OpenMed/multicare-articles huggingface dataset:
Pregnancy-Associated Osteoporosis Presented with Femoral Neck Fracture: A Case Report and Literature Review
Authors: Azam Faraji, Zahra Shomali, Sedigeh Yoosefi
Journal: Galen Med J (2020)
Keywords: femur, fracture, osteoporosis, pregnancy
MeSH terms: Case Reports

Background:
Pregnancy-associated osteoporosis (PAO) is a rare condition characterized by reduced bone mineral density during the third trimester or lactation. Multiple risk factors, such as genetic, sedentariness, and 25-hydroxy vitamin D deficiency, are associated with PAO. In the majority of cases, PAO is presented with a compression fracture in vertebras, but in our case, it presented with a fracture of the femoral neck. Case Presentation: A 29-year-old, gravida one woman, developed right hip joint pain during the gestational age 34 weeks who referred to our clinic. Despite conservative management, the pain intensified. The patient delivered a healthy neonate in the 38th week of gestation and afterward underwent magnetic resonance imaging of the pelvic, revealing a bruised bone in the femoral neck. Since she had developed a femoral neck fracture during the postpartum period, she underwent open reduction and fixation of the femoral neck. Dual-energy X-ray absorptiometry (DEXA) revealed osteoporosis of the vertebras and femoral neck. She received calcium supplements and alendronate, and the pain was relieved. On 2-year and 4-year follow-up, she was found to be osteopenic with significant improvement in DEXA indices.
Conclusion:
PAO is a rare condition among young women. This condition should be kept in mind when hip joint or back pain is encountered during pregnancy.
Profound Hypokalaemia Resulting in Maternal Cardiac Arrest: A Catastrophic Complication of Hyperemesis Gravidarum?
Authors: Anna Walch, Madeline Duke, Travis Auty, Audris Wong
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

We present a case of a 39-year-old G8P6 Pacific Islander woman who at 15+5 weeks' gestation had an out-of-hospital cardiac arrest secondary to profound hypokalaemia which was associated with severe hyperemesis gravidarum (HG). Her clinical course after arrest was complicated by a second 5-minute cardiac arrest in the Intensive Care Unit (ICU) (pre-arrest potassium 1.8), anuric renal failure requiring dialysis, ischaemic hepatitis, and encephalopathy and unfortunately fetal demise and a spontaneous miscarriage on day 2 of admission. Despite these complications, she was discharged home 4 weeks later with a full recovery. Following a plethora of inpatient and outpatient investigations, the cause of her cardiac arrest was determined to be profound hypokalaemia. The hypokalaemia was presumed second to a perfect storm of HG with subsequent nutritional deficiencies causing electrolyte wasting, extracellular fluid (ECF) volume reduction, and activation of the renin-angiotensin-aldosterone axis (RAAS). This combined with the physiological changes that promote potassium wasting in pregnancy including volume expansion, increased renal blood flow, increased glomerular filtration rate, and increase in cortisol contributed to the patient having a profoundly low total body potassium level. This diagnosis is further strengthened by the fact that her pre- and post-pregnancy potassium levels were within normal limits in the absence of supplementary potassium. This case highlights the potentially life-threatening electrolyte imbalances that can occur with HG and the importance of recognising the disease, comprehensive electrolyte monitoring, and aggressive management in pregnancy.
Appendiceal endometriosis and carcinoid presented as acute appendicitis in pregnancy: a rare case report and review of the literature
Authors: Panagiotis A Dimitriadis, Ragai R Makar, Gearoid Kingston, Ridzuan Farouk
Journal: Case Rep Obstet Gynecol (2013)

A 22-year-old pregnant woman presented at the twenty-seventh week of gestation in the Emergency Department with acute abdominal pain and right iliac fossa tenderness. Urgent MRI was done and was suggestive of acute appendicitis. A laparoscopy was performed that confirmed an inflamed and purulent appendix that was removed. The technique used is described in detail. The histopathologic findings were those of acute appendicitis, carcinoid, and endometriosis of the appendix. We report the first case of this extremely rare triad presented in pregnancy.
Initial Presentation of OCD and Psychosis in an Adolescent during the COVID-19 Pandemic
Authors: Sahana Nazeer, Abhishek Reddy
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

