bluuebunny/crossref_metadata_2025 huggingface dataset:
Rare Presentation of Toxoplasma Pneumonitis in the Absence of Neurological Symptoms in an AIDS Patient and Use of Next-Generation Sequencing for Diagnosis
Authors: Moni Roy  , Nikhut Siddique  , Bindu Bathina  , Sharjeel Ahmad
Published: May 2021

Toxoplasma gondii is a known cause of encephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. Toxoplasma pneumonitis is a manifestation of extracerebral toxoplasmosis and can be clinically indistinguishable from other opportunistic infections including Pneumocystis jirovecii pneumonia (PJP) and miliary tuberculosis. In this case report, Toxoplasma pneumonitis and disseminated toxoplasmosis was diagnosed using next-generation sequencing (NGS) and polymerase chain reaction (PCR) assessment. NGS can detect microbial cell-free DNA (cfDNA) circulating in the plasma of over 1,000 pathogens. This case is a rare presentation of Toxoplasma pneumonitis in the absence of neurological symptoms and we discuss the use of NGS of microbial cfDNA and PCR tests that may be utilized for the timely diagnosis of such challenging cases.
Leucocytosis and Stroke in a Lung Cancer Patient
Authors: Neha Akkad  , Yang Jiang  , Daniel Shin
Published: May 2021

Significant leucocytosis in the setting of an underlying malignancy may be attributed to several causes and is not uncommon; however, extreme leucocytosis (>50×109 cells/l) and hypereosinophilia is less common and may represent a paraneoplastic syndrome. The underlying mechanism is thought to be bone marrow stimulation by tumour-produced cytokines, most notably interleukin-5 (IL-5) and granulocyte-macrophage colony-stimulating factor (GM-CSF). This paraneoplastic syndrome is likely reflective of extensive disease and dissemination, and options for treatment are limited but include tumour resection, corticosteroids and hydroxyurea. In this report, we discuss an unusual case of known stage III lung adenocarcinoma presenting with an ischaemic stroke and extreme leucocytosis and hypereosinophilia.
A Rare Association of Antiphospholipid Antibody Syndrome, Systemic Lupus Erythematosus and Aortic Dissection: A Striking Presentation with Multi-Organ Failure?
Authors: Firdevs Ulutaş  , Veli Çobankara  , Aslı Bozdemir  , Uğur Karasu
Published: May 2021

Systemic lupus erythematosus is a chronic autoimmune disease with a wide variety of clinical presentations induced by different immunocomplexes and autoantibodies. Antiphospholipid antibody syndrome (APLAS) is a life-threatening clinical condition characterized by venous and arterial thromboses or pregnancy morbidity in the presence of persistent moderate/high levels of antiphospholipid antibodies. Aortic dissection is rarely associated with APLAS and always requires prompt diagnosis and early treatment. We report a rare case with a striking presentation. The patient developed multi-organ failure due to lethal aortic dissection and the obstruction of abdominal and thoracic branch vessels.
Urinary Retention and Severe Hyponatremia: An Unusual Presentation of COVID-19
Authors: Ahmed Osman Saleh  , Shaikha D. Al-Shokri  , Ashraf Ahmed  , Ahmed Elmustafa Musa  , Mouhand FH Mohamed
Published: May 2021

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019. The disease is caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). A few published cases have linked COVID-19 and hyponatremia. The mechanism of hyponatremia in these cases is related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Here we present a unique case of urinary retention and SIADH as unusual presenting features of SARS-CoV-2 infection.
Transient ST Segment Elevation in a Patient with COVID-19 and a Normal Transthoracic Echocardiogram
Authors: Tareq Tuaima  , Abdulhalim Jamal Kinsara  , Amtalkaliq Alrajawi  , Hassan Allam  , Shadwan Alfakih
Published: May 2021

The effect of COVID-19 on the cardiovascular system still needs to be clarified. Patients can develop a spectrum of cardiac diseases, from mild myocarditis to acute coronary syndrome with an impaired systolic fraction. We describe an interesting case of transient ST segment elevation in a COVID-19 patient admitted to ICU for severe respiratory distress syndrome. During his stay in ICU, the patient developed transient ST segment elevation in inferior-lateral leads which promptly resolved without requiring any additional invasive and/or pharmacological treatment. Transthoracic echocardiography showed a preserved ejection fraction without any regional abnormalities and the rise in enzyme biomarkers was insignificant. The case highlights the importance of avoiding invasive procedures in this subset of patients to reduce both patient complications and medical staff exposure. Careful evaluation including echocardiogram and second-line examinations should be performed before invasive and aggressive treatment is undertaken.
COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm
Authors: Pascale Daniel  , Marc Raad  , Rami Waked  , Jacques Choucair  , Moussa Riachy  , Fady Haddad
Published: May 2021

