bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous Intra-Cerebral Haemorrhage Presenting with Chest Pain in a Healthy Young Man
Authors: Dimitrios Anyfantakis  , Fani Katsanikaki  , Serafim Kastanakis
Published: May 2021

Spontaneous, non-traumatic intra-cerebral haemorrhage is the second most common type of stroke and is associated with significant morbidity and mortality. It is defined as the presence of blood within the cerebral parenchyma without prior injury or surgery. The purpose of this work is to describe an atypical presentation of spontaneous intra-cerebral haemorrhage in a healthy young adult. A literature review was also carried out.
Respiratory Distress in SARS-CoV-2 without Lung Damage: Phrenic Paralysis Should Be Considered in COVID-19 Infection
Authors: Francois Maurier  , Benoit Godbert  , Julie Perrin
Published: May 2021

We describe an overweight COVID-19 patient with respiratory distress preceded by anosmia/dysgeusia with no lung injury shown on CT, angio-CT or ventilation/perfusion scans. Orthopnoea and paradoxical abdominal respiration were identified. Phrenic paralysis, demonstrated by examination of patient breathing, and on x-ray while standing breathing in and out, explained the respiratory distress. This is a rare and previously undescribed neurological complication of COVID-19 infection caused by vagus nerve injury.
Simultaneous Presentation of Parvovirus B19 Infection and Systemic Lupus Erythematosus in a Patient: Description and Review of the Literature
Authors: Paul Chabert  , Hatem Kallel
Published: May 2021

We present the case of a 25-year-old woman without medical history, presenting with acute respiratory failure needing mechanical ventilation. Aetiologic screening showed PVB19 primary infection and concomitant SLE flare-up. We discuss the causative interactions between PVB19 and SLE in the pathogenesis of the disease. Difficulty diagnosing inaugural SLE flare-up concomitant with PVB19 infection can lead to delayed diagnosis and treatment. Inversely, overtreating a SLE-mimicking PVB19 infection with immunosuppressive agents can be highly detrimental.
COVID-19, Chronic Obstructive Pulmonary Disease and Pneumothorax: A Frightening Triad
Authors: Erika Poggiali  , Andrea Vercelli  , Teresa Iannicelli  , Valentina Tinelli  , Laura Celoni  , Andrea Magnacavallo
Published: May 2021

We describe the case of a male patient admitted to our emergency department during the Italian COVID-19 epidemic, for progressive worsening dyspnoea. A diagnosis of pneumothorax and diffuse interstitial lung involvement was promptly made by lung ultrasound and confirmed by an HRCT scan. A chest CT scan also showed diffuse emphysema, as observed in chronic obstructive pulmonary disease (COPD), and small consolidations in the lower lobes, suggestive for COVID-19 pneumonia. A chest tube was immediately inserted in the emergency room with complete resolution of the dyspnoea. A nasopharyngeal swab for 2019-nCoV was positive. Unfortunately, the patient died from COVID-19-related acute respiratory distress syndrome after 48 days of hospitalization.
Can Lung Ultrasound be Used to Screen for Pulmonary Embolism in Patients with SARS-CoV-2 Pneumonia?
Authors: Andrea Boccatonda  , Eugenia Ianniello  , Damiano D'Ardes  , Giulio Cocco  , Fabrizio Giostra  , Claudio Borghi, Prof  , Cosima Schiavone, Prof
Published: May 2021

Thromboembolic disease is strongly associated with, or even an integral part of, COVID-19 pneumonia. Indeed, endothelial/microvascular damage to pulmonary capillaries seems to be the main trigger of the pneumonia. Here we report a case of pulmonary embolism in a COVID-19 patient with an atypical clinical presentation. Blood gas analysis and lung ultrasound allowed the correct diagnosis to be reached.
Embolic Showering from Non-Bacterial Thrombotic Endocarditis and Adenocarcinoma of the Lung
Authors: Brian Cheung  , Abhijit Shivkumar  , Ahmed Ahmed
Published: May 2021

Background: Non-bacterial thrombotic endocarditis (NBTE) is a paraneoplastic phenomenon with sterile vegetations. It is associated with adenocarcinoma and can shower emboli, which can be the presenting symptom. Case Presentation: A 44-year-old woman with adenocarcinoma of the lung presented with chest pain, left hand weakness, and ataxia due to repeated embolic showering from NBTE to the central nervous system (CNS) and spleen. Conclusion: NBTE is a rare condition that should be on the differential diagnosis in patients with culture-negative endocarditis and a history of adenocarcinoma.
Mondor's Disease in SARS-CoV-2 Infection: A Case of Superficial Vein Thrombosis in the Era of COVID-19
Authors: Gianfranco Lessiani  , Andrea Boccatonda  , Damiano D'Ardes  , Giulio Cocco  , Giuseppe Di Marco  , Cosima Schiavone
Published: May 2021

SARS-CoV-2 causes blood hypercoagulability and severe inflammation resulting in an increased risk of thrombosis. Consequently, COVID-19 patients with cardiovascular disease seem to be at higher risk of adverse events. Mondor’s disease is a rare, generally self-limiting, thrombosis of the penis. The pathogenesis of Mondor’s disease is unknown, and it is usually diagnosed through clinical signs and with Doppler ultrasound evaluation. We describe the case of a young man with COVID-19 infection who manifested Mondor’s disease.
Repetitive Sharps Ingestion and Challenges with Retrieval and Prevention
Authors: Subash Ghimire  , Kriti Suwal  , Tsujung Yang  , Hafiz Khan  , Matthew Lincoln
Published: May 2021

