OpenMed/multicare-articles huggingface dataset:
Six Sigma Application in Healthcare Logistics: A Framework and A Case Study
Authors: Lina Al-Qatawneh, Abdallah A A Abdallah, Salam S Z Zalloum
Journal: J Healthc Eng (2019)
MeSH terms: Efficiency, Organizational, Hospital Administration, Total Quality Management / methods, Drug Costs, Health Care Costs, Hospitals, Jordan, Models, Organizational, Outcome and Process Assessment, Health Care, Purchasing, Hospital, Quality Indicators, Health Care, Surveys and Questionnaires

Six Sigma is used heavily in various industrial sectors, yet no noticeable applications are seen in healthcare logistics. This paper reveals the special case of healthcare logistics where cost reduction is not the only factor considered in project selection; performance and criticality of each item in the logistics system are of high importance as well. This paper provides a proposed framework to apply Six Sigma in the area of healthcare logistics. It also presents a case study implementing the proposed framework at a Jordanian hospital. In the case study, the paper reveals how the modifications of the define phase to take into consideration the criticality, cost, and performance of items make typical Six Sigma methodology very beneficial for healthcare logistics. In addition, it shows how the Six Sigma project selection can be done to deal effectively with healthcare logistics issues. This paper paves the road for research to elaborate on ways to use Six Sigma in the area of improving healthcare logistics.
Trimethoprim-Sulfamethoxazole-Induced Aseptic Meningitis: A Rare Presentation of Commonly Used Antibiotic
Authors: Salem Agabawi
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Drug-induced aseptic meningitis is a rare medical condition with trimethoprim-sulfamethoxazole being one of the most common antimicrobial agents associated with it. Here, I report a case of a 56-year-old male who presented to a health care facility with shock and meningitis-like syndrome in two occasions, one year apart following an exposure to trimethoprim-sulfamethoxazole for treatment of skin/soft tissue infection. Investigations did not reveal an infectious etiology in the two presentations. The patient improved with supportive care and withdrawal of the offending agent. In the two admissions, the patient improved following stopping the offending drug in addition to supportive care. The diagnosis of trimethoprim-sulfamethoxazole-induced aseptic meningitis was the most likely explanation for this case. Trimethoprim-sulfamethoxazole-induced aseptic meningitis is rare although it is a life-threatening side effect of TMP/SMX; therefore, the clinicians should keep the diagnosis of drug-induced aseptic meningitis in the differential diagnosis of aseptic meningitis in the appropriate clinical setting as early withdrawal of the culprit drug and supportive measurements will lead to early recovery.
Case report: Novel compound heterozygosity for pathogenic variants in MED23 in a syndromic patient with postnatal microcephaly
Authors: Emanuela Salzano, Marcello Niceta, Simone Pizzi, Francesca Clementina Radio, Martina Busè, Francesca Mercadante, Sabina Barresi, Arturo Ferrara, Cecilia Mancini, Marco Tartaglia, Maria Piccione
Journal: Front Neurol (2023)
Keywords: med23, case report, epilepsy, post-natal microcephaly, whole exome sequencing
MeSH terms: Case Reports

Biallelic loss-of-function variants in MED23 cause a recessive syndromic intellectual disability condition with or without epilepsy (MRT18). Due to the small number of reported individuals, the clinical phenotype of the disorder has not been fully delineated yet, and the spectrum and frequency of neurologic features have not been fully characterized. Here, we report a 5-year-old girl with compound heterozygous for two additional MED23 variants. Besides global developmental delay, axial hypotonia and peripheral increased muscular tone, absent speech, and generalized tonic seizures, which fit well MRT18, the occurrence of postnatal progressive microcephaly has been here documented. A retrospective assessment of the previously reported clinical data for these subjects confirms the occurrence of postnatal progressive microcephaly as a previously unappreciated feature of the phenotype of MED23-related disorder.
A Case of Proliferative Glomerulonephritis with Monoclonal IgG Deposits That Showed Predominantly Membranous Features
Authors: Homare Shimohata, Kentaro Ohgi, Hiroshi Maruyama, Yasunori Miyamoto, Mamiko Takayashu, Kouichi Hirayama, Masaki Kobayashi
Journal: Case Rep Nephrol (2017)
MeSH terms: Case Reports