Introduction: The coronavirus disease COVID-19 is considered a pandemic disease that has developed rapidly all over the world. As of today, it is unclear whether immunosuppression confers an increased risk for pulmonary complications, or conversely, whether it can be a protective factor with respect to a cytokine storm.  Case description: We report the case of a 55-year-old male patient with granulomatosis with polyangiitis treated with rituximab who was infected with COVID-19 pneumonia. To the best of our knowledge, only 1 case has been reported in the literature with similar characteristics. The patient had a non-classic evolution of clinical symptoms with persistent fever and viral shedding, in addition to a negative serology. Conclusion: This case emphasizes the management and immunity response to COVID-19 pneumonia in such patients. Data are still needed regarding patients who have prolonged B-cell depletion, which may put the patient at a higher risk for reinfection.
Late Worsening of COVID-19 Pneumonia: Successful Treatment with Ruxolitinib and Steroid
Authors: Mauro Betelli  , Fabio De Stefano  , Alberto Tedeschi
Published: May 2021

We describe the case of a patient hospitalized for the second time in a month due to delayed worsening of lung lesions in COVID-19 infection without bacterial superinfection. He was treated with hydroxychloroquine, IV dexamethasone and ruxolitinib with rapid improvement of respiratory failure; 1 month after the second discharge, maintaining low-dose oral prednisone, lung consolidations were significantly reduced on control CT.
Acalculous Cholecystitis Complicated by Liver Abscess as a Manifestation of Cholesterol Embolization Syndrome – Infrequent Manifestation Precipitated by a Common Procedure
Authors: Ossama Maadarani  , Hany Alfayed  , Zouheir Bitar  , Moataz Daher  , Tamer Zaalouk  , Mohamed Abdelfatah
Published: May 2021

Cholesterol embolization syndrome (CES) is an atherosclerotic complication affecting different systems with various clinical manifestations, usually triggered iatrogenically by interventional and surgical procedures or thrombolytic therapy, although spontaneous cases have been reported. The hepatobiliary system can also be affected when the showered cholesterol crystals obliterate small vessels within this system causing both ischaemic and inflammatory responses. We describe a case of a male patient who initially developed multiple lacunar cerebral infarcts 10 days post-thrombolytic therapy and percutaneous coronary intervention (PCI) due to acute myocardial infarction. Several weeks later he developed acalculous cholecystitis complicated by liver abscess and kidney injury. The consequences and latency of manifestations within different organs and the temporal relationship with well-known trigger factors raised the suspicion of CES.
Presentation of Severe Rheumatic Mitral Stenosis at the Peak of the COVID-19 Pandemic and the Presumptive Treatment as Severe Coronavirus Illness
Authors: Christopher Balfe  , Cormac O'Connor  , Gerard Giblin  , Kevin Walsh  , Ivan Casserly  , David Moore  , Vincent Maher
Published: May 2021

This case report describes a young female Caucasian patient with newly presenting severe mitral stenosis at the peak of the coronavirus pandemic in the Republic of Ireland. The initial presumptive diagnosis was of severe coronavirus illness. This case report highlights the importance of keeping an open mind to alternative diagnoses and examines some of the challenges in the diagnosis and management of a rare condition in the pandemic environment. This patient gained 10 kg of weight within 6 weeks of percutaneous balloon mitral valvuloplasty, highlighting the contribution of cardiac cachexia to her low body weight and demonstrating the exceptional benefit that this treatment can offer to patients.
The Relationship of Cholangiocarcinoma with Human Immunodeficiency Virus Cholangiopathy and Cytomegalovirus Infection
Authors: Arda Yavuz  , Rabia Burçin Girgin  , İlyas Tuncer
Published: May 2021

Human immunodeficiency virus (HIV) is a worldwide disease with an increasing number of cases globally. Initially, HIV cholangiopathy was often observed among such patients but has become rare after three decades because of the availability of new treatment options and potent antiretroviral drugs. Consequently, its occurrence now suggests drug resistance or disease progression. The relationship between cholangiocarcinoma and HIV remains unclear. We report the case of a patient with high-grade dysplasia of the ductus choledochus and uncontrolled disease which was treated with potent antiviral agents and bile duct dilatation.
Treatment of Crimean-Congo Haemorrhagic Fever by Favipiravir in a Patient with Novel Coronavirus Co-Infection
Authors: Ahmet Cumhur Dülger  , Mustafa Yakarişik  , Yusuf Emre Uzun  , Ahmet Melih Şahin
Published: May 2021

Introduction: Crimean-Congo haemorrhagic fever (CCHF) is a lethal zoonotic disease caused by an RNA virus that is a member of the Nairovirus genus in the Bunyaviridae family from the arbovirus group. CCHF is transmitted by Hyalomma ticks through direct contact with the blood and other bodily fluids of patients or infected animals. Case description: A 65-year-old man was admitted to the emergency unit with dry cough, myalgia and fever. He was treated with favipiravir. He had disseminated intravascular coagulopathy with thrombocytopenia in the setting of COVID-19 infection. He tested positive for both COVID-19 and CCHF. By the end of the fifth day of treatment, his laboratory parameters and clinical symptoms had normalized. Conclusion: Favipiravir is currently on the market for treating COVID-19 infection worldwide. It has also been used to treat CCHF in laboratory animals. To the best of our knowledge this is the first report of CCHF successfully treated with favipiravir, which could be a key drug for treating human CCHF.
Infectious Mononucleosis Presenting with Loss of Taste and Smell During the SARS-CoV-2 Pandemic?
Authors: Krishna Nareshkumar Patel  , Muhammad Hussein  , Amir Khalil  , Najeeb Rehman  , Hazim Mahdi  , Muhammad Jamil Malik  , Salim P L Meghjee
Published: May 2021