Introduction: Recurrent deliberate sharp foreign body ingestion is associated with frequent hospitalizations and a high risk of complications, including perforation and peritonitis. These patients require urgent care. In addition, removal of foreign bodies can be challenging. Case Description:We describe the case of a patient with borderline personality disorder who was admitted multiple times with sharps ingestion and presented challenges with her care. Conclusion: Our case highlights the cause of recurrent sharps ingestion and provides recommendations on the retrieval of sharp foreign bodies and prevention.
Diagnostic Enigma: Spindle Cell Sarcoma of the Aorta Presenting as Pulmonary Embolism and Chronic Anaemia
Authors: Gabriella A Conte  , Marjan Alidoost  , Mitchel S Devita  , Jonathan S Harmon  , Jake W Schuler  , Fernando Brea  , Taliya Farooq  , Angelo A Chinnici
Published: May 2021

Primary aortic sarcoma is a rare and aggressive malignancy with only approximately 190 cases reported in the literature. While angiosarcoma and intimal sarcomas represent an estimated 67.7% of malignant aortic tumours, spindle cell sarcomas are even more exclusive, consisting of only 0.9% of malignant aortic tumours. Differentiated from other malignant aortic tumours, spindle cell sarcomas are of mesenchymal origin and usually express vimentin and osteopontin. Clinical presentations are variable and nonspecific, ranging from back pain, abdominal pain or elevated blood pressure, misleading to differentials like pulmonary emboli or aortic aneurysms such as in our case here. In this article, we discuss the finding of an extremely rare aortic sarcoma masquerading as a pulmonary embolism. The patient underwent surgical resection; however, the course was complicated by the development of brain metastases and intracranial haemorrhage. The literature is expanding regarding the evolution of adjuvant chemotherapy and radiation therapy in the treatment of these patients. The exact pathogenesis of spindle cell sarcomas is unknown but thought to be related to the MDM2-p53 pathway. The development of spindle cell sarcomas may be related to Li-Fraumeni syndrome, which should be on the differential for these patients. This case highlights the importance of identifying aortic sarcomas in patients who present with signs and symptoms of peripheral embolization as the diagnosis can be easily misconstrued for thrombus or aortic aneurysm, leading to a delay in proper and timely management. We herein emphasize that aortic sarcomas should be included in the clinician’s working differential due to the poor prognosis and outcomes that these aggressive tumours carry.
Erythromelalgia Caused by Polycythemia Vera Combined with Primary Aldosteronism
Authors: Morika Suzuki  , Takashi Watari
Published: May 2021

A 61-year-old woman with a history of primary aldosteronism caused by unilateral hyperplasia of the adrenal gland presented with a 2-week history of redness and severe pain in the right thumb and thenar regions. She had initially visited a dermatologist and was diagnosed with cellulitis and treated with cefditoren pivoxil for 5 days, but there was no improvement. The pain worsened and was accompanied by a burning sensation. The dermatologist prescribed famciclovir for 5 days owing to suspicion of herpes zoster. The patient was then referred to our department because her symptoms persisted. Physical examination showed no abnormalities other than the redness in the right thumb and thenar regions and spontaneous moderate pain present throughout the right thumb. Investigations revealed normal blood chemistry and coagulation factor levels, except for elevated haemoglobin (18.2 g/dl). Further investigations revealed an erythropoietin level of 2.3 IU/ml and Janus kinase 2 mutation. Hence, we diagnosed the patient with erythromelalgia caused by polycythemia vera. In this report, we discuss the treatment of polycythemia causing erythromelalgia, and the aetiology of primary aldosteronism and polycythemia vera.
Pleural Effusion Secondary to Obstructive Uropathy: A Case of Urinothorax
Authors: Andreia Freitas  , Telmo Coelho  , Sara Beça  , Tiago Gregório
Published: May 2021

Urinothorax is a rare type of pleural effusion and usually the result of genitourinary tract disease. An accurate and early diagnosis is crucial as resolution of the underlying pathology is the mainstay of treatment. We report the case of a 69-year-old man who was admitted to the Internal Medicine ward due to obstructive acute kidney injury of unknown origin. The patient was submitted to urinary catheterization and to right percutaneous nephrostomy. Two weeks after admission he developed a large left pleural effusion; a left urinoma was also visible on computed tomography. After thoracentesis, pleural fluid analysis demonstrated a paucicellular transudate with pH <7.40 and pleural fluid/serum creatinine ratio >1.0. The diagnosis of urinothorax was made and further study allowed the diagnosis of prostate cancer as the aetiology of the obstruction. When bilateral percutaneous nephrostomy was performed, resolution of the urinothorax and normalization of renal function occurred.
Intracranial Neurenteric Cyst in a Patient with Acute Unilateral Thalamic Infarction
Authors: Van Trung Hoang  , Hoang Anh Thi Van  , Hoang Quan Nguyen  , Ngoc Trinh Thi Pham  , Minh Tri Thi Vo  , Vichit Chansomphou  , Cong Thao Trinh
Published: May 2021

Intracranial neurenteric cysts are rare congenital lesions that can be mistaken for other lesions. They may contain mucous or serous glands, smooth muscle, lymphoid tissue and components of connective tissue. We report a case of neurenteric cyst which was detected accidentally by diagnostic imaging in the context of a thalamus infarct in a 45-year-old woman. We also discuss the results of a brief literature review and the pathological findings, imaging spectrum, evaluation and management of neurenteric cysts and thalamic infarctions.
First-Degree Atrioventricular Block with Tachycardia from Paliperidone and Mirtazapine Overdose
Authors: Brian Cheung  , Chris Levy  , Abhijit Shivkumar
Published: May 2021

