OpenMed/multicare-articles huggingface dataset:
Can the posterior:anterior urethral ratio on voiding cystourethrogram be used as a reliable predictor of successful posterior urethral valve ablation in male children?
Authors: Zakiyah Gaibie, Nasreen Mahomed, Karen L Petersen, Glenda Moonsamy, Akram A H Bokhari, Ahmed Adam
Journal: SA J Radiol (2020)
Keywords: golden ratio, posterior anterior urethral ratio, posterior urethral valves, urethral ratio, voiding cystourethrogram

Background:
The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful.
Objectives:
We aimed to review the role of the 'ideal' ratio on predicting residual PUV post-ablation.
Methods:
A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included 'Urethral Ratio and Posterior urethral valve ablation'. All cited reference lists were further evaluated for additional inclusive studies.
Results:
Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 (p = 0.001), 2.5-3 and 3.5.
Conclusion:
Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2-3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.
Surgical tracheostomy in COVID-19 patients: report of 5 cases
Authors: Ouissal Aissaoui, Afak Nsiri, Mohamed Anass Fehdi, Mohamed Mouhaoui, Rachid Alharrar
Journal: Pan Afr Med J (2020)
Keywords: covid-19, surgical tracheostomy, health care worker´s safety
MeSH terms: COVID-19 / complications, Respiration, Artificial / methods, Respiratory Distress Syndrome / therapy, Tracheostomy / methods, Case Reports, Aged, Aged, 80 and over, COVID-19 / therapy, Female, Humans, Intensive Care Units, Male, Middle Aged, Respiratory Distress Syndrome / virology, Time Factors

Severe acute respiratory distress syndrome (ARDS) related to SARS-COV-2 is resulting in increasing numbers of patients requiring mechanical ventilation. Although tracheostomy may reduce the duration of mechanical ventilation in these patients, it is considered a highly aerosol generating procedure and controversies regarding its safety, time of realization and indications remain to date. We share our experience about 5 cases of surgical tracheostomy in COVID-19 patients performed in our ICU.
Case report: New insights into persistent chronic pelvic pain syndrome with comorbid somatic symptom disorder
Authors: JiChao Huang, Yi Zhong, Yu Duan, Jie Sun
Journal: Front Psychiatry (2023)
Keywords: covid-19, case report, chronic pelvic pain syndrome, comorbidities, somatic symptom disorder
MeSH terms: Case Reports

Chronic pelvic pain syndrome (CPPS) is generally defined as pain in the pelvic area that persisted for 3-6 months or longer. The pain can be constant or episodic and functionally disabling. Any dysfunction of the central nervous system can lead to central sensitization, which enhances and maintains pain as well as other symptoms that are mediated by the central nervous system. It occurs in subgroups of nearly every chronic pain condition and is characterized by multifocal pain and co-occurring somatic symptoms. Somatic symptom disorder (SSD) is defined as a condition in which having one or more somatic symptoms, such as excessive worries, pressure, and catastrophic events. These symptoms can be very disruptive to a patient's life and can cause significant distress. SSD cases with severe symptoms frequently undergo repeated medical investigations and the symptoms often lead patients to seek emergency medical treatment and consult with specialists repeatedly, which is a source of frustration for patients and clinicians. Here we report a case that Asian female with persistent CPPS with comorbid SSD, who got in trouble for up to 8 years. This case reminds clinicians to pay excessive attention to the diagnosis of CPPS with comorbid SSD after recovery from acute COVID-19, with hope of raising awareness in the identification of SSD and present new insight into appropriate treatment for each woman who suffers from it.
Multiple myeloma with isolated central nervous system relapse after autologous stem cell transplantation: A case report and review of the literature
Authors: Xian Li, Weiqin Wang, Xiaohong Zhang, Yun Liang
Journal: Front Oncol (2022)
Keywords: autologous stem cell transplantation, case report, isolated central nervous system relapse, multiple myeloma, pathogenesis and treatment
MeSH terms: Case Reports