A 53-year-old woman presented during the SARS-CoV-2 pandemic with an 18-day history of pyrexia, myalgia, progressive dyspnoea and loss of taste and smell after a close contact had tested positive for SARS-CoV-2. In this period two swabs had been negative for SARS-CoV-2. Clinical examination was normal. During this admission a third SARS-CoV-2 swab was negative, and investigations showed mildly elevated inflammatory markers, mildly deranged liver function, atypical lymphocytes on a blood film and a normal chest x-ray. Her Epstein–Barr virus serology was positive and thus the diagnosis was infectious mononucleosis.
Diabetic Ketoacidosis, Hypertriglyceridemia and Abdominal Pain due to Acute Pancreatitis Complicated by Non-immune Haemolytic Anaemia
Authors: Monica Joustra  , Janneke Raidt  , Florens Droog  , Thiemo Veneman
Published: May 2021

The triad of diabetic ketoacidosis, acute pancreatitis and hypertriglyceridemia is a rare phenomenon, with mortality rates of up to 80%. A unique characteristic of the described case is the co-occurrence of non-immune haemolytic anaemia (NIHA) with the complex triad. It is suggested that this presentation is secondary to hyperlipidemia which leads to increased fragility of erythrocytes due to destabilization of red cell membranes. Supportive treatment with intravenous insulin and blood transfusions is the cornerstone of treatment.
Skeletal Myopathy as the Initial Manifestation of Light Chain Multiple Myeloma
Authors: Mohamed Reda Belkhribchia  , Sara Moukhlis  , Tarik Bentaoune  , Najat Chourkani  , Mohamed Zaidani  , Mehdi Karkouri
Published: May 2021

Monoclonal gammopathies due to plasma cell dyscrasias can cause various rare neuromuscular disorders. The peripheral nervous system is most commonly affected, while muscle diseases associated with monoclonal gammopathies are rare. Skeletal myopathy, as a manifestation in the context of multiple myeloma, is extremely uncommon and is usually the result of immunoglobulin light chain (AL) amyloidosis deposits in the muscles. Here we present an atypical case of a patient with generalized myopathy as the presenting manifestation of light chain multiple myeloma. Interestingly, muscle involvement in our case was not the consequence of AL amyloidosis deposits but rather due to non-amyloid light chain deposition disease associated with light chain multiple myeloma.
Is Persistent Thick Copious Mucus a Long-Term Symptom of COVID-19?
Authors: Patrick Manckoundia  , Evelyne Franon
Published: May 2021

Introduction: The typical clinical picture of COVID-19 is gradually becoming clearer, both in the acute phase and in the long-term. However, new symptoms are gradually being identified. We describe a long-term symptom that has not yet been reported. Case description: A 49-year-old man consulted for persistent asthenia. The general practitioner found a fever (39.2°C), and COVID-19 was confirmed by the polymerase chain reaction test. Further symptoms appeared, notably thick, white, painless tracheal hypersecretion for 3 months before diminishing, without disappearing. Conclusion: Non-inflammatory tracheal hypersecretion, not yet reported in COVID-19, may be an additional long-term symptom. The hyperstimulation of tracheal goblet cells secreting mucus is 1 pathophysiological hypothesis.
Dengue Fever and COVID-19 Co-Infection at the Emergency Department of a Tertiary Care Hospital in Jeddah, Saudi Arabia
Authors: Abdalla Khalil  , Badr Badr  , Harry Wright  , Mohammed Talo  , Mohammad Atteiya
Published: May 2021

Introduction: Co-infection with COVID-19 and other viral or bacterial infections has been described in many studies. Most cases of dengue fever in Saudi Arabia have been reported in Jeddah city and mainly during the summer season. Method and results: We describe four patients who presented to the emergency department with febrile illness accompanied by symptoms and blood tests suggestive of dengue fever. They also had radiological findings suggestive of COVID-19 chest infection and positive PCR tests. Three of the patients required hospital admission, and all had a good outcome. Conclusion: In areas with a high rate of dengue fever, serological screening for dengue fever should be considered as part of COVID-19 investigation, especially if symptoms or a full blood count are suggestive.
Midthoracic Pain, Sentinel Arterial Haemorrhage and Exsanguination after a Symptom-Free Interval (Chiari's Triad) is Diagnostic of Arterio-Oesophageal Fistula: A Life-Threatening Cause of Gastrointestinal Bleeding
Authors: Andra Glodean  , Rainer Grobholz  , Karim El-Hag  , Mairi Ziaka  , Jean-Paul Schmid
Published: May 2021

Introduction: Arterio-oesophageal fistulae are a very uncommon cause of severe gastrointestinal bleeding, and mostly result from an aberrant right subclavian artery and mediastinal surgery or prolonged endotracheal/nasogastric intubation. Material and Methods: We present the case of a patient with an oesophageal adenocarcinoma and haematemesis due to a subclavian arterio-oesophageal fistula after mediastinal radiotherapy.  Conclusion: We discuss the rare, life-threatening condition of acute erosion of the left subclavian artery caused by an oesophageal tumour and presenting with Chiari's triad.
Gitelman Syndrome: A Rare Case of Hypokalaemia and a Novel Mutation
Authors: Maria Clara Novais de Matos  , Fábio Correia  , Maria Inês Silva  , Sofia Carola  , Ana Órfão  , Maria Ferreira  , Maria Teresa Branco
Published: May 2021