Background: Paliperidone and mirtazapine are psychotropic agents associated with proarrhythmic effects.  Case Presentation: A 21-year-old woman was admitted to the intensive care unit on two separate occasions for attempting suicide by overdosing on paliperidone and mirtazapine. During both admissions, the patient had atypical chest pain and a first-degree atrioventricular block (AVB) with paradoxical sinus tachycardia, which resolved with the discontinuation of paliperidone and mirtazapine and aggressive intravenous fluids. Conclusion: Drug-induced first-degree AVB from paliperidone and mirtazapine should be on the differential diagnosis in patients on paliperidone and/or mirtazapine who present with chest pain, tachycardia or new-onset first-degree AVB
Spontaneous Splenic Rupture in an Ill Returned Traveller
Authors: David FGJ Wolthuis  , Ron W Bosboom  , Robert-Jan Hassing
Published: May 2021

Spontaneous splenic rupture is a known, but rare and possibly fatal, complication of different infectious diseases. We present a case of a 38-year-old male patient who presented with fever, icterus and spontaneous splenic rupture after a visit to Vietnam and discuss the differential diagnosis of splenic rupture in ill returned travellers.
Point-of-Care Ultrasound Can Suggest COVID-19
Authors: Ossama Maadarani  , Zouheir Bitar  , Tamer Zaalouk  , Mohammad Mohsen  , Ragab Elshabasy
Published: May 2021

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the World Health Organization (WHO) declared it a pandemic on 11 March 2020. Point-of-care ultrasound (POCUS) is a real-time bedside tool used by physicians to guide rapid, focused and accurate evaluation in order to identify or rule out various pathologies. We describe the case of an elderly man who had fallen at home 3 days previously and was hypoxic at presentation to the emergency department (ED). POCUS in the ED helped to identify a combination of lung and vascular involvement that indicated COVID-19 infection, which was confirmed by a laboratory test.
Cryptogenic Stroke and Valvular Strands
Authors: Cátia Castanheira Figueiredo  , Carla Sofia Rebelo  , Joana Lemos
Published: May 2021

Background: Ischaemic stroke can be classified according to its aetiology. In cryptogenic stroke, Lambl’s excrescences should be considered since they can only be detected through transesophageal echocardiography (TEE), which is not routinely performed. Case description: The authors report the case of a 63-year-old Caucasian man with two ischaemic cerebral events associated with the presence of Lambl’s excrescences in the aortic valve detected with TEE. Switching antiaggregant therapy to anticoagulant therapy allowed the patient to remain asymptomatic throughout a 3-year follow-up. Conclusion: The lack of protocols for the management of cryptogenic stroke results in a delay in the identification of less frequent causes of stroke, leading to recurrent vascular events, morbidity and loss of functionality. The authors describe a patient who experienced multiple cerebral ischaemic events until the correct diagnosis was made.
Sinonasal Chondrosarcoma, an Unusual Location
Authors: Oumniya Abouhanine  , Aicha Merzem  , Vianney Ndayishimiye  , Omar Amriss  , Hasnaa Belgadir  , Nadia Moussali  , Naima El Benna
Published: May 2021

Introduction: Chondrosarcoma is a tumour with a cartilaginous matrix frequently encountered in long bones and the pelvis with rare sinonasal location. Patient and methods: We report the case of a 25-year-old patient who was referred to us for an extension work-up for sinonasal chondrosarcoma confirmed by anatomopathological examination. Results: Facial magnetic resonance imaging (MRI) confirmed by a CT scan showed an osteolytic tumour process of the hard palate and walls of the left maxillary sinus that was locally advanced. Conclusion: The sinonasal location of a chondrosarcoma is rare. Characterized by cross-sectional imaging, confirmation was provided by histological assessment.
Rare Features of Dermatomyositis in a Patient with Ovarian Cancer
Authors: Lissandra Dal Lago  , Frédéric Vandergheynst  , Ahmad Awada  , Thierry Pepersack
Published: May 2021

Despite a classical presentation of dermatomyositis, a patient with ovarian cancer had several uncommon features: (i) unexpected onset of dermatomyositis in spite of cancer remission, (ii) development of Evans’ syndrome and subcutaneous edema, and (iii) dysphagia. We discuss the occurrence of these clinical situations as well as the treatments.
Pseudoacromegaly Associated with Non-Functioning Pituitary Adenoma
Authors: Awatef Alotaibi  , Ahmad Habib  , Moutaz Osman  , Khaled Alzahrani  , Faisal Alzahrani
Published: May 2021

Acromegaly is characterized by excess skin and soft tissue growth due to increased growth hormone (GH) levels. Patients with similar physical findings but without somatotroph axis abnormalities are considered to have pseudoacromegaly. The list of pseudoacromegaly differential diagnoses is long. It may be caused by several congenital and acquired conditions and diagnosis can be challenging due to its rarity and occasional overlapping of some of these conditions. The presence of a pituitary tumour in such cases may lead to a misdiagnosis of acromegaly, and thus, biochemical evaluation is key. Here, we present a case of pseudoacromegaly with an acromegaloid phenotype, normal IGF levels, a supressed GH response to an oral glucose tolerance test, moderate insulin resistance and non-functioning pituitary microadenoma.
An Unusual Association: Takayasu’s Arteritis and Tubulointerstitial Nephritis and Uveitis Syndrome
Authors: Abir Derbel  , Mariam Ghribi  , Sameh Marzouk  , Zouhir Bahloul
Published: May 2021