Patients with multiple myeloma (MM) rarely present with central nervous system (CNS) involvement as a manifestation of extramedullary disease (EMD), a condition that is associated with poor prognosis. CNS relapse without evidence of systemic involvement is even rarer, and there is no standardized treatment because there are only few case reports. We present a 47-year-old female who was diagnosed with nonsecretory multiple myeloma (NSMM) 9 years previously. She had a complete remission after receiving aggressive therapies, including high-dose chemotherapy and autologous stem cell transplantation (ASCT). However, after 7 years of progression-free survival, she had CNS relapse without evidence of systemic involvement. We switched to a salvage regimen consisting of high-dose methotrexate with lenalidomide. She achieved rapid clinical improvement, with a reduction in cerebrospinal fluid plasmacytosis of more than 80%, and no notable side effects. Our description of this unique case of a patient with MM and isolated CNS relapse after ASCT provides a reference for physicians to provide more appropriate management of these patients. We also reviewed previously reported cases and summarized the outcomes of isolated CNS relapse after ASCT, and discuss the pathogenesis and possible treatment strategies for MM with isolated CNS relapse.
Very Elevated IgE, Atopy, and Severe Infection: A Genomics-Based Diagnostic Approach to a Spectrum of Diseases
Authors: A Chin, S Balasubramanyam, C M Davis
Journal: Case Reports Immunol (2021)
MeSH terms: Case Reports

Elevated IgE has been long recognized as an important clinical marker of atopy but can be seen in a myriad of conditions. The discovery of autosomal dominant STAT3 deficiency marked the first recognition of hyper-IgE syndrome (HIES) and the first primary immunodeficiency linked to elevated IgE. Since then, genomic testing has increased the number of defects with associated mutations causing hyper-IgE syndrome and atopic diseases with FLG, DOCK8, SPINK5, and CARD11, among others. A spectrum of recurrent infections and atopy are hallmarks of elevated IgE with significant phenotypic overlap between each underlying condition. As treatment is predicated on early diagnosis, genomic testing is becoming a more commonly used diagnostic tool. We present a 6-year-old male patient with markedly elevated IgE and severe atopic dermatitis presenting with staphylococcal bacteremia found to have a heterozygous variant in FLG (p.S3247X) and multiple variants of unknown significance in BCL11B, ZAP70, LYST, and PTPRC. We review the genetic defects underpinning elevated IgE and highlight the spectrum of atopy and immunodeficiency seen in patients with underlying mutations. Although no one mutation is completely causative of the constellation of symptoms in this patient, we suggest the synergism of these variants is an impetus of disease.
Orbital T-Cell Lymphoma with Discrete Enlargements of All Extraocular Muscles Bilaterally in Patient with Moon Face Countenance
Authors: Hideaki Kawakami, Kiyofumi Mochizuki, Hideko Goto, Naoki Watanabe, Takuji Tanaka
Journal: Case Rep Ophthalmol Med (2017)
MeSH terms: Case Reports

Purpose. To report our findings in a case of orbital T-cell lymphoma in which all of the extraocular muscles (EOMs) were bilaterally and discretely enlarged and the patient had a moon face countenance. Case. A 59-year-old woman presented with visual disturbances in her left eye, hyperemia in both eyes, and a moon face countenance. Examinations showed limited upward gaze in the right eye, blepharoptosis, hypertropia, and limited downward and rightward gaze in the left eye. Slit-lamp examination showed only chemosis and hyperemia of both eyes. Magnetic resonance imaging with contrast revealed discrete enlargements of the muscle bellies in all EOMs without abnormalities of the orbital fat in both eyes. Blood examinations excluded thyroid- and IgG4-related ophthalmopathy, and EOM biopsy revealed peripheral T-cell lymphoma. After beginning aggressive chemotherapy, the enlarged EOMs, limited eye motility, and moon face countenance improved. Unfortunately, the patient died of sepsis during the chemotherapy. Conclusions. A lymphoma should be included in the differential diagnosis of eyes with enlarged EOMs. Because lymphomas can lead to death, it is important for clinicians to consider lymphomas in eyes with enlarged EOMs.
MRI as a Aiagnostic Tool for Paroxysmal Nocturnal Hemoglobinuria: A Case Report
Authors: Bade Von Bodelschwingh, Huseyin Ozkurt
Journal: Sisli Etfal Hastan Tip Bul (2021)
Keywords: hemochromatosis, hemosiderosis, magnetic resonance imaging, paroxysmal nocturnal hemoglobinuria, radiology
MeSH terms: Case Reports