The COVID-19 pandemic is unparalleled in recent history when accounting for the true disease burden and dramatic impact on physical and mental health. Due to its infectious pathology, COVID-19 presents with a variety of symptoms including neuropsychiatric complications. Moreover, factors such as quarantine, social isolation, and fear of illness have negatively impacted the health of non-COVID-19 patients. There has been significant literature reporting new-onset psychiatric illness in all global populations including those without history of psychiatric illness. This report discusses an adolescent male without prior psychiatric history presenting with new onset symptoms of obsessive-compulsive disorder and psychosis in the context of COVID-19. There are considerable reports describing new-onset obsessive-compulsive disorder, albeit conflicting in terms of prevalence and exacerbations in the setting of COVID-19 in both adult and adolescent populations but limited reports of new-onset psychosis in those same populations and setting.
Reaching hidden youth in Singapore through the Hidden Youth Intervention Program: A biopsychosocial approach integrating mental health and social work interventions
Authors: Sonia Khiatani, Denise Liu, Benjamin Sen Son Yeo, John Chee Meng Wong
Journal: Front Psychiatry (2023)
Keywords: singapore region, biopsychosocial, hidden youth, hikikomori (social withdrawal), intervention, multidisciplinary, socially withdrawn behavior

Hidden youth are youth who withdraw from society for at least 6 months, physically isolating within their homes or rooms. There has been a steady rise in this phenomenon across many developed countries, and this trend is expected to continue. As hidden youths often present with complex psychopathology and psychosocial issues, multi-factorial intervention approaches are recommended. To reach this isolated population and address gaps in services, a community mental health service and a youth social work team collaborated to develop the first specialized intervention for hidden youth in Singapore. This pilot intervention combines components from Hikikomori treatment models from Japan and Hong Kong, and a treatment program for isolated individuals diagnosed with Internet Gaming Disorder. This paper describes the development of the pilot intervention model- a four-stage biopsychosocial intervention targeting the complex needs of hidden youth and their families- and illustrates its implementation and challenges faced through a case study. Based on 2 years of service delivery to 25 youths, good practices such as utilizing novel outreach strategies and the importance of involving and caring for caregivers are also highlighted. Preliminary outcomes of this ongoing pilot intervention indicate reductions in social withdrawal behavior and increased engagement in school or work, especially for youth at the final stage of intervention. Strengths of the program include its multi-disciplinary and flexible nature, and the whole-family approach. Limitations of this program included a lack of information on Singaporean hidden youth and the lack of quantitative outcome data of this pilot program. In future, we aim to further enhance program elements through collaboration with international and local partners, and to develop an evaluative framework to determine program effectiveness.
An unusual presentation of adenoid cystic carcinoma of the breast with metastatic disease in the clavicle
Authors: Thomas Edward Glover, Ryan Butel, Cara Manmeet Bhuller, Emma Louise Senior
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

Adenoid cystic carcinoma (ACC) of the breast is a rare subtype of invasive breast cancer. Prognosis is excellent with low rates of recurrence and metastatic disease compared with other triple-negative forms of breast carcinoma and other non-breast forms of ACC. We present a case of a 63-year-old female with metastatic disease in the clavicle 13 years after excision of the breast primary. Metastasis to bone is rare, and this is the first case described in the clavicle. There are no specific radiological features of breast primaries but imaging usually reveals a circumscribed mass, often without microcalcifications. Histology is similar to that of non-breast forms of ACC. Mastectomy or wide local excision is curative in virtually all cases without lymph node involvement. However, as our case demonstrates, the presence of bone pain with a history of ACC of the breast should prompt musculoskeletal imaging. Discussion at a multidisciplinary team meeting is essential for accurate diagnosis.
Inraoperative and Histological Visualization of Disrupted Vulnerable Plaques following Diagnostic Angiography of Moderate Carotid Stenosis
Authors: Tatsushi Mutoh, Tatsuya Ishikawa, Akifumi Suzuki, Nobuyuki Yasui
Journal: Stroke Res Treat (2010)
MeSH terms: Case Reports

Background. Digital subtraction angiography (DSA) remains an important tool for diagnosis of carotid stenosis but is associated with risk for periprocedural complications. This is the first report of direct intraoperative and histolopathologic visualization of DSA-related carotid plaque disruption. Case. A 64-year-old man diagnosed to have a 60% right carotid stenosis received diagnostic DSA for therapeutic decision-making. He developed transient left hand numbness and weakness immediately after the procedure. Intraoperative imaging during carotid endarterectomy revealed a fragile plaque with sharp surface laceration and intraplaque hemorrhage at the bifurcation. Microscopy of the specimen demonstrated a large atheromatous plaque with fibrous hypertrophy and intraplaque hemorrhage filled with recent hemorrhagic debris. Conclusion. The visualized carotid lesion was more serious than expected, warning the danger of embolization or occlusion associated with the catheter maneuvers. Thus the highest level of practitioner training and technical expertise that ensures precise assessment of plaque characteristics should be encouraged.
Acute Coronary Artery Occlusion during Transcatheter Aortic Valve Replacement in a Patient with an Anomalous Left Circumflex Coronary Artery
Authors: Rongfeng Xu, Jiandong Ding, Lijuan Chen, Yi Feng, Genshan Ma
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

