OpenMed/multicare-articles huggingface dataset:
Anorexia Nervosa and Osteoporosis: A Possible Complication to Remember
Authors: André Rosas Pereira, Marta Costa, Gustavo G Costa, Ana Sofia Carvalho
Journal: Cureus (2024)
Keywords: anorexia nervosa, back pain, feeding and eating disorders, osteoporosis, spinal fractures
MeSH terms: Case Reports

Anorexia nervosa (AN) belongs to the spectrum of food disorders and affects approximately 2.9 million people worldwide. It is responsible for numerous and serious medical complications. Osteoporosis is a common complication, and the decrease in bone mineral density (BMD) is one of the few potentially irreversible consequences of AN. When associated with AN, it can manifest at a very young age, possibly leading to irreparable damage. We describe the case of a 30-year-old woman with a one-year evolution diagnosis of AN, complaining of back pain. Physical examination revealed a slight elevation of the right shoulder and pain at compression of paravertebral right dorsal musculature with a palpable strained muscle. Full-length X-ray imaging of the dorsal spine revealed a slight dextroconvex dorsolumbar scoliosis. A dorsal spine computerized tomography (CT) was performed, confirming a fracture of the upper platform of the sixth dorsal vertebrae. Osteodensitometry showed lumbar spine osteoporosis and femoral osteopenia. The decrease in BMD and, later on, the development of osteoporosis can occur in both types of AN. It is a severe complication that affects up to 50% of these patients. It can be irreversible and increase the lifetime risk of bone fractures and, therefore, morbimortality. Low body weight and body mass index (BMI) strongly correlate with the decrease in BMD. Treatment of osteoporosis associated with AN is not standardized and clearly labeled. Weight gain is described as the strategy with the most impact in reversing the loss of bone mass and increasing the BMD. The regularization of gonadal function also seems to independently potentiate the increase of BMD. The occurrence of long bone and vertebrae fractures frequently results in a decrease in height and chronic back pain, culminating in greater morbimortality and healthcare costs. This clinical case aims to show theclose relationship between restrictive food disorders and the decrease of BMD and the subsequent development of osteoporosis and its complications. Although rare in young and healthy people, when associated with restrictive food disorders, it should raise a red flag in its clinical evaluation. Preventing osteoporosis development and reduction of fracture risk in this population is essential. The current absence of consistent evidence regarding screening of osteoporosis in this particular group should raise awareness and promote further larger-scale studies to establish standardized recommendations concerning not only screening but also pharmacological treatment of osteoporosis in patients with AN.
A case study on anthrax in an eight-month old infant at Kyrgyz Republic
Authors: Mamatkulova Nazgul Mamatkulovna, Zholdoshev Saparbai Tezekbaevich, Utepbergenova Gulmira Alkenovna
Journal: Bioinformation (2024)
Keywords: anthrax, kyrgyz republic, child, clinical case, clinical course, epidemiological history, focus of anthrax, vaccination

Anthrax remains a threat, especially in countries like Kyrgyzstan with developed livestock farming. Despite preventive efforts, sporadic outbreaks endure on an annual basis, transmitted from infected animals to humans. Here, we report a severe anthrax case in an 8-month-old child known to be caused when a sick calf was slaughtered in the neighborhood without proper protocols, resulting in intra-family infection. This underscores the importance of swift diagnosis, treatment, preventive measures, and awareness of zoonotic infections, animal vaccination and adherence to sanitary and veterinary protocols.
Case report: Inhaled nitric oxide rescued a hypoxemia patient caused by dermatomyositis complicated with interstitial pneumonia
Authors: Xiaoyan Wu, Ruiqiang Zheng, Zhanqi Zhao
Journal: Front Med (Lausanne) (2024)
Keywords: dermatomyositis, hypoxemia, inhaled nitric oxide, interstitial pneumonia, ventilation/perfusion matching
MeSH terms: Case Reports

