OpenMed/multicare-articles huggingface dataset:
Decannulation protocol in pediatric patients: case series study
Authors: Luciana Diniz Gomide de Miranda, Luiza Araujo Alves Borges, Laura Caldeira Zavaglia, Tereza Cristina Lara Mesquita, Luanna Rodrigues Leite, Larissa Tavares Aguiar, Isabela Furtado de Mendonça Picinin
Journal: Rev Paul Pediatr (2024)
MeSH terms: Device Removal / methods, Tracheostomy / adverse effects, Tracheostomy / methods, Observational Study, Adolescent, Airway Obstruction / etiology, Airway Obstruction / surgery, Child, Child, Preschool, Clinical Protocols, Deglutition Disorders / etiology, Female, Humans, Infant, Male, Retrospective Studies

Objective:
The aim of this study was to describe the phases of a decannulation protocol and the results from its application in hospitalized children.
Methods:
This is a retrospective, observational study. Data were collected from medical records of decannulated patients followed up in a pediatric hospital in Belo Horizonte, Minas Gerais between 2011 and 2021.
Results:
Among the children followed up in the service (n=526), 23% (n=120) were successfully decannulated. Children aged between 2 months and 16 years, with a mean age of 4 years, 69% of whom were male, were evaluated. About 75% of the patients have tracheostomy due to upper airway obstruction and 60% of these due to acquired subglottic stenosis. At the beginning of the decannulation protocol, 5.5% of the patients had moderate oropharyngeal dysphagia, while 80.4% had normal swallowing. Correction in the upper airway pre-decannulation was performed in 39.5% of the patients, dilation in 63.8%, and endoscopic correction was performed in 55.3%. After performing the decannulation, none of the patients had complications.
Conclusions:
The described decannulation protocol is safe, since no complications such as death and need for recannulation happened.
Network-targeting combination therapy of leptomeningeal glioblastoma using multiple synthetic lethal strategies: a case report
Authors: Michael P Castro, Bence Sipos, Saskia Biskup, Nina Kahn
Journal: Front Oncol (2023)
Keywords: glioblastoma, intra-patient dose escalation, leptomeningeal, lomustine, network-targeting combination therapy (ntct), olaparib, synthetic lethal
MeSH terms: Case Reports

Network targeting of disease-specific nodes represents a useful principle for designing combination cancer therapy. In this case of a patient with relapsed leptomeningeal glioblastoma, comprehensive molecular diagnosis led to the identification of a disease network characterized by multiple disease-specific synthetic lethal vulnerabilities involving DNA repair, REDOX homeostasis, and impaired autophagy which suggested a novel network-targeting combination therapy (NTCT). A treatment regimen consisting of lomustine, olaparib, digoxin, metformin, and high dose intravenous ascorbate was employed using the principle of intra-patient dose escalation to deliver the treatment with adequate safety measures to achieve a definitive clinical result.
Case Report: Multiple atherosclerotic plaques at its extreme in synchrony
Authors: Saket Toshniwal, Isha Sahai, Benumadhab Ghosh, Anuj Chaturvedi, Gajendra Agrawal, Sourya Acharya, Sunil Kumar, Satish Khadse, Kashish Khurana
Journal: F1000Res (2024)
Keywords: atherosclerosis, coronary angiography, dyslipidemia, peripheral vascular disease, renal artery stenosis, subclavian artery stenosis, triple vessel disease
MeSH terms: Atherosclerosis / complications, Atherosclerosis / diagnosis, Coronary Artery Disease / complications, Coronary Artery Disease / diagnosis, Peripheral Arterial Disease, Plaque, Atherosclerotic / complications, Renal Artery Obstruction / complications, Renal Artery Obstruction / diagnosis, Case Reports, Humans