Background:
Acute coronary artery occlusion (CAO) during transcatheter aortic valve replacement (TAVR) is a rare but life-threatening complication during the procedure; there were a few case reports about an anomalous LCX during perioperative period. We report a case of successful coronary protection using the chimney stenting technique in a patient with a severely calcified aortic valve and an anomalous LCX. Case Summary. A 75-year-old man was found an anomalous left circumflex coronary artery (LCX) originating from the right coronary cusp with severely calcified aortic valve stenosis requiring TAVR. When a self-expanding aortic valve was deployed, we found flow compromise in the right coronary system and circumflex to TIMI-0 flow. By using the chimney stenting technique, we rapidly planted 2 stents from the proximal CX branch to the sinotubular junction and the coronary flow was maintained.
Conclusion:
Chimney stenting protection as a bailout technique is safe and feasible and should be considered in patients deemed to be at high risk of coronary flow compromise, especially with an anomalous LCX.
Vitamin A and Hydrochlorothiazide Causing Severe Hypercalcemia in a Patient With Primary Hyperparathyroidism
Authors: Ron T Varghese, Khaled Khasawneh, Raman K Desikan, Anandaraj Subramaniam, Todd Weaver, Ganesh K V Nair
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: nutrition, primary hyperparathyroidism, vitamin a
MeSH terms: Hydrochlorothiazide / adverse effects, Hypercalcemia / chemically induced, Hyperparathyroidism, Primary / diagnosis, Vitamin A / adverse effects, Case Reports, Aged, Calcium / administration & dosage, Calcium / adverse effects, Dietary Supplements / adverse effects, Female, Humans, Hyperparathyroidism, Primary / blood, Hyperparathyroidism, Primary / surgery, Parathyroid Hormone / blood, Vitamin D / adverse effects, Parathyroid Hormone, Hydrochlorothiazide, Vitamin A, Vitamin D, Calcium

Objective:
To report a case of severe hypercalcemia, exacerbated by vitamin A supplementation and hydrochlorothiazide, in a patient with primary hyperparathyroidism.
Methods:
Clinical and laboratory findings are presented along with response to therapy.
Results:
A 68-year-old white female presented to the emergency department complaining of nausea, vomiting, and altered mental status. Laboratory findings revealed calcium 15.8 mg/dL (8.4-10.2), albumin 4.1 g/dL (3.8-4.8), and parathyroid hormone 62 pg/mL (14-64). Serum calcium improved after intravenous hydration with normal saline. Prior to this hospitalization, over-the-counter medications were significant for calcium (600 mg daily), vitamin A (11 000 IU daily), and vitamin D (800 IU daily).The patient's prescription medications were significant for hydrochlorothiazide (12.5 mg daily). Twenty-four-hour urine calcium was subsequently found to be 146 mg (35-250). Myeloma, lymphoma, and sarcoidosis were ruled out as the etiology for hypercalcemia. The diagnosis of primary hyperparathyroidism was confirmed. She was treated surgically for primary hyperparathyroidism. The right and left superior parathyroid showed hypercellular parathyroid on pathology. The patient was normocalcemic after surgery.
Conclusion:
Previous reports suggest that very high doses of vitamin A is required to cause hypercalcemia. This case suggests that in a setting of primary hyperparathyroidism and hydrochlorothiazide therapy, vitamin A may contribute to the development of severe hypercalcemia in patients who are on calcium and vitamin D supplements. Given their biologic effects, public awareness needs to be created regarding the injudicious use of vitamins.
Lung Transplantation in a Patient with COPA Syndrome
Authors: Jorge M Mallea, Anna Kornafeld, Andras Khoor, David B Erasmus
Journal: Case Rep Transplant (2020)
MeSH terms: Case Reports