Interstitial pneumonia is the most common and serious secondary lesion of dermatomyositis. In some cases, patients may develop severe acute pneumonia that can quickly progress to respiratory failure, resulting in high mortality rates. A 57-year-old woman with dermatomyositis and interstitial pulmonary fibrosis experienced severe hypoxemia due to pulmonary infection. Despite receiving various treatments after entering the intensive care unit (ICU), such as anti-infection therapy, lung recruitment, prone position ventilation, sedative and muscle relaxation, the patient's oxygen saturation continued to decline. Electrical impedance tomography (EIT) monitoring revealed that prone position could not improve ventilation homogeneity. However, the patient's ventilation/perfusion (V/Q) matching significantly improved 10 min after initiation of supine position ventilation combined with inhalation of nitric oxide (iNO). The patient's PaO2/FiO2 (P/F) ratio increased from 86 mmHg to 150 mmHg at 30 min post-treatment. iNO treatment continued for 2 days. Then the patient's condition improved and she was successfully weaned off the ventilator with rigorous monitoring and symptomatic care. The implementation of mechanical ventilation combined with iNO therapy rapidly improved V/Q matching and oxygenation in a patient with hypoxemia caused by dermatomyositis complicated with interstitial pneumonia. This approach successfully avoided the need for invasive extracorporeal membrane oxygenation (ECMO) support.
Dermatofibroma with Verocay Body-Type Palisading Features and a Brief Discussion on Potential Schwannoma Mimickers of the Skin
Authors: Yunus Baran Kok, Cuyan Demirkesen
Journal: Turk Patoloji Derg (2023)
MeSH terms: Histiocytoma, Benign Fibrous / diagnosis, Neurilemmoma / diagnosis, Neurilemmoma / pathology, Sebaceous Gland Neoplasms / pathology, Skin Neoplasms / diagnosis, Skin Neoplasms / pathology, Case Reports, Humans, Immunohistochemistry

Several types of cutaneous tumors can show palisading features or the so-called rippled pattern. The list includes adnexal tumors such as trichoblastoma and sebaceoma, basal cell carcinoma, leiomyoma, perineuroma, myofibroblastoma, and even malignant melanoma. Dermatofibroma, which is known for having a large variety of histological patterns, is also in the list. Here we present a case of dermatofibroma with palisading features strikingly similar to Verocay bodies of schwannoma.
Case report: Granulocyte-macrophage colony-stimulating factor sargramostim did not rescue the neutrophil phenotype in two patients with JAGN1-mutant severe congenital neutropenia
Authors: Susan Farmand, Susanne Eva Aydin, Katharina Wustrau, Svea Böhm, Francis Ayuk, Gabriele Escherich, Julia Skokowa, Ingo Müller, Kai Lehmberg
Journal: Front Immunol (2024)
Keywords: g-csf, gm-csf, jagn1 deficiency, scn6, case report, severe congenital neutropenia
MeSH terms: Congenital Bone Marrow Failure Syndromes / genetics, Granulocyte-Macrophage Colony-Stimulating Factor / therapeutic use, Mutation, Neutropenia / congenital, Neutropenia / drug therapy, Neutropenia / genetics, Neutrophils / immunology, Recombinant Proteins / therapeutic use, Case Reports, Adolescent, Female, Humans, Infant, Membrane Proteins, Phenotype, Pregnancy, Granulocyte-Macrophage Colony-Stimulating Factor, sargramostim, JAGN1 protein, human, Recombinant Proteins, Membrane Proteins, Neutropenia, Severe Congenital, Autosomal Recessive 3