The coexistence of two immune-mediated diseases in the same patient is unusual. Takayasu’s arteritis (TA), which is a chronic granulomatous vasculitis, was discovered in a 47-year-old woman followed for tubulointerstitial nephritis and uveitis syndrome (TINU syndrome). We present the first case of this association.
An Unexpected Favourable Evolution of Advanced Stage Cirrhosis
Authors: Tiago Rabadão  , Leonor Naia  , Filipa Ferreira  , Mariana Teixeira  , Marcelo Aveiro  , Margarida Eulálio  , Susana Calretas
Published: May 2021

The elimination of the aetiological factors causing liver injury is an important cornerstone in preventing progression and increasing survival in patients with cirrhosis. The authors present the case of a 63-year-old woman with a history of long-term alcohol abuse and consequent liver cirrhosis. Over the years, the patient presented progressive deterioration with severe malnutrition and had multiple hospital admissions due to decompensated cirrhosis, including refractory ascites, variceal bleeding and an extensive portal vein thrombosis (PVT). Anticoagulant therapy was not initiated due to a high risk of variceal bleeding. She eventually became abstinent, but PVT precluded a liver transplant. Over the following 10 years, her performance status gradually improved, with no new decompensation episodes and liver function normalization, although refractory ascites persisted. Abdominal CT showed spontaneous recanalization of the portal vein and a transjugular intrahepatic portosystemic shunt (TIPS) procedure was performed with gradual improvement of ascites. In this atypical case, an unexpected favourable evolution of advanced stage cirrhosis was observed with long-term improvement in clinical status and liver function, resulting in an estimated 10-year cumulative mortality rate of 99.98% and highlighting the importance of abstinence. Unexpectedly, spontaneous complete repermeabilization of the PVT was also observed, despite its extent and the absence of anticoagulation therapy.
Primary Malignant Mesothelioma of the Liver: Case Report and Review of the Literature
Authors: Subash Ghimire  , Nilisha Regmi  , Tsujung Yang  , Harshil Shah  , Ukorn Srivatana  , Ashit Sarker  , Hafiz Khan
Published: May 2021

Introduction: Primary malignant mesothelioma of the liver is an extremely rare cancer, with only 16 cases reported in the literature so far. Diagnosis is challenging due to morphological similarity with common liver cancers and the extreme rarity of the condition. Case description: We present the case of a 70-year-old man who was found to have an incidental liver mass which was diagnosed as primary malignant mesothelioma of the liver. Conclusion: Our report describes the presentation of this rare liver malignancy and the challenges associated with diagnosis and treatment.
Hypercalcaemia, Renal Dysfunction, Anaemia, Bone Disease (CRAB Criteria): A Case of Lymphoma
Authors: Balraj Singh  , Pooja Gogia  , Parminder Kaur  , Nirmal Guragai  , Michael Maroules
Published: May 2021

Calcium elevation, Renal dysfunction, Anaemia and Bone disease (CRAB criteria) are usually seen in multiple myeloma (MM). We report a unique case of lymphoma with all the features of CRAB criteria. We describe a 59-year-old patient who presented with confusion, severe back pain, fatigue and constipation and was found to have hypercalcaemia, kidney dysfunction, anaemia and multiple osteolytic lesions. Physical examination and imaging did not reveal any enlarged lymph nodes. Work-up for MM (serum protein electrophoresis, serum immunofixation, bone marrow biopsy) was negative. The patient was diagnosed with diffuse large B-cell lymphoma based on a pelvic mass biopsy. Hence, our case report suggests that CRAB criteria are not pathognomonic of MM and that in the appropriate clinical scenario, lymphoma is a possible diagnosis.
After All, It was Not Lung Cancer: When The Evidence is Misleading
Authors: Joana Braga  , Francesca Pereira  , Cristiana Fernandes  , Marinha Silva  , Cristina Marques  , Daniela Alves  , Carlos Oliveira
Published: May 2021

The aetiology of pulmonary nodules is varied, with malignant lesions being the most important and requiring rapid diagnosis and treatment. However, although clinical presentation and imaging may suggest a specific diagnosis, it should be kept in mind that some benign pathologies mimic more serious disease. A 50-year-old man presented with left pleuritic chest pain. A CT scan showed an ipsilateral pulmonary spiculated nodule. Pneumonia was assumed and the patient was started on antibiotic therapy. In the absence of improvement, positron emission tomography and a transthoracic aspiration biopsy were performed. Lung cancer was diagnosed and the patient underwent an upper lobectomy. However, examination of the surgical specimen showed no malignancy.
Reversible Neurological Adverse Reaction to Apixaban
Authors: Eduardo Rodrigues Cernadas  , Catarina Dionisio  , Dalia Estevão  , Leopoldina Vicente
Published: May 2021

Prescriptions for the novel oral anticoagulant factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) have equalled or exceeded those for vitamin K antagonists in many clinical settings requiring chronic anticoagulation, and those of injectable heparins for deep vein thrombosis prophylaxis. The authors report the case of an 80-year-old woman followed by her cardiologist for permanent atrial fibrillation who was prescribed apixaban. Within a few days the patient developed neurological symptoms of imbalance and non-vertiginous dizziness, headache, confusion/disorientation and asthenia. Her symptoms began to resolve after the drug was stopped, with return to baseline function within 72 h. The plasma concentration of apixaban was 4 times higher than the laboratory upper limit of normal. Symptoms did not recur when the patient was switched to rivaroxaban therapy.
Pulmonary Synovial Sarcoma: An Unpleasant Surprise
Authors: Gabriela Pereira  , Ana Pires  , Sandra Barbosa  , Jorge Cotter
Published: May 2021