Paroxysmal nocturnal hemoglobinuria (PNH) is a type of hematopoietic stem cell disease and the clinical manifestation of the disease is mainly a combination of anemia and thrombosis. Intravascular hemolysis in PNH leads to hemosiderosis in renal cortex as a rare pattern of hemochromatosis. With this case presentation, we aim to show the radiological findings of this disease.
Non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy
Authors: Wisit Cheungpasitporn, Stephen L Kopecky, Ulrich Specks, Kharmen Bharucha, Fernando C Fervenza
Journal: J Renal Inj Prev (2016)
Keywords: adverse effect, cardiomyopathy, cardiovascular disease, membranous nephropathy, rituximab
MeSH terms: Case Reports

Rituximab is an anti-CD20 monoclonal antibody frequently used for the treatment of non-Hodgkin's lymphoma, chronic lymphocytic leukemia (CLL), rheumatoid arthritis (RA), and anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis. In addition, rituximab has recently been increasingly used as an off-label treatment in a number of inflammatory and systemic autoimmune diseases. It is advised that rituximab infusion may cause infusion reactions and adverse cardiac effects including arrhythmia and angina, especially in patients with prior history of cardiovascular diseases. However, its detailed cardiotoxicity profile and effects on cardiac function were not well described. We report a 51-year-old man who developed non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy. The patient experienced reduced cardiac functions within 48 hours after the initial infusion, which remained markedly reduced at 9-month follow-up. As the utility of rituximab expands, physicians must be aware of this serious cardiovascular adverse effect.
SARS-CoV-2 precipitating a stroke in a child? A case report from Tanzania
Authors: Rukhsar Shabir Osman, Saliha Shafik Dawood, Sheliza Parvez Thawer, Shivangi Mukesh Mandania, Mudassir Hussein Amirali, Maria Nathaniel Bulimba, Nahida Zahir Walli, Edward Nkingwa Kija, Hussein Karim Manji
Journal: Pan Afr Med J (2022)
Keywords: covid-19, sars-cov-2, tanzania, case report, pediatric stroke
MeSH terms: COVID-19 / complications, COVID-19 / diagnosis, Stroke / diagnosis, Stroke / etiology, Case Reports, Child, Health Personnel, Humans, Male, SARS-CoV-2, Tanzania

There is scanty data on overall pediatric presentations with COVID-19 in sub-Saharan Africa and none reported related to stroke. Management of acute stroke in children has been challenging due to delays in presentation and difficulties in deducing the exact etiology. This is the first such case of a stroke in a child with COVID-19 infection reported in Tanzania to the best of our knowledge. A six-and-a-half-year-old male child of Asian origin with no history of chronic illness presented to our facility with fever, rash, gastrointestinal symptoms and conjunctivitis. Subsequently, he developed headache, irritability, altered mentation, loss of speech, facial nerve palsy and hemiparesis. He was provisionally diagnosed with bacterial meningitis with a differential diagnosis of viral encephalitis and received standard treatment for the same. On further investigations, magnetic resonance imaging (MRI) of the brain showed ischemic infarct along the territory of left middle cerebral artery and given the history of the child´s exposure to a relative with COVID-19 infection, child underwent a nasopharyngeal swab for polymerase chain reaction testing which was negative but the serum IgG for COVID was positive. Despite the severe presentation initially, early detection and appropriate management resulted in survival, regained speech and motor function. Due to constraints in health care systems in sub-Saharan Africa, it is difficult to exhaust the diagnostics in order to narrow down the list of differentials in a child with stroke. This case is reported to further describe the diverse presentations of COVID-19 particularly in children which has been under-represented especially in sub-Saharan Africa. Attending physicians should have a high index of suspicion for SARS-CoV-2 as the etiology for exposed children presenting with neurological symptoms.
Afferent loop syndrome in a patient having incomplete annular pancreas
Authors: Warun Jose, Deepali Saxena, Ravi Hoisala
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Afferent loop syndrome is a rare complication following a Billroth II procedure and is seen in 3/1000 cases. This case report shows the importance of radiological imaging in a patient with a past history of abdominal surgery, for which no records were available. Imaging showed incomplete annular pancreas, leading to narrowing of the second part of the duodenum, which was the indication for gastrojejunostomy in the past, now presenting with features of afferent loop syndrome.
Clinical Comparison of the Subepithelial Connective Tissue versus Platelet-Rich Fibrin for the Multiple Gingival Recession Coverage on Anterior Teeth Using the Tunneling Technique
Authors: Victor Fabrizio Cabrera Pazmiño, Miguel Agusto Riquelme Rodas, Carlos David Barrios Cáceres, Guillermo Gustavo Renault Duarte, Melanie Vanesa Cano Azuaga, Bruna Luísa de Paula, Eliana Aparecida Caliente, Simone Soares, Elcia Maria Varize Silveira
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