Gitelman syndrome (GS) is a hereditary renal tubulopathy caused by mutations in the SLC12A3 gene which encodes the thiazide-sensitive apical sodium-chloride cotransporter. GS is characterized by hypokalaemia, hypomagnesaemia and metabolic alkalosis. Treatment is based on potassium and magnesium replacement ad eternum. We present the case of a young man with palpitations and persistent hypokalaemia, who was diagnosed with GS. Genetic testing revealed 2 mutations in the gene SLC12A3 of combined heterozygosity, both considered pathological. Interestingly, 1 of these mutations was not yet described in the literature or in the reviewed databases. We also discuss the clinical approach and the specificities of managing this rare hereditary renal tubulopathy.
Intercostal Muscle Cavernous Haemangioma: A Chest Wall Pandora’s Box: Intercostal muscle cavernous hemangioma
Authors: Klein Dantis  , Yashwant Kashyap  , Aghosh Raju  , Swastik Bhardwaj
Published: May 2021

Background: Haemangiomas are uncommon chest wall tumours arising outside the rib cage. Their occurrence in intercostal muscle is extremely rare. Aim: We describe a case of intercostal muscle cavernous haemangioma as a differential diagnosis for chest wall swelling. Case description: We describe an 18-year-old male patient with an asymptomatic left-sided chest wall swelling. Contrast-enhanced computed tomography revealed a well-defined homogenously non-enhancing mass lesion arising from the seventh intercostal muscle with differential diagnoses of various chest wall tumours. Clinical presentation and imaging findings were inconclusive, but histopathological examination following excision biopsy revealed a cavernous haemangioma. The present case emphasizes the importance of histopathological diagnosis when clinical and radiological examination is inconclusive. Hence, it is necessary to consider intercostal muscle haemangiomas as a differential diagnosis for chest wall tumours in the absence of a feeding vessel. Conclusion: Despite its rare occurrence, intercostal muscle haemangioma must be considered as a differential diagnosis in chest wall tumours even in the absence of a feeding vessel. We believe that histopathology can provide a definitive diagnosis when most investigative procedures are inconclusive.
Sarcoidosis Versus Lymphoma?
Authors: Lissandra Dal Lago  , Julie Sarrand  , Erwin Woff  , Ahmad Awada  , Michaël Vouche  , Thierry Pepersack
Published: May 2021

An association between lymphoma and sarcoidosis was first suggested in 1960. We report a case of sarcoidosis-lymphoma syndrome, which is a diagnostically challenging condition. We conclude that an associated lymphoma should be considered in all patients with suspected sarcoidosis, especially those who do not respond to treatment or who present with persistent haematological abnormalities. Splenomegaly should prompt splenectomy to rule out lymphoma if a less invasive approach has failed to confirm the diagnosis.
Should CD4 Levels be Monitored in a Patient on Temozolomide?
Authors: Sriram Gonakoti  , Luis Parra-Rodriguez
Published: May 2021

Introduction: Temozolomide is an alkylating agent, indicated in the treatment of refractory anaplastic astrocytoma and newly diagnosed glioblastoma. We describe a case of Salmonella typhimurium bacteraemia associated with septic arthritis in the setting of concurrent temozolomide use. Case: A 67-year-old woman presented with acute onset of bilateral knee pain and swelling. She had a medical history of glioblastoma multiforme treated with temozolomide. Synovial fluid analysis and blood cultures revealed S. typhimurium, confirming a diagnosis of S. typhimurium bacteraemia associated with septic arthritis. Conclusion: We conclude that chemotherapy with temozolomide and corticosteroid use will increase an individual’s susceptibility to a wide variety of opportunistic infections akin to HIV-associated acquired immunodeficiency syndrome (AIDS). Furthermore, we hypothesize a possible benefit of monitoring CD4 levels and prophylaxis against opportunistic infections (based on the CD4 levels) in individuals receiving temozolomide-based chemotherapy, similar to HIV-AIDS.
Severe L-asparaginase-induced Hypertriglyceridaemia Treated with Plasmapheresis
Authors: José Silvano  , Nídia Marques  , Isabel Tavares  , Inês Ferreira
Published: May 2021

L-asparaginase is used for the treatment of acute lymphoblastic leukaemia. Hypertriglyceridaemia is a side effect and associated with potentially fatal complications, including acute pancreatitis. Plasmapheresis may have a role in treatment when triglycerides are >2000 mg/dl. We report the case of a 39-year-old woman treated with L-asparaginase for acute lymphoblastic leukaemia, who developed severe hypertriglyceridaemia (6560 mg/dl) and acute pancreatitis. Intravenous insulin infusion was started, along with fenofibrate and atorvastatin administration, and platelet transfusion. Plasmapheresis was carried out leading to a frank decline in serum triglyceride levels (366 mg/dl), a decrease in pancreatic enzymes and clinical improvement. The diagnosis of pancreatitis secondary to L-asparaginase should lead to immediate drug withdrawal, and plasmapheresis should be considered when serum triglyceride values exceed 2000 mg/dl. In our case, there was a 95% triglyceride removal rate. This response illustrates the strong effectiveness of early treatment with plasmapheresis in severe and symptomatic hypertriglyceridaemia associated with L-asparaginase.
Successful Use of a GLP-1 Receptor Agonist as Add-on Therapy to Sulfonylurea in the Treatment of KCNJ11 Neonatal Diabetes
Authors: Morten Hindsø  , Christoffer Martinussen  , Maria Saur Svane  , Simon Veedfald  , Birthe Gade-Rasmussen  , Torben Hansen  , Sten Madsbad
Published: May 2021

