides complete control of anterior tooth position, is extremely well tolerated, requires no adjustment by the patient and allows accurate and rapid positioning of teeth.
Head Down Deep Breathing for Cardioversion of Paroxysmal Supraventricular Tachycardia
Authors: Steven Hoon Chin Lim, Shieh Mei Lai, Kelvin Cheok Keng Wong
Journal: Case Rep Emerg Med (2018)
MeSH terms: Case Reports

The first-line recommended treatment for stable paroxysmal supraventricular tachycardia (PSVT) is the use of vagal maneuvers. Often the Valsalva maneuver is conducted. We describe two patients who converted to sinus rhythm without complications, using a head down deep breathing (HDDB) technique.
BYPASS-OMA: Hypoglycemic Hyperinsulinemic Nesidioblastosis after Gastric Bypass Surgery-A Case Report and Review of the Literature
Authors: Jessica Cao, Cindy Kim, Thatcher Huynh, Amanda Frugoli, Heidi Henson, Vera Valdez, Tricia Westhoff-Pankratz
Journal: Case Rep Endocrinol (2022)
MeSH terms: Case Reports

This rare case vignette describes hypoglycemic, hyperinsulinemic nesidioblastosis in a female patient with prior Roux-en-Y gastric bypass. The patient presented with severe symptomatic hypoglycemia resistant to IV dextrose and diazoxide, requiring surgical resection. Traditional imaging found nonspecific findings, and biochemical analysis was inconsistent with insulinoma. A gallium-68 dotatate PET scan was utilized to successfully localize the tumor in the distal pancreas. She underwent laparoscopic resection of the distal pancreatic lesion with resolution of her symptoms and return to euglycemia. The histological evaluation confirmed the diagnosis of nesidioblastosis. Nesidioblastosis is a rare complication of bariatric surgery that may be more clinically relevant with rising prevalence of obesity. Diagnosis with conventional imaging modalities may be challenging; however, the dotatate PET scan may have high utility in detecting lesions. It is essential for clinicians to consider nesidioblastosis in the differential diagnosis of hyperinsulinemic hypoglycemic conditions and recognize there may be a link with increasing rates of bariatric surgery.
Case Report: Local Anesthesia Round Window Plugging and Simultaneous Vibrant Soundbridge Implant for Superior Semicircular Canal Dehiscence
Authors: Giulia Mignacco, Lorenzo Salerni, Ilaria Bindi, Giovanni Monciatti, Alfonso Cerase, Marco Mandalà
Journal: Front Neurol (2020)
Keywords: canal dehiscence syndrome, middle ear implant, round window plugging, round window reinforcement, superior semicircular canal dehiscence
MeSH terms: Case Reports

The aim of the present study is to report the outcomes of round window reinforcement surgery performed with the application of a Vibrant Soundbridge middle ear implant (VSB; MED-EL) in a patient with superior semicircular canal dehiscence (SSCD) who presented with recurrent vertigo, Tullio phenomenon, Hennebert's sign, bone conduction hypersensitivity, and bilateral moderate to severe mixed hearing loss. Vestibular evoked myogenic potentials (VEMPs) and high-resolution computed tomography (HRCT) confirmed bilateral superior semicircular canal dehiscence while this was not seen in magnetic resonance imaging. The surgical procedure was performed in the right ear as it had worse vestibular and auditory symptoms, a poorer hearing threshold, and greatly altered HRCT and VEMPs findings. With local-assisted anesthesia, round window reinforcement surgery (plugging) with perichondrium was performed with simultaneous positioning of a VSB on the round window niche. At the one and 3 months follow-up after surgery, VSB-aided hearing threshold in the right ear improved to mild, and loud sounds did not elicit either dizziness or pain in the patient.
Multiple Severe Toxicities of L-Asparaginase and Their Innovative Management during Induction Therapy of Acute Lymphoblastic Leukemia in an Adult Patient
Authors: Guillaume Beziat, Suzanne Tavitian, Muriel Picard, Stanislas Faguer, Christian Recher, Françoise Huguet
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

L-asparaginase is a key chemotherapeutic agent in acute lymphoblastic leukemia (ALL). It is also known for multiple and severe specific toxicities, without consensual management. We report the case of a 51-year-old man treated with L-asparaginase for recently diagnosed T-cell ALL. During the treatment, he developed a coma due to multifactorial diffuse cerebral edema, by hepatic encephalopathy, cerebral venous thrombosis, and hyperammonemia, all linked to toxicity of L-asparaginase. Specific and innovative treatments were employed to manage these toxicities: supplementation with L-carnitine, thiamine, and pyridoxine for hepatic toxicity, perfusion of sodium benzoate to decrease ammonemia, and extrahepatic albumin-based dialysis sessions, along with anticoagulation. The patient improved within two weeks and is currently alive 13 months later, in first complete remission, without sequelae, on an alleviated chemotherapy regimen.
Acute gastric dilatation resulting in gastric emphysema following postpartum hemorrhage
Authors: Suhail Aslam Khan, Edmond Boko, Haseeb Anwar Khookhar, Sheila Woods, A H Nasr
Journal: Case Rep Surg (2012)
MeSH terms: Case Reports