The authors describe the case of a patient with primary monophasic pulmonary synovial sarcoma presenting as a right pleural effusion, and discuss the underlying diagnostic challenges.
Missed Diagnosis of Cholangiocarcinoma Presenting with Atypical Symptoms
Authors: Ren Kawamura  , Yukinori Harada  , Taro Shimizu
Published: May 2021

We report a case of delayed diagnosis of cholangiocarcinoma. A 62-year-old man developed acute abdominal pain in multiple sites. As the distribution pattern of the abdominal pain was not correctly interpreted based on the mechanisms of visceral and referred pain, the patient was not investigated with the best diagnostic test at first presentation. Moreover, miscommunication between physicians in a clinic and separate hospital delayed diagnosis. For prompt diagnosis, physicians should be practice careful reasoning and focus on good communication with physicians outside their hospital.
The Deceptive Mushroom: Accidental Amanita muscaria Poisoning
Authors: Francesca Irene Rampolli  , Premila Kamler  , Claudio Carnevale Carlino  , Francesca Bedussi
Published: May 2021

Amanita muscaria is considered to be one of the most remarkable and beautiful mushrooms. It has a red or orange cap covered with small white plaques and its distinctive appearance makes accidental and severe intoxication very rare. Its consumption is sometimes used as a means of suicide or it can be consumed for its psychedelic effects, and in some cases, it can be mistaken for edible species. In this paper, we will discuss a patient who fell into a coma after accidental Amanita muscaria poisoning. Rapid identification of the mushroom allowed the regression of symptoms and discharge from the hospital on the fourth day after consumption.
Sudden Death Due to Thrombosis Associated with Implantable Cardioverter-Defibrillator Electrodes
Authors: Jose Maria Frutos Perez  , Marina Llopis Sanchis  , Andrea Esteve Villar del Saz  , Beatriz Moreno Torres  , Ana Ventura Esteve  , Maria Angeles Martinez Pascual  , Mariam Perea Ribis  , Alba Camarena Molina  , Leyre Jorquer Vidal  , Gustavo Lobato Correia  , Jose Manuel Querol Ribelles
Published: May 2021

Thrombosis associated with pacemaker leads is extremely rare, although the literature on this subject is scarce. A clinical case is reported, describing this condition and its clinical presentation, the complementary tests for establishing the diagnosis and the available therapeutic options.
Pancreatic Lipoma: A Pancreatic Incidentaloma Diagnosis with Computed Tomography
Authors: Amina Beddi  , Aicha Merzem  , Meryem Harmak  , Hasna Belgadir  , Omar Amriss  , Nadia Moussali  , Naima El Benna
Published: May 2021

Lipoma of the pancreas is a rare benign tumour which is usually discovered incidentally on imaging. We present a case of an incidentally discovered pancreatic lipoma in a 79-year-old man with non-metastatic prostate adenocarcinoma who was referred to radiology for follow-up imaging. Fat-containing tumours originating from the pancreas are very rare. Most lipomas show characteristic features on imaging that allow their differentiation. We present the imaging features of a pancreatic lipoma on ultrasound, CT and MRI, discuss the differential diagnosis, and provide a brief review of the literature.
Autoimmune Hepatitis–Primary Biliary Cholangitis Overlap Syndrome Triggered by COVID-19
Authors: Balraj Singh  , Parminder Kaur  , Michael Maroules
Published: May 2021

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 infection, has caused the ongoing global pandemic. Initially considered a respiratory disease, it can manifest with a wide range of complications (gastrointestinal, neurological, thromboembolic and cardiovascular) leading to multiple organ dysfunction. A range of immune complications have also been described. We report the case of a 57-year-old man with a medical history of hypertension, prediabetes and beta thalassemia minor, who was diagnosed with COVID-19 and subsequently developed fatigue and arthralgias, and whose blood work showed hyperferritinemia, elevated liver enzymes (AST/ALT/GGT), hypergammaglobulinemia, anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-double-stranded DNA antibodies. The patient was diagnosed with autoimmune hepatitis–primary biliary cholangitis overlap syndrome triggered by COVID-19. To our knowledge, this is the first such case reported.
Crohn’s Disease with Atypical Extra-Intestinal Manifestations Developing Under Treatment with Vedolizumab
Authors: Aasem Abu Shtaya  , Shai Cohen  , Yana Kogan  , Michal Shteinberg  , Ori Sagol
Published: May 2021

Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the GI tract, which is frequently associated with extra-intestinal manifestations. Pulmonary parenchymal disease is very uncommon and usually considered to be debilitating and harder to diagnose. Pulmonary granulomas are rarely described in the literature as a complication of Crohn’s disease. Here, we present a patient with Crohn’s disease exacerbation who developed granulomatous lung disease under treatment with vedolizumab. Our case may add evidence to the emerging theory that gut-selective biologic agents could lead to upregulation of some pro-inflammatory factors leading to the evolution of pulmonary disease.
Congenital Inferior Vena Cava Agenesis with Ulceration and Deep Vein Thrombosis
Authors: Melanie Menning  , Mira Yousef
Published: May 2021

Objectives: This is one of the few case reports of congenital inferior vena cava atresia (IVCA) with extensive bilateral lower extremity ulcers. Background: IVCA is a congenital anomaly characterized by poor venous return in the lower extremities with increased risk of deep vein thrombi (DVTs) and, rarely, non-healing ulcers. Results: A 45-year-old woman with history significant for DVTs presented with extensive bilateral lower extremity ulcers, and a CT scan revealed congenital IVCA. Oedema management, DVT prevention, routine wound care and skin grafts resolved the ulcers. Conclusion: Congenital venous abnormalities should be included in the differential diagnosis of multiple unprovoked DVTs and non-healing ulcers.
An Unusual Cause of Proptosis: Orbital Metastasis of Paratesticular Leiomyosarcoma
Authors: Muhammet Ozer  , Kirti Juneja  , Mohammed Mahdi  , Namrata Jannareddy  , Neel Gandhi
Published: May 2021