Sulfonylurea monotherapy is the standard treatment for patients with the most common form of permanent neonatal diabetes, KCNJ11 neonatal diabetes, but it is not always sufficient. For the first time, we present a case of successful use of a GLP-1 receptor agonist as add-on therapy in the treatment of a patient with KCNJ11 neonatal diabetes and insufficient effect of sulfonylurea monotherapy. Good glycaemic control was maintained with a HbA1c level of 48 mmol/mol (6.5%) at the end of 26 months’ follow-up.
A 29-year-old Bodybuilder with Liothyronine-induced Thyrotoxic Hypokalaemic Periodic Paralysis
Authors: Querijn van Bokhorst  , Yvonne Krul-Poel  , Diederik Smit  , Willem de Ronde
Published: May 2021

We describe a 29-year-old male bodybuilder with recurrent attacks of myalgia and muscle weakness associated with hypokalaemia and thyrotoxicosis due to abuse of liothyronine. The attacks quickly resolved after potassium supplementation and liothyronine cessation. We concluded that the patient had thyrotoxic hypokalaemic periodic paralysis (TPP). Although muscle weakness and hypokalaemia are prominent symptoms of TPP, underlying thyrotoxicosis may be overlooked. Up to 25% of androgen abusers also abuse thyroid hormone. Lack of recognition of thyroid hormone abuse as a cause of hypokalaemic periodic paralysis may result in unnecessary, potentially harmful medical investigations and improper treatment and advice.
Persistent Antiphospholipid Antibodies, Mast Cell Activation Syndrome, Postural Orthostatic Tachycardia Syndrome and Post-COVID Syndrome: 1 Year On
Authors: Jill Schofield
Published: May 2021

This is the first case report of a patient with post-COVID-19 postural orthostatic tachycardia syndrome (POTS) with multiple persistent antiphospholipid antibody (aPL)-positivity more than a year after illness onset who also meets Global Consensus-2 criteria for mast cell activation syndrome (MCAS), suggesting pathological activation of the acquired and innate immune systems by SARS-CoV-2. While the patient continues to meet criteria for POTS 1 year on, her functional ability has improved significantly with therapy directed at MCAS, POTS and aPL-positivity.
Colonic Pseudo-obstruction as a Rare Complication of Pheochromocytoma
Authors: Kin Wai So  , Hoi Ling Tsui  , Kim Hung Tsang
Published: May 2021

Colonic pseudo-obstruction is characterized by dilatation of the colon without a structural lesion causing the obstruction. It usually involves the caecum and right side of the colon and is commonly observed in patients with severe illness or after surgery; it is rarely caused by pheochromocytoma.  The diagnosis of colonic pseudo-obstruction can be established by abdominal imaging including computed tomography (CT) of the abdomen or use of a water-soluble contrast enema. In additional to conservative or surgical treatment, alpha-blockers can be used in this setting to relieve the pseudo-obstruction.
Investigating Febrile Polyserositis: An Unusual Case of Idiopathic Hypereosinophilic Syndrome
Authors: Inês Rueff Rato  , Joana Rigor  , Paula Ferreira  , Joana Laranjinha  , Gualter Santos Silva  , Daniela Martins-Mendes
Published: May 2021

Hypereosinophilic syndrome (HES) is a heterogenous group of diseases characterized by abnormal accumulation of eosinophils in the blood or peripheral tissues. It can affect all organs and therefore clinical manifestations are highly variable. We describe the case of a 38-year-old man admitted for febrile polyserositis. He developed cardiac tamponade requiring pericardiocentesis complicated by left ventricle perforation which was successfully repaired. He presented mild peripheral eosinophilia. Bronchoalveolar lavage evidenced eosinophilic alveolitis, and pleural and pericardium histopathology revealed the presence of abundant eosinophils. All other causes of tissue eosinophilia were excluded and the diagnosis of idiopathic HES was made. The patient was started on glucocorticoids with resolution of symptoms. This case report describes a rare but potentially fatal presentation of HES and demonstrates the difficulty and delay in diagnosis when peripheral hypereosinophilia is absent.
Diagnosis of Primary Cardiac T-cell Lymphoma: Feasibility and Safety of Endomyocardial Biopsy Guided by Pre-acquired Cardiovascular Magnetic Resonance
Authors: Andrea Avella  , Carla Giordano  , Vitaliano Buffa  , Piergiuseppe De Girolamo  , Massimo Uguccioni
Published: May 2021