Background:
Homozygous or compound heterozygous mutations in JAGN1 cause severe congenital neutropenia. JAGN1-mutant patients present with severe early-onset bacterial infections and most have been described as low-responders to recombinant granulocyte colony-stimulating factor (G-CSF) therapy. In a murine, hematopoietic JAGN1 knockout model, which displays susceptibility to Candida albicans infection in the absence of neutropenia, treatment with granulocyte-macrophage-CSF (GM-CSF) was able to restore the functional defect of neutrophils.
Patients:
We present two unrelated patients with biallelic JAGN1 mutations, who were both treated with subcutaneous GM-CSF (sargramostim) after treatment failure to G-CSF. The first patient was an 18-year-old pregnant woman who received GM-CSF at 12 weeks of gestation up to a dose of 10 µg/kg/d for 7 days. The second patient was a 5-month-old girl who received GM-CSF for a total of 9 days at a dose of up to 20 µg/kg/d. GM-CSF did not increase neutrophil counts in our patients. Treatment was stopped when neutrophil numbers declined further, no beneficial effect was noticed, and patients presented with infections. No adverse effects were observed in either patient and the fetus. Both patients ultimately underwent successful hematopoietic stem cell transplantation.
Discussion:
Both patients showed a high recurrence rate of severe infections on G-CSF treatment. GM-CSF therapy did not ameliorate the clinical phenotype, in contrast to the improvement of neutrophil function observed in the JAGN1 mouse model. No major additional extra-hematopoietic manifestations were evident in our patients.
Conclusion:
In two unrelated patients, GM-CSF did not have any beneficial effect on neutrophil counts. Patients with JAGN1-mutant SCN with reduced G-CSF responsiveness and elevated infection rate should be evaluated early for stem cell transplantation.
Small Intestinal Volvulus Caused by Lipomatosis in a Middle-Aged Female
Authors: Deepak Kumar, Shashikant Kumar, Anurag Kumar, Shreekant Bharti, Majid Anwer, Anil Kumar
Journal: Case Rep Surg (2023)
MeSH terms: Case Reports

Lipomas are benign tumors composed of adipose tissue that can occur in various locations throughout the body, including the gastrointestinal (GI) tract. Lipoma of the small bowel is a rare clinical condition. It infrequently results in small bowel obstruction and volvulus. In most of the patients, it is an incidental diagnosis. However, it may present with abdominal pain, nausea, vomiting, GI bleeding, and constipation. It is commonly diagnosed using imaging studies, such as computerized tomography scan or magnetic resonance imaging. The management of small bowel lipomas depends on the presence of symptoms and the risk of complications. Asymptomatic lipomas can be safely monitored with imaging studies, as the risk of complications is low. However, in symptomatic cases, surgical or endoscopic treatment may be necessary to relieve obstruction and prevent complications. We report a case of volvulus of small bowel in a middle-aged female presenting to our hospital with acute GI symptoms.
Candida auris infection; diagnosis, and resistance mechanism using high-throughput sequencing technology: a case report and literature review
Authors: He Hong, Yang Ximing, Ma Jinghan, Abdullah Al-Danakh, Pan Shujuan, Lin Ying, Yang Yuting, Liu Yuehong, Yao Xingwei
Journal: Front Cell Infect Microbiol (2023)
Keywords: candida auris infection, drug resistance, epidemiology and prevention, gene mutation, virulence
MeSH terms: Antifungal Agents / pharmacology, Antifungal Agents / therapeutic use, Candidiasis, Invasive, Review, Case Reports, Aged, 80 and over, Candida, Drug Resistance, Fungal, Female, Humans, Microbial Sensitivity Tests, Multicenter Studies as Topic, Saccharomyces cerevisiae, Antifungal Agents, Candida auris infection

Background:

Candida auris (C. auris), a recently developing fungal disease with high virulence, easy transmission, and substantial medication resistance in hospitals, poses a growing danger to human health. In 2009, the initial documentation of this disease was made when it was discovered in the ear canal of an elderly Japanese patient. Since its initial isolation, the presence of C. auris across six continents has been a cause for severe concern among medical professionals and scientists. According to recent findings, C. auris is connected with five geographically different lineages and significant rates of antifungal resistance. Furthermore, C. auris infections in healthcare settings lack appropriate treatment options and standardized strategies for prevention and control. This results in many treatment failures and hinders the elimination of C. auris in healthcare institutions. To examine the drug resistance mechanism of C. auris and to aid in clinical therapy, we provide a case of C. auris infection along with a short review of the relevant literature.
Clinical presentation:
An 81-year-old female with cerebral hemorrhage was admitted to the hospital and diagnosed with a urinary catheter-related C. auris. The sample was evaluated and reported in terms of culture, identification, drug sensitivity, and gene sequencing. We also evaluated the relationship between the morphology of the isolated strains and their drug resistance. Whole-genome sequencing yielded the genes ERG11-Y132F, CDR1-E709D, TAC1B-Q503E, and TAC1B-A583S; however, no additional loci included alterations of concern, according to our results. ERG11-Y132F and TAC1B-A583S are drug-resistant gene loci, whereas CDR1-E709D and TAC1B-Q503E are unidentified variants.
Conclusion:
We discover a C. auris case of specific a strain in an old female that has some drug-resistant genes, and some genes may be different from already reported gene sites. Gene locus, mutation, and drug resistance mechanism studies may contribute to the creation of innovative drugs and therapeutic treatments. Clinicians and microbiologists must be aware of this globally spreading yeast, which poses substantial hospital diagnostic, treatment, and infection control challenges. Future multicenter research must be performed to uncover this health threat and provide new, effective treatments.
Persistent Bacteremia Due to Escherichia coli Vertebral Osteomyelitis
Authors: Shinichi Kida, Yasushi Shibue
Journal: Cureus (2024)
Keywords: blood stream infection, escherichia coli, persistent bacteremia, pyogenic osteomyelitis, pyogenic vertebral osteomyelitis
MeSH terms: Case Reports

Vertebral osteomyelitis is a disc and vertebral infection that causes nonspecific symptoms such as back pain, fever, and weakness. The most common causative pathogen is Staphylococcus aureus, and Escherichia coli (E. coli) is an uncommon cause. An 88-year-old man presented to the emergency department with a fever and lower back pain. His blood cultures were persistently positive for E. coli on days one, three, and five, and a diagnosis of vertebral osteomyelitis was made after an MRI of the lumbar spine. It has been reported that infectious dissemination to the vertebrae may occur through Batson's venous plexus, which is a network of paravertebral veins, and the pelvic venous plexus. Clinicians should remember that vertebral osteomyelitis can be a cause of persistent bacteremia.
Isopropyl Alcohol Intoxication Treated With Hemodialysis: A Case Report and Short Review
Authors: Sagar Kumar, Sarah Dabbas, Fnu Manisha, Huma Akta, Emad Al Jaber
Journal: Cureus (2024)
Keywords: acute encephalopathy, hemodialysis, isopropyl alcohol intoxication, osmolar gap, severe alcohol intoxication
MeSH terms: Case Reports

Isopropyl alcohol (IPA) is a common constituent of rubbing alcohol, household cleaning agents, and antiseptic agents. Ingestion of IPA usually leads to self-resolving mild symptoms in most cases but can result in severe symptoms, including central nervous system depression or hemodynamic instability. Treatment is mainly supportive, and hemodialysis is generally reserved for severe intoxication. Limited data are available on the use of hemodialysis to treat IPA intoxication. We are presenting a case of accidental ingestion of IPA in an elderly female with dementia leading to severe intoxication requiring hemodialysis at relatively non-toxic serum levels of IPA. The patient had a prompt recovery without any post-procedural or hospital-acquired complications.
Early vs. delayed QTc prolongation in acute poisoning: A prognostic accuracy study-A case series
Authors: Amirhossein Shahpar, Amirhossein Mirafzal, Mitra Movahedi, Nazanin Zeinali Nezhad
Journal: PLoS One (2024)
MeSH terms: Long QT Syndrome / chemically induced, Long QT Syndrome / diagnosis, Poisoning, Acute Disease, Adult, Aged, Electrocardiography, Female, Humans, Intensive Care Units, Male, Middle Aged, Prognosis, Retrospective Studies