Peripheral artery (PAD) disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral artery disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.
Ultrasound-guided stellate ganglion blockade - patient positioning is everything: a case report demonstrating the efficacy of a modified out-of-plane approach
Authors: Ke Mo, Liang Qian, Jingling Tian, Junling Liao, Fang Tan, Weirong Kong, Xianjun Yu, Xinjin Chi
Journal: Front Neurosci (2024)
Keywords: insomnia, lateral paravein approach, out-of-plane, stellate ganglion block, ultrasound guidance
MeSH terms: Case Reports

Background:
Insomnia has become increasingly prevalent in modern society and is notoriously difficult to treat. Many patients exhibit a poor response to pharmacological interventions. Stellate ganglion block (SGB) has emerged as an effective method for managing insomnia; however, its efficacy may be compromised in some patients, primarily due to a variant vertebral artery anatomy.
Case presentation:
This case report describes a patient with severe insomnia accompanied by anxiety. Through cervical ultrasound scanning, we identified richly branched cervical arteries at the C6-C7 segment of the vertebral artery, along with anatomical variations, which could pose a heightened risk for the traditional SGB procedure. Therefore, after carefully adjusting the patient's positioning, we proceeded with ultrasound-guided SGB using a lateral paravein out-of-plane approach. Clinical signs of successful insomnia symptoms alleviation were consistently observed after each block utilizing this alternative technique multiple times in a single patient.
Conclusion:
Our report reveals a new lateral paravein out-of-plane approach for ultrasound-guided SGB to treat insomnia, which might be considered an alternative method. More studies should be carried out to confirm the efficacy of this new approach.
Glucagon-like Peptide-1 Receptor Agonist Treatment With Semaglutide in Type 1 Diabetes
Authors: Lisa M Raven, Jerry R Greenfield, Christopher A Muir
Journal: JCEM Case Rep (2022)
Keywords: glp-1, glucagon-like peptide-1 receptor agonist, semaglutide, type 1 diabetes
MeSH terms: Case Reports

The efficacy of glucagon-like peptide-1 receptor agonists in type 2 diabetes is well established, but their role in type 1 diabetes (T1DM) is less clear. A 36-year-old woman with a 27-year history of T1DM and undetectable c-peptide presented for review of weight management, with body mass index 29.3 kg/m2. A previous trial of dapagliflozin led to no improvement in weight or glycemic control. Semaglutide was introduced (0.25 mg weekly increased to 0.5 mg weekly) and was well tolerated. After 6 months, weight had decreased by 16 kg and insulin dose by 36%. Despite less insulin, hemoglobin A1c improved, with reduced glycemic variability and no increase in hypoglycemia. Semaglutide may exert significant metabolic benefits in patients with established T1DM, even where c-peptide is no longer detectable. This case supports the need for a dedicated trial examining potential benefits of semaglutide in T1DM.
Scrotal epidermoid cysts penetrating the penile corpora cavernosa: Two case reports
Authors: Hiroshi Shimura, Atsuko Sato, Satoru Kira, Norifumi Sawada, Hiroyuki Satoh, Takahiko Mitsui
Journal: IJU Case Rep (2023)
Keywords: epidermoid cyst, intrascrotal tumor, pediatric tumor, penile corpora cavernosa, tumor resection
MeSH terms: Case Reports

Introduction:
Epidermoid cysts are tumors and that rarely occur in intrascrotal extratesticular tissues. It is extremely rare for the tumors to penetrate the penile corpora cavernosa.
Case presentation:
We encountered a 4-year-old and a 6-year-old boy with intrascrotal tumors that penetrated the penile corpora cavernosa. Both the patients underwent tumor resection. In the former case, some of the tumor within the corpora cavernosa was left behind, while in the latter case, the tumor was completely resected. Pathological examination in both cases confirmed the diagnosis of epidermoid cysts.
Conclusion:
We should consider the possibility of epidermoid cysts in children presenting with intrascrotal tumors. Moreover, care should be taken when handling the corpora cavernosa during surgery.
Coinfection of SARS-CoV-2 and influenza A (H3N2) detected in bronchoalveolar lavage fluid of a patient with long COVID using metagenomic next-generation sequencing: a case report
Authors: Xuefei Liang, Qiushi Wang, Jia Liu, Jing Ma, Yajuan Zhang, Meng Wang, Yang Yu, Linlin Wang
Journal: Front Cell Infect Microbiol (2023)
Keywords: balf, coinfection, h3n2, sars-cov-2, diagnose, long covid, metagenomic next-generation sequencing
MeSH terms: COVID-19 / diagnosis, Coinfection / diagnosis, Influenza, Human / diagnosis, Case Reports, Bronchoalveolar Lavage Fluid, Dyspnea, Fatigue, High-Throughput Nucleotide Sequencing, Humans, Influenza A Virus, H3N2 Subtype, Post-Acute COVID-19 Syndrome, SARS-CoV-2 / genetics