In 2004, the novel category of monoclonal IgG deposition disease has been proposed and termed "proliferative glomerulonephritis with monoclonal IgG deposits" (PGNMID). This disease is characterized by membranoproliferative glomerulonephritis and staining for a single light-chain isotype and gamma heavy-chain subclass. A 76-year-old male who had monoclonal gammopathy was referred to our hospital because of proteinuria. The renal biopsy showed diffuse thickening of the glomerular capillary walls with focal mesangial proliferation. On immunofluorescence study, only IgG1 among the four subclasses and lambda light chains were detected mainly in the glomerular capillary walls. From these results, we diagnosed our case as PGNMID showing predominantly membranous features. Almost all pathological findings on light microscopy of PGNMID are membranoproliferative GN or endocapillary proliferative GN, while membranous GN cases are rare. Here, we present the case of PGNMID that showed predominantly membranous features on light microscopy.
Case Report: Adult Still's Disease in an Alemtuzumab-Treated Multiple Sclerosis Patient
Authors: Julia Krämer, Tanja Krömer-Olbrisch, Heinz-Jürgen Lakomek, Peter D Schellinger, Dirk Foell, Sven G Meuth, Vera Straeten
Journal: Front Immunol (2020)
Keywords: adult onset still disease, alemtuzumab, anakinra, case report, multiple sclerosis, rituximab, secondary autoimmunity
MeSH terms: Alemtuzumab / administration & dosage, Alemtuzumab / adverse effects, Multiple Sclerosis / drug therapy, Multiple Sclerosis / immunology, Multiple Sclerosis / pathology, Still's Disease, Adult-Onset / chemically induced, Still's Disease, Adult-Onset / immunology, Still's Disease, Adult-Onset / pathology, Case Reports, Adult, Female, Humans, Alemtuzumab

Background:
Autoimmune adverse events are the most relevant risks of alemtuzumab therapy. We present a patient with relapsing-remitting multiple sclerosis, who developed adult-onset Still's disease (AOSD) following alemtuzumab treatment.
Case presentation:
The patient suffered from sore throat, swallowing difficulties, high spiking quotidian fever, generalized skin rash, arthritis, and myalgia 2 months after the second course of alemtuzumab. Laboratory tests revealed elevated acute-phase reactants, anemia, neutrophilic leukocytosis, and thrombocytosis. Serum calprotectin, interleukin-2, and interleukin-6 levels were strongly increased. Autoimmune, rheumatic, neoplastic, infectious, and granulomatous disorders were excluded. The NLRP1 and NLRP3 gene test, which was performed under the presumption of a cryopyrin-associated autoinflammatory syndrome, was negative. Based on the Yamaguchi and Fautrel criteria, and supported by the histological findings from a skin biopsy of the rash, the diagnosis of AOSD was established. Therapy with the anti-IL-1 agent (anakinra) led to a significant improvement of symptoms and blood parameters. However, anakinra had to be converted to rituximab due to generalized drug eruption. Following therapy with rituximab, the patient has fully recovered.
Conclusion:
The current case highlights AOSD as another rare and potentially life-threatening secondary autoinflammatory/autoimmune event following alemtuzumab treatment.
Palatine Tonsil Stenting of the Airway as Determined by Drug-Induced Sleep Endoscopy
Authors: Habib G Zalzal, Steven Coutras
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

Objective:
To demonstrate lateral pharyngeal wall collapse and increased apnea-hypopnea index in a child posttonsillectomy.
Background:
Some children have worsening of their sleep symptoms after tonsillectomy for obstructive sleep apnea. This case report demonstrates an open airway on drug-induced sleep endoscopy (DISE) in a child with tonsillar hypertrophy followed by more pronounced airway obstruction related to lateral pharyngeal wall collapse after tonsillectomy.
Case presentation:
A 7-year-old boy presented with obstructive sleep apnea and underwent workup with DISE. Following adenotonsillectomy and subsequent lingual tonsillectomy with epiglottopexy, the patient's sleep apnea symptoms and polysomnogram results worsened. Subsequent DISE showed a more narrowed oropharyngeal airway space as compared to his preoperative DISE.
Discussion:
Palatine tonsillar tissue may splint open the airway and prevent airway obstruction in a subset of pediatric patients. Further clinical studies are necessary to determine which children experience this phenomenon. Clinical examination using DISE can be useful in making clinical decisions prior to tonsillectomy.
Inhalational Toxicity of Aluminum Phosphide as an Ongoing Concern; a Report of Two Cases
Authors: Azam Shafahi, Babak Mostafazadeh, Bita Dadpour
Journal: Arch Acad Emerg Med (2019)
Keywords: aluminum phosphide, gas poisoning, inhalation, inhalation exposure
MeSH terms: Case Reports