Paratesticular leiomyosarcomas are uncommon malignant tumors that originate from smooth muscle. Paratesticular leiomyosarcoma shows aggressive tumor behavior due to a high incidence of local recurrence and distant metastasis. The orbit metastasis is also rare and associated with a poor prognosis. Clinical suspicion plays an essential role in the diagnosis of orbital leiomyosarcoma due to uncommon presentation. Comprehensive neuroimaging and histopathological work-up warranted for definitive diagnosis and management. To date, surgical resection remains the best curative treatment. However, leiomyosarcomas are usually friable and unencapsulated, which makes surgery challenging. Also, whether adjunctive chemotherapy will alter the long-term prognosis remains to be determined. Herein, we report the case of a young male who presented with proptosis and decreased vision, subsequently diagnosed with metastatic orbital leiomyosarcoma from a primary paratesticular tumor. We performed orbital enucleation with negative margins. The patient is currently under systemic, systemic pazopanib chemotherapy.
Palatoschisis, Schizophrenia and Hypocalcaemia: Phenotypic Expression of 22q11.2 Deletion Syndrome (DiGeorge Syndrome) in an Adult
Authors: Melissa Elise van der Meijs  , Dave Henri Schweitzer  , Henk Boom
Published: May 2021

22q11.2 deletion syndrome typically presents with congenital cardiac anomalies, immunodeficiencies and hypoparathyroidism. However, clinical findings vary greatly. We present the case of a 56-year-old man, with a history of cleft palate and schizophrenia, who was newly diagnosed with 22q11.2 deletion syndrome during an episode of hypocalcaemia. The syndrome is caused by developmental abnormalities of the embryonic pharyngeal arch system. Treatment of hypocalcaemia with oral calcium and vitamin D is usually sufficient.
Unusual Presentation of COVID-19 Disease Leading to Respiratory Distress and Coma
Authors: Julie Paradis  , Hendrik Kevers  , Soufiane Chebli  , Serge Blum  , Pascal Reper
Published: May 2021

Multiple neurological complications including Guillain-Barré syndrome (GBS) have been associated with COVID-19. We describe a case of GBS related to SARS-CoV-2 infection with an unusual presentation beginning with mobilization problems at home without previous classic respiratory or general manifestations. Asymptomatic infection with COVID-19 can lead to critical situations with respiratory insufficiency because of neurological complications such as GBS.
COVID-19-related Multisystem Inflammatory Syndrome in a Young Adult
Authors: Francisco Pombo  , Carolina Seabra  , Vergílio Soares  , Ana João Sá  , Inês Ferreira  , Marina Mendes
Published: May 2021

Introduction: A condition called multisystem inflammatory syndrome in children (MIS-C), related to past SARS-CoV-2 infection, has been described in a series of cases. There is a growing body of evidence suggesting a similar entity in adults (MIS-A). We report a case of a young adult with a hyperinflammatory systemic syndrome with end-organ lesions and a recent SARS-CoV-2 infection. Methods and Procedures: The patient developed end-organ lesions in the respiratory, cardiovascular, digestive, haematological and mucocutaneous systems. A wide diagnostic work-up did not find any specific aetiology (autoimmunity, neoplastic or infectious). There was evidence of past SARS-CoV-2 infection with positive autoimmune titres (positive IgG). A presumptive diagnosis of MIS-A was made and treatment with corticosteroids was introduced with improvement. Discussion: COVID-19-related multisystem inflammatory syndrome in adults is still an unknown entity with no diagnostic criteria or treatment guidelines. Much of what is known is inferred from what we already know about MIS-C. There have been several reported cases with severity ranging from mild to severe. The mechanisms behind this condition are still largely unknown. More evidence is needed to establish diagnosis and treatment.
Proteus Syndrome: A Rare Case in An Adult Ward
Authors: Catarina Duarte Santos  , Rita Lizardo Grácio  , Tatiana Costa Pires  , Miguel González Santos  , Rita Jesus Rodrigues  , Miriam Magalhães  , Alcina Mota Ponte
Published: May 2021

Proteus syndrome is an extremely rare disorder that manifests as an asymmetric, disproportionate overgrowth of any connective tissue, such as bone, fat or epidermal nevi, in a mosaic or patchy pattern. It has an estimated prevalence of less than 1/1,000,000 live births. The diagnosis can be difficult because the phenotypes of the patients are variable. Many individuals develop cutaneous capillary malformation and prominent varicosities (large and complex vascular malformations). Thus, Proteus syndrome patients are at risk of developing deep vein thrombosis and pulmonary embolism. The authors present the case of a patient with Proteus syndrome who was admitted because of pulmonary thromboembolism and presented hypertrophy of the left arm and left hemithorax.
Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome
Authors: Ulusoy Cemal , Nikolovski Andrej , Öztürk Nazım
Published: May 2021

Abdominal cocoon syndrome (sclerosing encapsulating peritonitis) is a rare condition associated with clinical signs of intestinal dysfunction, episodes of small bowel obstruction and sometimes a palpable abdominal mass. We present the case of a 46-year-old male patient with clinical signs of intestinal obstruction caused by primary sclerosing encapsulating peritonitis.
Risk Management Implementation in Indonesian State Budget Fiscal Risk Disclosure
Authors: Himawan Audra Rizki , Pribadi Yanuar
Published: May 2021