The growing number of long COVID cases has drawn clinical attention to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has been spreading worldwide since winter 2019. Its symptoms are not limited to fatigue and shortness of breath but also affect daily life. We report the use of metagenomic next-generation sequencing (mNGS) to detect coinfection with SARS-CoV-2 and influenza A virus in a patient with long COVID. The patient was admitted with fever, expectoration, fatigue, and shortness of breath. The PCR test was negative due to possible clearance of SARS-Cov-2 in the upper respiratory tract of patients with long COVID. Other routine microbiological tests were also negative, making the clinical diagnosis difficult. Bronchoalveolar lavage fluid (BALF) samples were tested using mNGS. The patient was diagnosed and treated promptly, recovered quickly, and continued taking azvudine after discharge; his condition was stable. This study illustrates that mNGS may be valuable for the timely diagnosis of patients with long COVID and their mixed infections.
Case report: A rare case of skin abscess caused by coinfection of Actinobaculum schaalii and Actinomyces turicensis
Authors: Peng Liu, Kangchao Sun, Rongguo Li, Xiaodi Chen
Journal: Front Cell Infect Microbiol (2024)
Keywords: actinobaculum schaalii, actinomyces turicensis, case report, coinfection, skin abscess
MeSH terms: Abscess, Actinomycetaceae, Coinfection / diagnosis, Case Reports, Adult, Bacteria, Anaerobic, Female, Humans, Schaalia turicensis, Actinotignum schaalii

Skin abscess is one of the most common infections of the skin and soft tissues. However, anaerobic bacteria are infrequently identified as the causative agents of this particular form of abscess. In this case, a 34-year-old pregnant woman was diagnosed with a skin abscess with the use of ultrasonography. The microbiological analysis results of the purulent fluid revealed the coinfection of Actinobaculum schaalii and Actinomyces turicensis. The patient was first treated empirically with 3 days of cefathiamidine, which resulted in no symptom improvement. Subsequently, a surgical procedure involving incision and draining was performed, with the administration of ceftriaxone. After 7 days of antibiotic intervention, the patient exhibited a satisfactory recovery. Clinicians need to be aware of other types of infections that might be attributed to Actinobaculum schaalii and Actinomyces turicensis, in addition to urinary tract infections.
Case report: A rare case of immunotherapy induced isolated left CN VI palsy in a patient with unresectable melanoma
Authors: Samantha Su Ping Low, Karim El-Shakankery, Ewan Brown, Alan Christie, Sally McCormack, Mark Stares
Journal: Front Oncol (2024)
Keywords: case report, cranial nerve palsy, immune-related adverse events, immunotherapy, unresectable melanoma
MeSH terms: Case Reports