Background: Multimodality imaging of a cardiac mass lesion may raise suspicion of a primitive cardiac lymphoma (PCL). However, a definitive diagnosis requires histopathological confirmation. Methods: This report describes the methodology we used to perform biopsy sampling of a cardiac mass lesion affecting a 45-year-old man. In order to increase endomyocardial biopsy diagnostic accuracy, we used pre-acquired cardiac magnetic resonance (CMR) images to guide the bioptome on a cardiac site overtly infiltrated by the suspected tumour. The right ventricular outflow tract was identified as the target site for biopsy sampling. To reduce the risk of the procedure, the biopsy was performed at a safe distance from the tip of a diagnostic quadripolar catheter positioned at the level of the pulmonary valve, previously identified by pacing manoeuvres. The reported approach demonstrated safety and diagnostic accuracy, allowing the identification of an extremely rare PCL subtype of T-cell origin. Conclusion: Biopsy sampling of a suspected tumour may be safely and accurately performed using pre-acquired CMR images to guide the bioptome on the target site.
Acute Confusional State Revealing Moyamoya Disease in the Emergency Department: A Rare Entity
Authors: Javier Guerrero-Niño  , Sarah Uge-Ginsberg  , Pierre Marcueyz  , Pierrick Le Borgne  , Xavier Jannot  , Noel Lorenzo-Villalba
Published: May 2021

A 54-year-old woman was admitted to the emergency department for an acute, fluctuating altered mental status and reduced perceptual awareness of her surroundings as well as disorganized thinking. Blood tests, including for drugs, were normal. A CT scan of the brain was normal. Magnetic resonance imaging and CT angiography of the supra-aortic vessels were both were consistent with moyamoya disease. The patient was hospitalized for further investigations.
Delayed Recognition of Levetiracetam-induced Pancytopenia
Authors: Mohammad Ammad Ud Din  , Syed Ather Hussain  , Amy Bodrog
Published: May 2021

Blood dyscrasias associated with levetiracetam use can be difficult to identify, especially when other potential differential diagnoses are concurrently present. Here we present a 57-year-old man with metastatic adenocarcinoma of unknown primary origin on levetiracetam who initially presented with an in-stent thrombosis of the right external iliac vein and then developed worsening thrombocytopenia followed by pancytopenia. Levetiracetam was not identified as the culprit until other causes like platelet consumption, heparin-induced thrombocytopenia, idiopathic immune thrombocytopenic purpura, and bone marrow involvement by metastatic disease were ruled out.
The VEXAS Syndrome: Uncontrolled Inflammation and Macrocytic Anaemia in a 77-Year-Old Male Patient
Authors: Andreas Himmelmann  , Rolf Brücker
Published: May 2021

The VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently described X-linked autoinflammatory condition caused by a somatic mutation of the UBA1 gene and characterized by an evolving phenotype. This includes inflammatory processes such as recurrent fever, Sweet’s syndrome of the skin, pulmonary fibrosis, relapsing polychondritis and venous thromboembolism. An important feature, present in almost all cases, is the development of a macrocytic anaemia with vacuolization of myeloid and erythroid precursors. Usually, these patients require high doses of steroids to control symptoms and respond poorly to disease-modifying drugs.  We describe a new case of the VEXAS syndrome presenting with Sweet’s syndrome which has now been followed for 6 years.
Cryptogenic Fibrosing Pleuritis
Authors: Manco Alessandra Anna , Alfieri Veronica , Gnetti Letizia , Aiello Marina , Bertorelli Giuseppina , Majori Maria , Chetta Alfredo
Published: May 2021

We report the case of a 46-year-old male patient who was referred for chest pain and bilateral pleural effusion. Despite treatment with antibiotics and steroids, the pleural effusion worsened over a few months until pulmonary function was halved. The CT scan showed bilateral pleural thickening with right basal opacity. Histology revealed extensive fibrotic tissue with focal collections of lymphocytes and giant cells without traces of asbestos bodies. Since no evidence of an infectious, embolic or occupational aetiology was found, this bilateral pleural effusion progressing to diffuse pleural thickening was diagnosed as cryptogenic fibrosing pleuritis, a rare pleural disease.
Disseminated Blastomycosis Presenting with Spontaneous Coronary Artery Dissection
Authors: Rahul Sehgal  , D Fearghas O'Cochlain  , Andrew Virata  , Gurpreet Singh
Published: May 2021

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of acute coronary syndrome (ACS) and myocardial infarction (MI) in individuals with few or no known atherosclerotic risk factors. While systemic autoimmune inflammatory disorders are associated with precipitating SCAD, the role of infection-induced systemic inflammation in SCAD is not well defined. We present the case of a 49-year-old Caucasian woman with ST-elevation myocardial infarction (STEMI) diagnosed as SCAD from a severe systemic inflammatory response related to disseminated blastomycosis. Punch biopsy of a skin lesion and synovial fluid culture confirmed Blastomyces dermatitidis. This case suggests the possibility of systemic infection-induced inflammation as a precipitating factor in SCAD pathogenesis similar to autoimmune inflammatory disorders.
Gemfibrozil-Induced Polyuria
Authors: Ashraf Ahmed  , Edmond Okotcha  , Abdul-Hussein Saad
Published: May 2021