The aim of this study was to evaluate and compare, clinically, the efficiency of the subepithelial connective tissue graft (SCTG) and platelet-rich fibrin (L-PRF) using the tunnel technique to cover the multiple gingival recessions on anterior teeth, in the same patient. Within the limits of this study, we conclude that both SCTG and L-PRF proved to be reliable options for the treatment of gingival recessions, efficiently supporting the biological and aesthetic demand, stimulating the periodontal tissues' health, and bringing reliable and highly predictable results.
Clinical utility of circulating miR-371a-3p for the management of patients with intracranial malignant germ cell tumors
Authors: Matthew J Murray, Thankamma Ajithkumar, Fiona Harris, Rachel M Williams, Ibrahim Jalloh, Justin Cross, Milind Ronghe, Dawn Ward, Cinzia G Scarpini, James C Nicholson, Nicholas Coleman
Journal: Neurooncol Adv (2020)
Keywords: biomarker, germ cell tumor, mir-371a-3p, microrna, vinblastine

Background:
The current biomarkers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) have limited sensitivity/specificity for diagnosing malignant germ cell tumors (GCTs) and "marker-negative" patients require histological confirmation for diagnosis. However, GCTs at intracranial sites are surgically relatively inaccessible and biopsy carries risks. MicroRNAs from the miR-371~373 and miR-302/367 clusters are over-expressed in all malignant GCTs and, in particular, miR-371a-3p shows elevated serum levels at diagnosis for testicular disease.
Methods:
Using our robust preamplified qRT-PCR methodology, we quantified miR-371a-3p levels in serum and cerebrospinal fluid (CSF) in a series of 4 representative clinical cases, 3 with intracranial malignant GCT and 1 with Langerhans cell histiocytosis (LCH), compared with appropriate control cases.
Results:
Serum and/or CSF miR-371a-3p levels distinguished those with intracranial malignant GCTs from LCH and, if known in real time, could have helped clinical management. The benefits would have included (1) the only confirmatory evidence of an intracranial malignant GCT in 1 case, supporting clinical decision making; (2) early detection of intracranial malignant GCT in another, where an elevated CSF miR-371a-3p level preceded the histologically confirmed diagnosis by 2 years; and (3) confirmation of an intracranial malignant GCT relapse with an elevated serum miR-371a-3p level, where serum and CSF AFP and HCG levels were below thresholds for such a diagnosis.
Conclusions:
This series highlights the potential for microRNA quantification to assist the noninvasive diagnosis, prognostication, and management for patients with intracranial malignant GCTs. Serum and CSF should be collected routinely as part of future studies to facilitate the extension of these findings to larger patient cohorts.
Recurrent Giant Malignant Phyllodes Tumor of the Breast
Authors: Erik Kudela, Karol Kajo, Erik Kozubik, Tomas Rokos, Terezia Pribulova, Jan Danko, Eva Kudelova, Igor Homola, Pavol Slavik, Barbora Macurova, Kamil Biringer
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breast. They have a proliferating stromal component that can be graded as benign, borderline, and malignant. In addition, they are associated with an increased risk of local recurrence and distant metastasis. The authors hereby present a case report of a 34-year-old woman with recurrent malignant PT with an increasing aggressiveness. There were two recurrences of giant tumors that consumed the entire right breast, which developed over a three-year period. The final surgical treatment was a total extirpation of the tumor with subsequent plastic reconstruction using a cutaneous flap from the region of the latissimus dorsi muscle. The patient died three months after the last recurrence due to multiorgan failure.
Therapeutic drug monitoring of voriconazole: a case report of multiple drug interactions in a patient with an increased CYP2C19 activity
Authors: Yassine Bouatou, Caroline Flora Samer, Kuntheavy Roseline Ing Lorenzini, Youssef Daali, Samira Daou, Marc Fathi, Michela Rebsamen, Jules Desmeules, Alexandra Calmy, Monica Escher
Journal: AIDS Res Ther (2014)
Keywords: cyp, drug interaction, individualization, pharmacogenetics, therapeutic drug monitoring, antifungal