Given the limited capacity of intensive care units in many countries, it is crucial to identify reliable prognostic markers to optimize poisoning patients management and improve outcomes. This study aimed to assess the predictive value of three variables, namely the initial QTc interval (iQTc) measured within two hours of admission, the delayed QTc interval (dQTc) measured between 6 and 12 hours of entry, and the QTc interval trend over time (ΔQTc), for mortality in patients with undifferentiated poisoning. A retrospective case series was conducted on 70 patients with undifferentiated poisoning admitted to the intensive care unit (ICU) of Afzalipour Hospital between March 21, 2021, and March 20, 2023. The results of the multivariate analysis revealed that dQTc, base deficit, and creatinine were independently associated with mortality (P value < 0.001). The dQTc had the highest predictive ability, with an area under the curve (AUC) of 0.84, followed by ΔQTc with an AUC of 0.76, and iQTc with an AUC of 0.67. Additionally, the results of the Generalized Estimating Equation model with repeated measurements revealed a higher odds ratio for dQTc (OR, 6.33; 95% CI, 2.54-15.79) compared to iQTc (OR, 4.92; 95% CI, 1.71-14.17). The study concluded that monitoring the dQTc interval could provide valuable prognostic information in acute poisoning cases.
Zero x-rays radiofrequency catheter ablation for ventricular premature contraction originating from the left coronary cusp during pregnancy: a case report
Authors: Changjin Li, Haoyu Gu, Chao Liu, Ke Li, Xianbu Gao, Manli Yu, Zhifu Guo
Journal: Front Cardiovasc Med (2023)
Keywords: catheter ablation, left coronary cusp, radiofrequency, ventricular premature, zero x-rays
MeSH terms: Review

Pregnancy predisposes to arrhythmias in females due to physiological changes in the cardiovascular system, enhanced activity of the sympathetic nervous system (SNS), and changes in the endocrine system, regardless of whether there exist cardiovascular diseases before the pregnancy. Tachyarrhythmias may present for the first time or worsen persistently during pregnancy, potentially leading to maternal heart failure and sudden death, as well as some adverse fetal outcomes such as growth restriction, distress, premature birth, and stillbirth. Radiofrequency ablation (RFA) is one of the most important therapeutic methods for tachyarrhythmias. According to the 2019 European Society of Cardiology (ESC) guidelines, RFA in pregnant women should preferably be performed without x-rays. Since the 2000s, 3D mapping technique has rapidly developed, laying the foundation for cardiac electrophysiology examination free from x-rays. Ventricular arrhythmia originating from the left coronary cusp (LCC) is not common in clinic. RFA is challenging in the treatment of this type of disease due to the anatomical feature that the opening of the left main coronary artery is localized in the LCC.
Delayed surgical management of rectovaginal fistula: a case report highlighting challenges and lessons learned
Authors: Kristina Drusany Starič, Rosario Emanuele Carlo Distefano, Giorgia Campo, Gregor Norčič
Journal: Front Surg (2023)
Keywords: anal incontinence, delayed repair, multidisciplinary approach, obstetric laceration, rectovaginal fistula
MeSH terms: Case Reports

Background:
Rectovaginal fistulas following an obstetric anal sphincter injury's repair are rare in developed country and their management could be challenging, particularly in cases of delayed repair. This study emphasizes the importance of accurately diagnosing and promptly repairing such fistulas for optimal patient well-being.
Case:
A 30-year-old patient presented with gas incontinence and a greenish discharge from the vagina, 6 months after delivering her baby. Examination revealed a small pinhole lesion on the posterior vaginal wall, and an endoanal ultrasound confirmed the presence of a rectovaginal fistula. Surgical repair was delayed for 9 months due to the patient's breastfeeding. The fistula was eventually repaired through a transrectal approach, with excision of the fistulous tract and closure of both the rectum and vagina. A laparoscopic protective ileostomy was also performed due to the delayed repair. However, a recurrence of the fistula was detected 8 months later, requiring a second repair. The patient underwent physiotherapy for the anal sphincter and achieved optimal sphincter function. After 6 months, the ileostomy was successfully closed, and the patient remained continent.
Conclusions:
This case highlights the importance of early recognition and prompt repair of rectovaginal fistulas following obstetric anal sphincter injury. Delayed repairs pose greater challenges and increase the risk of recurrence. Individualized surgical approaches, skilled pelvic floor repair, and a multidisciplinary approach are crucial for successful outcomes. This case underscores the need for careful planning and consideration of patient characteristics in the management of rectovaginal fistulas, aiming to achieve optimal outcomes and patient well-being.