Fiscal risk management is part of the management of financial risk in the State Budget. Basically, these risks are interrelated although they are different things. State financial risk as an inherent risk of State Budget has a different process from fiscal risk management. This study aims to evaluate the management process and disclosure of fiscal risk in the State Budget using a case study-qualitative approach. The integration of the risk management system between the risk management unit and the fiscal risk management unit, and development of fiscal risk management framework could improve the process of managing and disclosing fiscal risk in the Budget Statement.
Determinants of Local Original Income The Era of Special Autonomy for the Government of Aceh Province
Authors: Sukarniati Lestari , Lubis Firsty Ramadhona Amalia
Published: May 2021

Aceh's special autonomy status allows the province to be able to obtain a larger percentage of financial resources to finance its development. The purpose of this study was to determine the influence of government spending, GRDP, and population in increasing Aceh's local revenue. This study uses a quantitative approach, the analysis tool used is panel data regression which is processed using Stata. The results of the study prove that government expenditure, GRDP, total population have a positive and significant effect on the local revenue of Aceh Province for the period 2011-2018.
O céu onde relampeja a memória
Authors: De Moura Siano Jacqueline , Almeida Carneiro Isabel
Published: May 2021

O artigo busca traçar conceitos que foram motivados pela pandemia da Covid-19 surgida em 2020, a partir das falas de Paul Preciado, Achille Mbembe, Boaventura de Sousa Santos e Ailton Krenak. Os autores produziram pensamentos emergenciais e uma subteorização, segundo o próprio Sousa Santos, do momento em que vivemos. O texto também foi construído a partir das ideias da passagem entre sociedade soberana e disciplinar de Michel Foucault e de um pequeno lampejo presente na “filosofia da história” de Walter Benjamin.
Um tradutor da aldeia na cidade e da cidade na aldeia
Authors: Tupã Jekupé Xadalu , De Araujo Inês , Queiroz Tania , Souza Ana Clara , Fontenele Racquel , Souza Rafaella , Skymma Sofia
Published: May 2021

Entrevista realizada pelas autoras com o artista indígena Xadalu Tupã Jakupé, relacionando suasintervenções artísticas e seu trânsito entre cidade e aldeias a modos de estabelecer contato entre a arte e seu público através do contágio
Considerações sobre a representação visual das zoonoses na contemporaneidade: contágio interespécies e antropocentrismo
Authors: Berbara Maria
Published: May 2021

Zoonoses são doenças infecciosas causadas por patógenos que saltam de não-humanos para humanos.Algumas das doenças zoonóticas mais conhecidas e perigosas são ebola, “doença da vaca louca”(EEB), gripe aviária, gripe suína, raiva, e, mais recentemente, Covid-19. Este artigo traça algumas consideraçõessobre a representação visual das zoonoses na contemporaneidade e estabelece uma breve análisecomparativa sobre a relação entre humanos e seu alimento em dois modelos de consumo cárneo: o abateritual entre os Tupinambá nos séculos XVI e XVII e a atual produção pecuária industrial.
Statistical Analysis of Patients Attending the Department of Acupuncture and Moxibustion Medicine at DaeJeon Korean Medicine Hospital: from March 2015 to February 2020
Authors: Sung Ki Jung , Lee Ye Ji , Kim Hyo Bin , Kim Beom Seok , Jeon Ju Hyun , Kim Eun Seok , Kim Young Il
Published: May 2021

Background: This study was designed to statistically analyze the year, gender, age, insurance type, and condition/disease of patients who were admitted to the Department of Acupuncture and Moxibustion Medicine at DaeJeon Korean Medicine Hospital over a 5-year period (2015-2020).Methods: Patients who visited the Department of Acupuncture and Moxibustion Medicine at DaeJeon Korean Medicine Hospital were classified according to year, gender, age, insurance type, and condition/disease. The statistical analysis was performed using IBM SPSS 23.0.Results: There is an increasing number of patients attending the Department of Acupuncture and Moxibustion Medicine year-on-year over the 5-year period, with a higher frequency of females than males each year. The largest age groups represented in these patients were those aged in their 50s, followed by those aged in their 40s, and 60s. Furthermore, the number of patients using health insurance was greater than those using automobile insurance each year. Of the 5,061 patients, the most common group was the patients (n = 991) who reported sprain and strain of cervical spine, followed by lumbar spine, lumbar herniation of the intervertebral disc, and facial paralysis.Conclusion: The number of patients seeking traditional Korean medicine treatment continues to increase, particularly in the 40s to 60s age group, with a larger proportion using health insurance and sprain or strain of the cervical spine. The results of this study may be used as a local (Daejeon) reference to develop Korean medicine policies, such as setting up medical benefits for patients using Korean medicine hospitals.
Nonlinear optical properties in AlGaAs/GaAs symmetric coupled quantum wells
Authors: Ti Ruixia , Wang Chaoyang , Wang Guanghui
Published: May 2021

Based on the density matrix approach and iterative method, we calculated the analytic forms of linear and third-order nonlinear optical absorption coefficients and refractive index changes for symmetric coupled quantum wells (SCQWs) considering a two-level system, and gave the corresponding numerical results. The calculated results show that the optical properties of SCQWs are significantly better than those of asymmetrically coupled quantum wells, and the optical absorption coefficient and refractive index change are affected by the structure parameters of the SCQWs and the incident optical intensity. Their physical mechanisms are elucidated.
Localization of plasmon modes in a 2D photonic nanostructure with a controlled disorder
Authors: Ung T. P. L. , Quélin X. , Laverdant J. , Fulcrand R. , Hermier J.-P. , Buil S.
Published: May 2021