Background:
Voriconazole is metabolized by cytochrome P450 (CYP) 2C19 and CYP 3A4. Drug-drug interactions and genetic polymorphisms modulate their activities.
Case presentation:
A 35-year old African female patient with resistant HIV and a cerebral mass of unknown origin was treated with voriconazole for a suspicion of disseminated Aspergillosis infection. Voriconazole trough concentrations (C0) were within target range while the patient was under esomeprazole, a CYP2C19 inhibitor. Phenotyping showed decreased CYP2C19 activity, whereas genotyping showed a variant allele associated with increased enzyme activity. The patient was switched to ranitidine because of the introduction of atazanavir. CYP3A4 inhibition by atazanavir combined with uninhibited CYP2C19 activity resulted in subtherapeutic voriconazole C0. The reintroduction of esomeprazole allowed restoring voriconazole C0 back to target range.
Conclusion:
The integration of drug-drug interactions and pharmacogenetics data is crucial to interpret drug concentrations correctly, thus preventing suboptimal exposure to voriconazole.
Successful treatment of fetal intraperitoneal administration of immunoglobulin in a case of fetal hemolytic anemia with 131,072-fold anti-e alloimmunization
Authors: Masashi Yoshida, Hideo Matsuda, Eijiro Hayata, Akio Watanabe, Miho Oeda, Kenichi Furuya
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Object. We present here the case of severe fetal anemia caused by anti-E antibody positive, which showed a favorable course only with fetal intraperitoneal administration of immunoglobulin. Case. The mother was 31 years old, blood type B Rh : CCDee, gravida 1, with no history of transfusion. Anti-E antibody was detected in the maternal cross-match test at the 18th gestational week. In percutaneous umbilical blood sampling, the umbilical blood hemoglobin level was 9.1 g/dL and the result of the direct Coombs' test was positive at the 26th gestational week. Immunoglobulin injection into fetal abdominal cavity (IFAC) was administered a total 7 times. During the pregnancy, the indirect Coombs' test showed a 131,072-fold increase. Conclusion. In this case, IFAC to block the reticuloendothelial system Fc receptor was successful. This procedure is promising as one of the treatment options for blood group incompatible pregnancy.
Primary signet ring cell carcinoma of the male urethra
Authors: Danny Darlington Carbin Joseph, Jagatheswaran Chinnathambi, Arunkumar Jamburaj
Journal: Ecancermedicalscience (2022)
Keywords: adenocarcinoma, signet ring cell neoplasm, urethral cancer
MeSH terms: Case Reports

Malignant tumours of the male urethra are rare and commonly present at an advanced stage. The most common type of urethral cancer is urothelial carcinoma, followed by squamous cell carcinoma. Less than 5% of urethral cancers are adenocarcinoma. We report a young male with signet ring cell carcinoma of the membranous urethra who presented with recurrent lower urinary tract symptoms. Although he was initially treated for a urinary tract infection, the correct diagnosis was made with an appropriate imaging workup. He underwent radical urethrectomy with total pelvic exenteration with bilateral extended pelvic lymph node dissection. Ileal conduit and colostomy were performed as urinary and bowel diversions, respectively. The patient received adjuvant chemotherapy, however, succumbed to COVID-19 8 months after the procedure. This case has been presented to highlight the high index of suspicion required to diagnose this rare malignancy.
An Unusual Presentation of Multiple Superficial Mucoceles Occurring with Oral Lichen Planus
Authors: Dulyapong Rungraungrayabkul, Puangwan Lapthanasupkul, Naruemon Panpradit, Nis Okuma
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Superficial mucoceles, a rare variant of the mucocele occurring simultaneously with oral lichen planus, are uncommon. This report introduces a case of multiple superficial mucoceles developing with oral lichen planus in a 76-year-old Thai female and provides information to avoid misdiagnosis and over-management of this lesion. Pathogenesis and clinicopathological characteristics of this phenomenon are also discussed.