Gemfibrozil is a lipid-regulating agent used mainly to treat patients with hypertriglyceridaemia, especially those at risk for acute pancreatitis. Like any other pharmacological agent, gemfibrozil has known adverse effects, mainly gastrointestinal, such as cholelithiasis, gallstones, elevated transaminase, and other non-specific symptoms including dyspepsia, nausea and vomiting. Other reported adverse reactions are dizziness and vertigo, myopathy and rhabdomyolysis, angioedema, urticaria and rash. As far as we knew, gemfibrozil does not have urinary tract adverse reactions. In this report, we present a case of polyuria secondary to gemfibrozil with a score of 9 on the Naranjo scale, and a literature review.
The Effect of Governance on FDI Inflows in ASEAN
Authors: Niarachma Ranynda , Effendi Nury , Ervani Eva
Published: May 2021

This study examines the effect of governance on FDI inflows in ASEAN countries for the period 2002-2018 using the Worldwide Governance Indicator (WGI) index. This study uses a principal component analysis (PCA) method to reduce six WGI indexes and performs panel data regression analysis using fixed-effect GLS (cross-section weights). This study uses data from World Bank for FDI, WGI, and several control variables.  The results of this study have provided empirical evidence that good governance is a very important key factor in encouraging FDI inflows to host countries. This study finds three governance elements that have a positive relationship with FDI inflows in ASEAN countries are the quality of regulations, rule of law, and control of corruption.
A estranheza de Flusser: entre arte, ciência e filosofia
Authors: Beccari Marcos Namba
Published: May 2021

Este artigo põe em evidência a estranheza de Vilém Flusser enquanto horizonte prevalente de sua ficção filosófica. Com isso, busca-se apontar as potencialidades desse horizonte estranho para uma compreensão paradoxalmente mais clara e propositiva da ciência em sua interface com a arte e a filosofia, na medida em que se explicita a dimensão ficcional.
Coreografia para dias de enxaqueca
Authors: Galery Batista Lorena
Published: May 2021

Um corpo posa nu para a câmera. Do outro lado da lente é este mesmo corpo que calcula a distância focal, a abertura do diafragma e velocidade do obturador; configura o disparo para cinco segundos e anda um pouco apressado, um pouco arrastado por conta dos vários dias de dor que o acomete. Verifica a marcação do chão para condizer com o foco pré-configurado, olha para a lente para garantir que está centralizado. Então ombros, costas, mãos, rosto e estômago se deixam entregar a essa coreografia da dor repetida à exaustão ao longo dos anos.A série de fotografias são autorretratos realizados durante uma crise de enxaqueca e pretende funcionar como um ritual de cura. Transformar as impossibilidades que a enxaqueca gera no corpo, através do processo artístico, em uma linguagem. Um novo modo de expressão do corpo, suas dores e formas de sobrevivência.
A orelha de Van Gogh: a reconstituição de um corte em detalhes
Authors: Sá Ricardo Tamm Lessa de
Published: May 2021

Este artigo parte da recriação em tecido vivo da orelha decepada de Van Gogh para investigar versões e motivações para o incidente. Considerando a relevância dos detalhes em análises estéticas, históricas, psicológicas e criminais sobre questões de autoria e identidade, proporemos alternativas para a mutilação da orelha e para a herança genética de sua reprodução biotecnológica.
Imagem e devoção em tempos de pandemia: apontamentos sobre a Peste Negra e a religiosidade cristã no fim da Idade Média
Authors: Quírico Tamara
Published: May 2021

Tendo como pano de fundo a atual pandemia de Covid-19, queremos discutir no presente artigoa produção artística que se desenvolve no fim da Idade Média na Europa, particularmente após o surto de Peste Negra. O objetivo é lançar nova luz sobre essa arte, tirando-a de um esquecimento oriundo de um preconceito ultrapassado, porém ainda presente nos nossos dias.
Pressure Changes During Layer Cupping in a Skin Model
Authors: Shim Dong Wook , An Soo Kwang , Lee Ha Lim , Lee Jae Yong , Lee Byung Ryul , Yang Gi Young
Published: May 2021

Background: Cupping is widely used in Korean medicine, but there is a risk of bacterial infection if the suction pump (used for inducing negative pressure) and the patients’ skin are not separated. This study aimed to investigate the effect of layer cupping by comparing the pressure changes between layer cupping and conventional cupping.Methods: To evaluate pressure changes the study was designed with 3 types of conditions applied to a skin model: (1) a Dongbang cup with a manual or motor suction pump (conventional cupping); (2) layer cupping with 2 Dongbang cups; and (3) layer cupping with a cup made by 3D printing and a Dongbang cup.Results: When a manual suction pump was used (conventional cupping), the pressure did not decrease steadily, and in 1 section there was an increase in pressure. When layer cupping was used, the pressure in the lower cup (which would be directly applied to the patient’s skin), decreased steadily.Conclusion: In the pressure change graph for layer cupping in this skin model, the pressure in the lower cup (which would be placed on the patient’s skin) steadily decreased, and reached equilibrium. Therefore, the layer cupping model may help to reduce the risks of bacterial infection.
Effective Low-Level Laser Therapy Including Laser Acupuncture Treatment Conditions for Non-Specific Chronic Low Back Pain: Systematic Review and Meta-Analysis
Authors: Yeum Hyewon , Hong Yejin , Nam Dongwoo
Published: May 2021