COPA syndrome is a newly discovered, rare genetic autoimmune disorder, which can affect the lungs, joints, and kidneys. It is difficult to recognize, and the survival benefit of lung transplantation for these patients is not yet known. We present a case of a 24-year-old woman who received bilateral lung transplant for COPA syndrome. At 15 months posttransplant, her pulmonary function is stable with no episodes of acute cellular- or antibody-mediated rejection and no evidence of disease recurrence.
A Single Amino Acid Deletion (ΔF1502) in the S6 Segment of CaV2.1 Domain III Associated with Congenital Ataxia Increases Channel Activity and Promotes Ca2+ Influx
Authors: Maria Isabel Bahamonde, Selma Angèlica Serra, Oliver Drechsel, Rubayte Rahman, Anna Marcé-Grau, Marta Prieto, Stephan Ossowski, Alfons Macaya, José M Fernández-Fernández
Journal: PLoS One (2015)
MeSH terms: Ataxia / genetics, Calcium Channels, N-Type / genetics, Sequence Deletion / genetics, Case Reports, Research Support, Non-U.S. Gov't, Ataxia / congenital, Ataxia / pathology, Brain / pathology, Calcium / metabolism, Child, Humans, Magnetic Resonance Imaging, Male, Neuroimaging, Sequence Deletion / physiology, Calcium Channels, N-Type, voltage-dependent calcium channel (P-Q type), Calcium

Mutations in the CACNA1A gene, encoding the pore-forming CaV2.1 (P/Q-type) channel α1A subunit, result in heterogeneous human neurological disorders, including familial and sporadic hemiplegic migraine along with episodic and progressive forms of ataxia. Hemiplegic Migraine (HM) mutations induce gain-of-channel function, mainly by shifting channel activation to lower voltages, whereas ataxia mutations mostly produce loss-of-channel function. However, some HM-linked gain-of-function mutations are also associated to congenital ataxia and/or cerebellar atrophy, including the deletion of a highly conserved phenylalanine located at the S6 pore region of α1A domain III (ΔF1502). Functional studies of ΔF1502 CaV2.1 channels, expressed in Xenopus oocytes, using the non-physiological Ba2+ as the charge carrier have only revealed discrete alterations in channel function of unclear pathophysiological relevance. Here, we report a second case of congenital ataxia linked to the ΔF1502 α1A mutation, detected by whole-exome sequencing, and analyze its functional consequences on CaV2.1 human channels heterologously expressed in mammalian tsA-201 HEK cells, using the physiological permeant ion Ca2+. ΔF1502 strongly decreases the voltage threshold for channel activation (by ~ 21 mV), allowing significantly higher Ca2+ current densities in a range of depolarized voltages with physiological relevance in neurons, even though maximal Ca2+ current density through ΔF1502 CaV2.1 channels is 60% lower than through wild-type channels. ΔF1502 accelerates activation kinetics and slows deactivation kinetics of CaV2.1 within a wide range of voltage depolarization. ΔF1502 also slowed CaV2.1 inactivation kinetic and shifted the inactivation curve to hyperpolarized potentials (by ~ 28 mV). ΔF1502 effects on CaV2.1 activation and deactivation properties seem to be of high physiological relevance. Thus, ΔF1502 strongly promotes Ca2+ influx in response to either single or trains of action potential-like waveforms of different durations. Our observations support a causative role of gain-of-function CaV2.1 mutations in congenital ataxia, a neurodevelopmental disorder at the severe-most end of CACNA1A-associated phenotypic spectrum.
Ruptured intramural pregnancy with myometrial invasion treated conservatively
Authors: Anis Fadhlaoui, Mohamed Khrouf, Kais Nouira, Anis Chaker, Fethi Zhioua
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Background. Intramural pregnancy is a rare form of ectopic pregnancy, difficult to diagnose and generally complicated by uterine rupture. Case. A 38-year-old woman, gravida 5 para 1, was diagnosed with intramural pregnancy by ultrasound and confirmed with MRI. A uterine rupture occurred, which lead to laparotomy and a conservative treatment. Conclusion. Early diagnosis is necessary for conservative treatment.
A case of co-existence of muscle bridge and anomalous origin of coronary artery
Authors: Federica Iezzi, Francesca Chiara Surace, Massimo Colaneri, Alessandro Capestro, Marco Pozzi
Journal: Int J Surg Case Rep (2019)
Keywords: case report, coronary artery anomalies, myocardial bridge