Acute gastric dilatation is a rare entity, with varying aetiologies the majority of which are benign. Delay in diagnosis and treatment could result in sequelae such as gastric emphysema (pneumatosis), emphysematous gastritis, gangrene, and perforation. Gastric emphysema as a result of a benign nongangrenous condition such as gastroparesis, adynamic ileus can be successfully managed conservatively. Here, we present an interesting case of acute gastric dilatation resulting in gastric emphysema following massive postpartum hemorrhage.
Necrotizing pelvic infection after rectal resection. A rare indication of endoscopic vacuum-assisted closure therapy. A case report
Authors: Tomáš Řezáč, Martin Stašek, Pavel Zbořil, Katherine Vomáčková, Linda Bébarová, Jan Hanuliak, Čestmír Neoral
Journal: Int J Surg Case Rep (2019)
Keywords: anastomotic leak in colorectal surgery, case report, endoscopic vacuum-assisted closure (evac), low anterior rectal resection, necrotizing pelvic infection

Introduction:
Anastomotic leak after colorectal surgery is a major problem associated with higher morbidity and mortality. In most cases of contained leaks, treatment recommendations are clear and effective. However, in rare cases like necrotizing pelvic infection, there is no clear treatment of choice, despite the mortality rate almost 21%. We present successful management with endoscopic vacuum-assisted closure therapy.
The presentation of a case:
A 68-year-old female patient with BMI 26, hypothyroidism and high blood pressure was indicated to low anterior rectal resection because of high-risk neoplasia of lateral spreading tumor type of the upper rectum. Four days after the primary operation, sepsis (SOFA 12) with diffuse peritonitis and unconfirmed leak according to CT led to surgical revision with loop ileostomy. On postoperative days 6-10, swelling, inflammation and subsequent necrosis of the right groin and femoral region communicating with the leak cavity developed. The endoscopy confirmed a leak of 30% of the anastomotic circumference with the indication of debridement and endoscopic vacuum-assisted closure therapy. EVAC sessions with 3-4 day intervals healed the leak cavity. Secondary healing of the skin defects required 4 months.
Conclusion:
Necrotizing pelvic infection after a leak of the colorectal anastomosis is a very rare complication with high morbidity and mortality. Endoscopic vacuum-assisted closure therapy should be implemented in the multimodal therapeutic strategy in case of major leaks, affecting up to 270° of the anastomotic circumference.
Neoadjuvant concurrent chemoradiation for curative treatment of penile squamous cell carcinoma
Authors: Arpit Chhabra, David Schwartz, Andrea Leaf, Nikolaos Karanikolas, Jeffrey P Weiss, David Schreiber
Journal: Case Rep Oncol Med (2014)

Introduction. Penile cancer is a rare malignancy often treated with neoadjuvant chemotherapy followed by surgery. However, the utility of neoadjuvant chemoradiation, particularly when the tumor is resistant to chemotherapy alone, has not been established. In this study, we report a case of pT3cN3M0 penile squamous cell carcinoma with progression of nodal disease on chemotherapy, which was cured with use of neoadjuvant concurrent chemoradiation. Case Report. A 65-year-old male presented with a fixed left inguinal lymph node with associated firmness of the penile glans. Biopsies of both sites revealed evidence of squamous cell carcinoma. The patient underwent partial penectomy for the primary lesion and began neoadjuvant chemotherapy to reduce the size of the unresectable left inguinal node. However, he displayed disease progression in the left inguinal node. As such, we attempted concurrent chemoradiation therapy with regression of his nodal disease. The patient was able to undergo left inguinal node dissection and has no evidence of disease 18 months since his initial surgery. Conclusion. The use of neoadjuvant chemoradiation for bulky cN2-3 disease seems appropriate in the setting of progressive disease. Further studies are necessary to assess the utility of concurrent chemoradiation both in the neoadjuvant and salvage setting.
Advanced squamous cell carcinoma involving both upper and lower lips and oral commissure with simultaneous reconstruction by local flap: a case report
Authors: Chairat Burusapat, Anont Pitiseree
Journal: J Med Case Rep (2012)

Introduction:
Squamous cell carcinoma is one of the most common malignant tumors of the skin and oral mucosa. However, squamous cell carcinoma involving near total upper and lower lip and oral commissure is rarely seen in the English literature. Simultaneous reconstruction of the upper and lower lips has been inconclusive and presents a challenge to the surgeon. We report such a case and outline our simultaneous reconstruction with local flaps. To the best of our knowledge this has never been reported.
Case presentation:
A 73-year-old Thai woman presented with a large rapidly growing squamous cell carcinoma involving the upper lip, lower lip, left oral commissure and left cheek. En bloc resection of upper lip, lower lip, left oral commissure and buccal region was performed. Left radical neck dissection and right modified neck dissection were performed. Reconstruction of the upper lip with a left nasolabial-cheek cervicofacial rotational-advancement flap and right cheek advancement with perialar crescent flap was performed. The lower lip was reconstructed with bilateral labiomental advancement flaps.
Conclusions:
Squamous cell carcinoma can grow rapidly and spread along the orbicularis oris muscle and across the oral commissure to the opposite lip. In advanced cancer, multimodal treatment is necessary. No gold standard in the reconstruction of both upper and lower lips has been established. We report the case of an advanced squamous cell carcinoma involving both the upper lip, lower lip, left oral commissure and buccal area and simultaneous reconstruction with local flap coverage that, to the best of our knowledge, has never been reported.