Introduction:
Immune checkpoint inhibitors are the mainstay of treatment in patients with unresectable or metastatic melanoma. Combination immunotherapy with ipilimumab and nivolumab has shown to improve survival outcomes as compared to single agent immunotherapy in these patients. Neurological immune-related adverse effects (irAEs) are uncommon and cranial nerve palsies are seen even more infrequently.
Case presentation:
A 66-year-old woman with a background of metastatic, unresectable melanoma with supraclavicular and axillary lymph nodal involvement presented with a headache, photophobia and diplopia 3 weeks after her first cycle of ipilimumab and nivolumab. She was subsequently diagnosed with a left-sided cranial nerve VI palsy and treated with high dose oral steroids and steroid eye drops, with complete resolution of symptoms. She also experienced Grade 3 dermatitis requiring topical steroids, Grade 2 hypothyroidism and vitiligo. She continues to have an excellent clinical and radiological response, despite further immunotherapy being suspended.
Conclusion:
This is the first reported UK case of immunotherapy-induced isolated cranial nerve VI palsy. Multiple irAEs are more common with combination immunotherapy and its occurrence is associated with more favourable outcomes in melanoma. Immunotherapy continues to revolutionise oncological care, but clinicians must be cognizant of unpredictable irAEs, which may require prompt assessment and intervention.
Lissencephaly caused by a de novo mutation in tubulin TUBA1A: a case report and literature review
Authors: Sijing Ren, Yu Kong, Ruihan Liu, Qiubo Li, Xuehua Shen, Qing-Xia Kong
Journal: Front Pediatr (2024)
Keywords: tuba1a mutation, epilepsy, lissencephaly, neuronal migration, tubulinopathies
MeSH terms: Case Reports

Tubulin plays an essential role in cortical development, and TUBA1A encodes a major neuronal α-tubulin. Neonatal mutations in TUBA1A are associated with severe brain malformations, and approximately 70% of patients with reported cases of TUBA1A mutations exhibit lissencephaly. We report the case of a 1-year-old boy with the TUBA1A nascent mutation c.1204C >T, p.Arg402Cys, resulting in lissencephaly, developmental delay, and seizures, with a brain MRI showing normal cortical formation in the bilateral frontal lobes, smooth temporo-parieto-occipital gyri and shallow sulcus. This case has not been described in any previous report; thus, the present case provides new insights into the broad disease phenotype and diagnosis associated with TUBA1A mutations. In addition, we have summarized the gene mutation sites, neuroradiological findings, and clinical details of cases previously described in the literature and discussed the differences that exist between individual cases of TUBA1A mutations through a longitudinal comparative analysis of similar cases. The complexity of the disease is revealed, and the importance of confirming the genetic diagnosis from the beginning of the disease is emphasized, which can effectively shorten the diagnostic delay and help clinicians provide genetic and therapeutic counseling.
Case Report: Two cases of multiples and atypical dermal sinus tracts
Authors: Peter Spazzapan, Dominic N P Thompson
Journal: Front Pediatr (2024)
Keywords: case report, dermal sinus tract, dysraphic malformation, infection, tethered cord
MeSH terms: Case Reports

Dermal sinus tracts (DSTs) are congenital lesions that connect the cutaneous ectoderm with the underlying neuroectodermal tissues. They are typically midline, solitary lesions. Multiple, and atypically located DSTs have been only rarely described. We present two cases of multiple and laterally located DSTs. The first presented with bacterial meningitis and two tracts in the right buttock, one of which entered the spinal canal through the S3 neural foramen. The second child had three midline lumbar DSTs, one subcutaneous dermoid cyst and one intradural epidermoid cyst. Complete surgical excision was achieved in both cases with good late follow up. Multiple or atypically located DSTs appear to carry the same risks of infection as the more common, midline, single tracts. Complete surgical excision is recommended to avoid the risks of neurological deterioration, in particular due to infection. Incomplete disjunction is the proposed developmental anomaly for DSTs, however the location of the cases presented here requires an alternative explanation.
Communication board in locked-in syndrome: a practical interaction method with the patient
Authors: Gabriel de Deus Vieira, Zenóbio Cosme Gonçalves Ferreira, Lucas Nóbrega, Francisco Saulo Sampaio Cardoso, Eduardo Martins Leal, Rachel Schlindwein
Journal: Dement Neuropsychol (2023)
Keywords: communication disorders, locked-in syndrome, nonverbal communication
MeSH terms: Case Reports