In this paper, we focus on the optical properties of disordered hole arrays etched in a gold thin film. The disorder is induced and controlled using hole displacements following a Gaussian distribution and starting from a periodic array. The nanostructures present a transition from ordered arrays to short-range ordered arrays and random arrays by increasing the disorder amount. The associated optical properties are characterized in far and near fields by complementary approaches (absorption spectroscopy, classical scanning near field optical microscopy (SNOM) and Finite Difference Time Domain (FDTD) simulations). By increasing the disorder, a broadened absorption up to 30% in the far-field is achieved. Experiments in agreement with FDTD simulations point out the energy localization induced by the disorder and the dependence on the amount of disorder and on the excitation wavelength. By using a controlled disorder, we also show that the effect of these two parameters is also closely linked.
Bright correlated twin-beam generation and radiation shaping in high-gain parametric down-conversion with anisotropy
Authors: Riabinin M. , Sharapova P. R. , Meier T.
Published: May 2021

Uniaxial anisotropy in nonlinear birefringent crystals limits the efficiency of nonlinear optical interactions and breaks the spatial symmetry of light generated in the parametric down-conversion (PDC) process. Therefore, this effect is usually undesirable and must be compensated for. However, high gain may be used to overcome the destructive role of anisotropy in order to generate bright two-mode correlated twin-beams. In this work, we provide a rigorous theoretical description of the spatial properties of bright squeezed light in the presence of strong anisotropy. We investigate a single crystal and a system of two crystals with an air gap (corresponding to a nonlinear SU(1,1) interferometer) and demonstrate the generation of bright correlated twin-beams in such configurations at high gain due to anisotropy. We explore the mode structure of the generated light and show how anisotropy, together with crystal spacing, can be used for radiation shaping.
Multi-user accessible indoor infrared optical wireless communication systems employing VIPA-based 2D optical beam-steering technique
Authors: Li Zhi , Zang Zihan , Wei Zixian , Han Yaqi , Wu Lican , Zhao Zhenquan , Li Mutong , Fu H. Y.
Published: May 2021

Infrared optical wireless communication system can achieve ultrahigh capacity and high privacy data transmission. However, for using narrow infrared laser beam as carrier to transmit signal, the high-speed data transmission can only be achieved by point-to-point connection. With the rapid number increasement of consumer electronic devices, such connection method puts a heavy burden on the number of transmitters. Thus, the transmitting end with the point-to-multipoint capability or multi-user accessibility is required. In this paper, we present a multi-user accessible indoor infrared optical wireless communication system employing passive diffractive optics based on a virtually imaged phased array (VIPA). Multiple beams can be generated in a point-to-multipoint scheme by using VIPA-based beam-steering antenna (BSA). On the other hand, by tuning wavelength of laser source, fast 2D steering of multiple beams with the same steering trajectory is supported, which can be used for user ends with changing locations. In the experiment, 5 beams are generated by utilizing only one transmitter. All five beams can realize 12.5 Gb/s on-off-keying (OOK) data rate transmission. Free-space optical wireless transmission at 3.6-m communication distance is demonstrated for system performance verification and evaluation. a total 3.44°×7.9° scanning field of view of five beams is achieved.
Resonant reflection by microsphere arrays with AR-quenched Mie scattering
Authors: Razmjooei Nasrin , Ko Yeong Hwan , Simlan Fairooz Abdullah , Magnusson Robert
Published: May 2021

Periodic guided-mode resonance structures which provide perfect reflection across sizeable spectral bandwidths have been known for decades and are now often referred to as metasurfaces and metamaterials. Although the underlying physics for these devices is explained by evanescent-wave excitation of leaky Bloch modes, a growing body of literature contends that local particle resonance is causative in perfect reflection. Here, we address differentiation of Mie resonance and guided-mode resonance in mediating resonant reflection by periodic particle assemblies. We treat a classic 2D periodic array consisting of silicon spheres. To disable Mie resonance, we apply an optimal antireflection (AR) coating to the spheres. Reflectance maps for coated and uncoated spheres demonstrate that perfect reflection persists in both cases. It is shown that the Mie scattering efficiency of an AR-coated sphere is greatly diminished. The reflectance properties of AR-coated spherical arrays have not appeared in the literature previously. From this viewpoint, these results illustrate high-efficiency resonance reflection in Mie-resonance-quenched particle arrays and may help dispel misconceptions of the basic operational physics.
Metalenses for the generation of vector Lissajous beams with a complex Poynting vector density
Authors: Khonina Svetlana N. , Degtyarev Sergey A. , Ustinov Andrey V. , Porfirev Alexey P.
Published: May 2021

We propose a method for the design of metalenses generating and focusing so-called vector Lissajous beams (VLBs), a generalization of cylindrical vector beams (CVBs) in the form of vector beams whose polarization vector is defined by two orders (p, q). The designed metalenses consist of subwavelength gratings performing the polarization transformation of the incident linearly polarized laser beams and a sublinearly chirped lens term for the realization of the beam focusing. The possibility of using VLBs for the realization of laser beams with a complex Poynting vector is theoretically shown. The certain choice of orders (p, q) of the generated VLBs makes it possible to control the type of various electromagnetic field components as well as the components of the complex Poynting vector. For example, in contrast to VLBs, the classical types of CVBs cannot provide an imaginary part in the longitudinal component of the Poynting vector. Such light fields are promising for exciting non-standard forces acting on the trapped nano- and microparticles.