Acute aluminium phosphide (ALP) poisoning is an extremely lethal poisoning. Ingestion is usually suicidal in intent, uncommonly accidental and rarely homicidal. Unfortunately, the absence of a specific antidote results in very high mortality and the key to successful treatment is in rapid decontamination and institution of resuscitative measures. Phosphine gas is highly toxic, and fatality is expected even several hours after continuous exposure. However, intensive supportive treatments may be lifesaving in some cases. Here, two cases of accidental inhalation intoxication with ALP are reported. One patient was discharged and another suffered cardiac arrest during treatment.
Chinese skullcap in move free arthritis supplement causes drug induced liver injury and pulmonary infiltrates
Authors: Renumathy Dhanasekaran, Victoria Owens, William Sanchez
Journal: Case Reports Hepatol (2013)

Herbal medications are being increasingly used by the American population especially for common conditions like arthritis. They have been reported to cause adverse effects, including significant hepatotoxicity, but reporting remains sporadic. We report here a patient who developed drug induced liver injury following the intake of Move Free, which is an over-the-counter arthritis supplement. We propose that Chinese skullcap, which is one of the herbal ingredients of the medication, is responsible for the adverse event. There was a strong temporal association between the intake of supplement and onset of symptoms, and also there have been a few recent case reports implicating the same component. A unique observation in our case is the occurrence of pulmonary infiltrates simultaneously with the hepatotoxicity, and this side effect has not been well documented before. Both the hepatic and pulmonary complications completely resolved over few weeks after the patient stopped taking the medication. Since these supplements are readily available over the counter, we feel that it is important to document possible adverse outcomes to raise awareness in the medical community and also among patients.
Computer-Controlled Local Anesthesia Complication: Surgical Retrieval of a Broken Dental Needle in Noncooperative Autistic Paediatric Patient
Authors: Damian Chybicki, Małgorzata Lipczyńska-Lewandowska, Gaja Torbicka, Anna Janas-Naze
Journal: Case Rep Dent (2020)
MeSH terms: Case Reports

The article describes an unusual case of retrieval of 8 mm fragment of a broken 30-gauge 21 mm dental needle in a 6 y.o. noncooperative autistic male patient. The needle of a computer-controlled local anesthesia device was broken during an attempt to administer local anesthetic, in order to perform conservative treatment of teeth 55 and 54 by a pedodontist. Despite the fact that the patient was under nitrous oxide sedation, an unexpected movement of the patient occurred and resulted in needle breakage. Due to the lack of patient cooperation, the surgical retrieval of a broken needle was performed under general anesthesia as part of one-day surgery procedures. The purpose of the article is to emphasize careful decision-making in proper choice of dental instruments during treatment of noncooperative paediatric patients even under sedation and to suggest dentists to carry out treatment of such patients under general anesthesia.
Elevated prothrombin time/international normalized ratio associated with concurrent administration of regorafenib and warfarin in a patient with advanced colorectal cancer
Authors: Hironori Kitade, Azusa Hiromasa-Yamasaki, Kengo Hokkoku, Mitsue Mori, Michio Watanabe, Masuo Nakai, Seiji Yano
Journal: J Pharm Health Care Sci (2016)
Keywords: colorectal cancer, pt/inr, regorafenib, warfarin
MeSH terms: Case Reports