Locked-in syndrome is a neurological condition characterized by tetraplegia, mutism, preservation of vertical eye movement, superior eyelid movement, and intact consciousness, making it impossible for the patient to communicate properly. We herein describe a case to analyze the practice of developing a method of communication for a patient with locked-in syndrome. Two communication boards were created, adapted to the Portuguese language, as well as a shortcut to inquire about the physical and emotional patient's well-being. We had difficulty with the initial communication board, due to the patient's low education level, so we adapted a new one to the patient's social context, including a shortcut to inquire about physical and emotional well-being. The communication board had a positive impact on treatment development and the patient's life.
Robotic-assisted sleeve gastrectomy with simultaneous Roux-en-Y cystojejunostomy in a patient with sever obesity and a pancreatic pseudocyst: a case report
Authors: Zheng Zhang, Lun Wang, Zhiqiang Wei, Changyong E, Tao Jiang
Journal: Front Surg (2024)
Keywords: diabete, obesity, pancreatic pseudocyst, robotic surgery, sleeve gastrectomy
MeSH terms: Case Reports

Introduction:
We tried to apply a new surgical method to treat obesity combined with pancreatic pseudocyst and achieved satisfactory results.
Case and presentation:
We report a case of a severely obese patient with pancreatic pseudocyst who underwent robotic-assisted sleeve gastrectomy, while the pseudocyst was incised and cyst-jejunostomy was performed. The operation was successful, and the patient was discharged on the 8th day after the procedure. There were no complications during the perioperative period. After 12 months of follow-up examinations, the patient's pancreatic pseudocyst disappeared. Additionally, there was a significant decrease in body weight, body mass index, and other indicators. As a result, obesity and related metabolic diseases were completely relieved.
Conclusions:
This case summarizes and presents the experience of using robotic bariatric surgery for the treatment of pancreatic pseudocyst. This case report indicates that this surgical procedure is both safe and effective for patients with pancreatic pseudocyst who also have obesity and related metabolic diseases.
Combination treatment with anti-HER2 therapeutic antibody RC48, PD-1 inhibitor, radiotherapy, and granulocyte macrophage-colony stimulating factor (GM-CSF) in patient with metastatic gastric cancer: a case report
Authors: Zhuixing Liu, Fang Wang, Yingqi Zhang, Jun Lu, Yang Yang
Journal: Front Immunol (2024)
Keywords: gm-csf, her2-positive, pd-1 inhibitor, rc48, gastric cancer, stereotactic body radiotherapy
MeSH terms: Stomach Neoplasms / drug therapy, Stomach Neoplasms / etiology, Case Reports, Comment, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, B7-H1 Antigen, Granulocyte-Macrophage Colony-Stimulating Factor / therapeutic use, Granulocytes, Humans, Immune Checkpoint Inhibitors / therapeutic use, Macrophages, Trastuzumab / therapeutic use, Immune Checkpoint Inhibitors, Granulocyte-Macrophage Colony-Stimulating Factor, B7-H1 Antigen, Trastuzumab

HER2 overexpression/amplification is a prevalent driver in various types of cancer, including gastric cancer (GC). Limited options are available for patients with HER2-positive metastatic gastric cancer, particularly those who do not respond to the standard therapy of HER2 antibody trastuzumab combined with chemotherapy. Previous research suggests that combining a PD-1 inhibitor with radiotherapy and granulocyte macrophage-colony stimulating factor (PRaG regimen) may enhance the antitumor effects in patients with chemotherapy-resistant metastatic solid tumors. In this case study, we presented a potential treatment strategy of a patient having HER2-positive and PD-L1-negative gastric adenocarcinoma. The patient showed rapid tumor progression even after surgery and multiple trastuzumab plus chemotherapy treatments. To address this, we employed a novel anti-HER2 antibody called RC48 in combination with PRaG regimen therapy (PRaG3.0). The patient demonstrated a positive response after two treatment cycles and achieved a progression-free survival time of 6.5 months. This case highlights the potential of four-combination therapies for treating refractory, multiorgan, HER2-positive, PD-L1-negative metastatic gastric cancer. Additionally, varying radiation doses in targeting dual foci is critical to enhance tumor immunotherapy.