Introduction:
Coronary artery anomalies result from disturbances which may occur to the fetus in the third week of development. These disturbances may lead to anatomical variations which may affect the origin, trajectory, and termination of these arteries, or alterations in their intrinsic anatomy.
Presentation of case:
We report an unusual case in which both anomalous origin of the right coronary artery and myocardial bridge on left anterior descending artery were detected concurrently.
Discussion:
An investigation for myocardial bridge should be performed in all congenital coronary artery anomalies.
Conclusion:
Invasive testing could be considered in patients with myocardial and equivocal non-invasive functional testing, in order to obtain better risk stratification and treatment.
Probable Drug Interaction Between Etanercept and Cyclosporine Resulting in Clinically Unexpected Low Trough Concentrations: First Case Report
Authors: Haini Wen, Dongping Chen, Jiaqian Lu, Zheng Jiao, Bin Chen, Bin Zhang, Chaoyang Ye, Li Liu
Journal: Front Pharmacol (2020)
Keywords: biological therapy, case report, cyclosporine, drug-cytokine interaction, etanercept, inflammatory disease, trough level
MeSH terms: Case Reports

Preclinical studies have shown that anti-cytokine therapies could alter drug dispositions through affecting cytochrome P450 synthesis; however, evidence and case reports evaluating clinical relevance of this interaction are scarce. This is the first reported case of interaction between cyclosporine (CsA) and etanercept in a 42-year-old male patient with ankylosing spondylitis and immunoglobulin A nephropathy in whom cytokine levels were monitored both before and after CsA initiation. The initiation of etanercept led to at least 2.5-folds increase in total clearance of CsA. After comprehensive assessment and stepwise exclusion of alternative causes, it was considered that inflammation resolution with etanercept administration has highly induced clearance of CsA, probably mediated by interleukin-2. The case has shown that co-administration of CsA and anti-cytokine therapies such as etanercept needs close monitoring of trough levels. Physicians and pharmacists should be aware of similar interactions especially when the biological therapy is initiated or discontinued and for patients undergoing acute inflammation phase. Monitoring cytokine levels should be considered when drug-cytokine interaction is suspected.
Rare and unusual case of anti-factor XI antibodies in patient with plasma cell leukemia
Authors: Jean Uwingabiye, Hafid Zahid, Mohamed El Amrani, Fayçal Labrini, Abdelhak Elkhazraji, Driss El Kabbaj, Mohammed Benyahia, Anass Yahyaoui, Rachid Hadef, Nezha Messaoudi
Journal: BMC Hematol (2018)
Keywords: activated partial thromboplastin time, blood coagulation factor inhibitors, monoclonal gammopathy, plasma cell leukemia, russell’s viper venom time
MeSH terms: Case Reports

Background:
The acquired inhibitors of coagulation have been observed in very rare cases of monoclonal gammopathies. We report a very rare case of anti-factor XI antibodies in patient with plasma cell leukemia (PCL).
Case presentation:
This is a 59-year-old male patient without pathological history, admitted to the nephrology department for management of renal insufficiency and anemia syndrome. The history and physical examination revealed stigmata of hemorrhagic syndrome including hemothorax and hemoptysis. The hemostasis assessment showed an isolated prolonged activated partial thromboplastin time (APTT) with APTT ratio = 2.0.The index of circulating anticoagulant (37.2%) revealed the presence of circulating anticoagulants. The normalized dilute Russell viper venom time ratio of 0.99 has highlighted the absence of lupus anticoagulants. The coagulation factors assay objectified the decrease of the factor XI activity corrected by the addition of the control plasma confirming the presence of anti-factor XI autoantibodies. In addition, the blood count showed bicytopenia with non-regenerative normocytic normochromic anemia and thrombocytopenia. The blood smear demonstrated a plasma cell count of 49% (2842/mm3) evoking PCL. The bone marrow was invaded up to 90% by dystrophic plasma cells. The biochemical assessment suggested downstream renal and electrolyte disturbances from exuberant light chain production with abnormalities including hyperuricemia, hypercalcemia, elevated lactate dehydrogenase, non nephrotic-range proteinuria and high level of C reactive protein. The serum protein electrophoresis showed the presence of a monoclonal peak. The serum immunofixation test detects the presence of monoclonal free lambda light chains. He was treated with velcade, thalidomide and dexamethasone. The patient died after 2 weeks despite treatment.
Conclusion:
Both PCL and anti-factor XI inhibitors are two very rare entities. To the best of our knowledge, this is the first reported case of a factor XI inhibitor arising in the setting of PCL. Factor inhibitors should be suspected in patients whose monoclonal gammopathies are accompanied by bleeding manifestations.