Background:
Regorafenib and its metabolites may inhibit the activities of several CYP or UDP-glucuronosyltransferase isoforms, including that of CYP2C9. Therefore, pharmacological agents that are CYP2C9 substrates may show elevated circulating levels and enhanced drug efficacy when concurrently used with regorafenib. Previous studies showed that the area under the plasma concentration-time curve of warfarin, which is the substrate for CYP2C9, increased upon co-administration of regorafenib. However, there are no reports indicating that the anticoagulant effects of warfarin increased upon co-administration of regorafenib.
Case presentation:
We report a case of a 76-year-old man with liver metastasis of colon cancer. He was treated with regorafenib at a dosage of 120 mg daily on days 1 to 21 every 4 weeks as a third-line therapy. He had a history of acute myocardial infarction and had taken 2 mg warfarin daily. Three weeks after the treatment began, PT/INR values markedly increased, although there was no hemorrhage. Administration of regorafenib and warfarin was discontinued, and then PT/INR rapidly decreased. Warfarin administration was restarted (0.5 mg daily) and the dose was increased up to 1.5 mg daily. The patient's PT/INR values exhibited a tendency to increase when concurrently used with regorafenib, the dose of which was reduced to 80 mg daily on days 1 to 14 every 3 weeks at a physician's discretion.
Conclusions:
The clinical course of this patient suggested that PT/INR might increase during concurrent use of warfarin and regorafenib. Therefore, PT/INR should be periodically monitored during the concurrent use of warfarin and regorafenib.
Visual agnosia and prosopagnosia secondary to melanoma metastases: case report
Authors: Norberto Anízio Ferreira Frota, Lécio Figueira Pinto, Claudia Sellitto Porto, Paulo Henrique Pires de Aguia, Luiz Henrique Martins Castro, Paulo Caramelli
Journal: Dement Neuropsychol (2007)
Keywords: melanoma, metastasis, prosopagnosia, visual agnosia
MeSH terms: Case Reports

The association of visual agnosia and prosopagnosia with cerebral metastasis is very rare. The presence of symmetric and bilateral cerebral metastases of melanoma is also uncommon.We report the case of a 34 year-old man who was admitted to hospital with seizures and a three-month history of headache, with blurred vision during the past month. A previous history of melanoma resection was obtained. CT of the skull showed bilateral heterogeneous hypodense lesions in the occipito-temporal regions, with a ring pattern of contrast enhancement. Surgical resection of both metastatic lesions was performed after which the patient developed visual agnosia and prosopagnosia. On follow-up, he showed partial recovery of visual agnosia, while prosopagnosia was still evident. The relevance of this case is the rare presentation of metastatic malignant melanoma affecting homologous occipito-temporal areas associated with prosopagnosia and associative visual agnosia.
A Rare Association Between Gastrointestinal Stromal Tumor and Neurofibromatosis Type 1: A Case Report
Authors: Mohammad Abu-Abaa, Ali Abdulsahib, Salman Kananeh, Alaa Aldookhi
Journal: Cureus (2023)
Keywords: gastrointestinal stromal tumor (gist), neurofibroma, neurofibromatosis, obscure gi bleeding, tumor
MeSH terms: Case Reports

The association between gastrointestinal stromal tumor (GIST) and neurofibromatosis type 1 (NF1) has been documented in medical literature but remains rare. We report a 53-year-old male patient who was investigated extensively for months for lower gastrointestinal tract (GIT) bleeding that remained obscure despite upper and lower endoscopies as well as a barium follow-through. His past medical history is significant for NF1 with numerous cutaneous neurofibromas as well as café au lait spots and bilateral functional pheochromocytoma status post-bilateral adrenalectomy. However, the progression of his bleeding as well as iron deficiency anemia prompted more aggressive investigations. These have revealed a small bowel mass that proved to be GIST on histological and immunohistochemical staining examination. This case helps remind clinicians of the important association between NF1 and GIST, and the clinical pearl that most GISTs in NF1 are located in the small intestine and may not be apparent on endoscopy with barium follow-through and require push enteroscopy to allow for better localization.
Case report: Different clinical manifestations of the rare Loeffler endocarditis
Authors: Yuanyuan Zhao, Peiqing Jiang, Xiangyun Chen, Guihua Yao
Journal: Front Cardiovasc Med (2022)
Keywords: loeffler endocarditis, anticoagulant, corticosteroid, eosinophilia, thrombus
MeSH terms: Case Reports

Background:
Loeffler endocarditis is a rare and fatal disease, which is prone to be misdiagnosed, owing to its various clinical manifestations. Consequently, an early identification of Loeffler endocarditis and its effective treatment are crucial steps to be undertaken for good prognosis.
Case presentation:
This report describes two cases of Loeffler endocarditis with different etiologies and clinical manifestations. Case 1 was caused by idiopathic eosinophilia and presented with a thrombus involving the tricuspid valve and right ventricular inflow tract (RVIT). The patient suffered from recurrent syncope following activity. After the patient underwent tricuspid valve replacement and thrombectomy, he took oral prednisone and warfarin for 2 years, consequent to which he discontinued both drugs. However, the disease recurred 6 months later, this time manifesting as edema of both legs. Echocardiography showed that a thrombus had reappeared in the RVIT. Thus, oral prednisone and warfarin therapy was readministered. Three months later, the thrombus had dissolved. Low-dose prednisone maintenance therapy was provided long term. Case 2 involved a patient who presented with recurrent fever, tightness in the chest, and asthma, and whose condition could not be confirmed, despite multiple local hospitalizations. In our hospital, echocardiography revealed biventricular apical thrombi. After comprehensive examinations, the final diagnosis was eosinophilic granulomatosis polyangiitis (EGPA) involving multiple organs, including the heart (Loeffler endocarditis), lungs, and kidneys. After administration of corticosteroid, anticoagulant, and immunosuppressive agents along with drugs to improve cardiac function, the patient's symptoms improved significantly.
Conclusion:
In Loeffler endocarditis due to idiopathic eosinophilia, long-term corticosteroid use may be required. Diverse and non-specific symptoms cause Loeffler endocarditis to be easily misdiagnosed. So, when a patient shows a persistent elevation of the eosinophil count with non-specific myocardial damage, the possibility of this disease, should always be considered. Furthermore, even when an invasive clinical procedure such as endomyocardial biopsy (EMB) is not available or acceptable, corticosteroids should be administered promptly to bring the eosinophil count back to the normal range, thereby halting the progression of disease and reducing patient mortality.
Durable complete response for oligometastatic renal cell carcinoma with immune checkpoint inhibition and cytoreductive nephrectomy in a Jehovah's witness: A case report
Authors: Tony Zibo Zhuang, Lara Harik, Seth Force, Agreen Hadadi, Mehmet Asim Bilen, Jacqueline T Brown, Bradley C Carthon, Jamie Goldman, Omer Kucuk, Viraj A Master, Bassel Nazha
Journal: Front Oncol (2022)
Keywords: tki (tyrosine kinase inhibitor), cytoreductive, ipilimumab, nivolumab, oligometastatic, renal cell carcinoma
MeSH terms: Case Reports

The role of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma is a subject of debate. We report a durable complete response in a 62-year-old man Jehovah's Witness with metastatic clear cell renal cell carcinoma who received two cycles of nivolumab/ipilimumab followed by radical nephrectomy and metastasectomy of known pulmonary disease site, both without a clinical need for perioperative blood transfusions. The patient continues to be without evidence of disease and without additional need for systemic therapy over a year after his radical nephrectomy. The case highlights that cytoreductive nephrectomy continues to play a role in the era of immune checkpoint inhibitors.
Pulmonary embolism after arthroscopic rotator cuff repair: a case report
Authors: Tadashi Yamamoto, Kazuya Tamai, Miwa Akutsu, Kazuo Tomizawa, Takuya Sukegawa, Yutaka Nohara
Journal: Case Rep Orthop (2013)

Total hip/knee arthroplasty may cause venous thromboembolism (VTE) as a postoperative complication. However, there are few reports on VTE after arthroscopic shoulder surgery. We report a patient who developed pulmonary embolism (PE) 6 days after arthroscopic rotator cuff repair but recovered without sequelae. In this case, the possibility of DVT of the lower limbs was denied by contrast-enhanced CT. Most possibly, the source of PE was deep vein thrombosis (DVT) of the upper limb under Desault fixation which showed arthroscopic surgery-related swelling postoperatively.
Management of Ruptured Subcapsular Liver Hematoma as a Result of Hemolysis, Elevated Liver Enzyme, and Low Platelet Syndrome in a Rural Facility
Authors: Audrey Marinelli, Jennifer Hill
Journal: Cureus (2023)
Keywords: argon beam, emergency obstetric care, hellp, hemolysis elevated liver enzymes and low platelets, pre-eclampsia, subcapsular hepatic hematoma, subcapsular hepatic rupture
MeSH terms: Case Reports

Subcapsular liver hematoma is a rare complication of hemolysis, elevated liver enzyme, and low platelet (HELLP) syndrome. This case depicts a previously healthy 27-year-old primigravida at 39 weeks' gestation who presented with severe abdominal pain and was diagnosed with HELLP syndrome based on vital signs and laboratory values. While arranging transport to a regional perinatal care facility she became acutely unstable with maternal hypotension and resultant fetal bradycardia. An emergent cesarean section was performed and a ruptured subcapsular liver hematoma was diagnosed intraoperatively. She was successfully managed with supportive care and surgical intervention and was discharged from the hospital on postoperative day 6. Here we review the indications and methods of conservative and surgical management of subcapsular liver hematoma as a result of HELLP syndrome.