Low-level laser therapy including laser acupuncture has been widely used for non-specific chronic low back pain in primary Korean medical clinics. However, there is no critically appraised data regarding which treatment conditions are most effective. A systematic review and meta-analysis was conducted to determine effective treatment conditions using 12 databases (PubMed, Ovid, CENTRAL, KoreaMed, KMBASE, KISS, NDSL, KISTI, OASIS, CNKI, CiNII, and J-STAGE). There were 1,019 studies retrieved and 13 studies included in this review. It was determined that when the power output was ≥ 50 mW, the beam size was increased to ≥ 1 cm2, the energy dose was increased to ≥ 4 J per point, the treatment interval was increased to ≥ 3 times a week, and the number of treatment sessions was increased to ≥ 10 treatments, these conditions appeared to increased treatment effectiveness.
Fish swim water bulk displacement visualization with digital holographic interferometry
Authors: De la Torre I. Manuel H. , Frausto-Rea Gloria del R. , Mendoza-Santoyo Fernando , del S. Hernandez Montes Maria
Published: May 2021

A collimated transmission beam interferometer is used to measure the water motion provoked by the fish swimming through it. An indirect measurement of the fish motion impact in the water contained in a home-type aquarium is detected. Measurements of the whole aquarium are possible due to a large diameter collimated laser beam in the interferometer’s object arm. This beam goes through the aquarium, and any perturbation inside it deflects the collimated beam. The interferometer detects a phase difference, i.e., the beam through the disturbed water undergoes different optical paths. This optical phase change was first demonstrated by means of a simple test using spherical steel marbles placed in a cuvette. For this, the small water movements for a single steel marble are detected with the acquired optical phase. Next, the aquarium optical phase results show water movements according to the fishes’ size and swimming speed. It is worth mentioning that no additives were added to the aquarium’s fresh water during the tests, so the water was crystal clear.
2048-QAM transmission at 15 GBd over 100 km using geometric constellation shaping
Authors: Wakayama Yuta , Gerard Thomas , Sillekens Eric , Galdino Lídia , Lavery Domaniç , Killey Robert I. , Bayvel Polina
Published: May 2021

We experimentally investigated a pilot-aided digital signal processing (DSP) chain in combination with high-order geometric constellation shaping to increase the achievable information rates (AIRs) in standard intradyne coherent transmission systems. We show that the AIR of our system at 15 GBd was maximised using geometrically-shaped (GS) 2048 quadrature amplitude modulation (QAM), reaching 18.0 b/4D-symbol in back-to-back transmission and 16.9 b/4D-symbol after transmission through 100 km of a single-mode fibre after subtracting the pilot overhead (OH). This represents the highest-order GS format demonstrated to date, supporting the highest AIR of any standard intradyne system using conventional optics and 8-bit electronics. Detailed characterisation of the DSP, transceiver performance, and transmission modelling has also been carried out to provide insight into sources of impairments and directions for further improvement.
Ultraviolet dual comb spectroscopy: a roadmap
Authors: Schuster Vittoria , Liu Chang , Klas Robert , Dominguez Pablo , Rothhardt Jan , Limpert Jens , Bernhardt Birgitta
Published: May 2021

Dual Comb Spectroscopy proved its versatile capabilities in molecular fingerprinting in different spectral regions, but not yet in the ultraviolet (UV). Unlocking this spectral window would expand fingerprinting to the electronic energy structure of matter. This will access the prime triggers of photochemical reactions with unprecedented spectral resolution. In this research article, we discuss the milestones marking the way to the first UV dual comb spectrometer. We present experimental and simulated studies towards UV dual comb spectroscopy, directly applied to planned absorption measurements of formaldehyde (centered at 343 nm, 3.6 eV) and argon (80 nm, 16 eV). This will enable an unparalleled relative resolution of up to 10−9 – with a table-top UV source surpassing any synchrotron-linked spectrometer by at least two and any grating-based UV spectrometer by up to six orders of magnitude.
Countermeasure for security loophole caused by asymmetric correlations of reference frame independent quantum key distribution with fewer quantum states
Authors: Lim Kyongchun , Choi Byung-Seok , Baek Ju Hee , Kim Minchul , Choe Joong-Seon , Kim Kap-Joong , Ko Young-Ho , Youn Chun Ju
Published: May 2021

One of the challenging issues in free-space quantum key distribution (QKD) is the requirement of active compensation of the reference frame between the transmitter and receiver. Reference frame independent (RFI) QKD removes active compensation, but it requires more quantum states. A recent proposal can effectively reduce the required quantum states, but this can be achieved assuming the correlations defined in RFI QKD are symmetric. In a real QKD system, such symmetric correlations cannot always be satisfied owing to the device imperfections and optical misalignment. We theoretically analyze the effect of asymmetric correlations. Consequently, we report that the asymmetry causes security loopholes and provide a countermeasure to prevent them. Furthermore, we provide the experimental results of a free-space RFI QKD system to verify the countermeasure for the aforementioned problem. In conclusion, our work provides feasibility of the practical RFI QKD system with fewer quantum states by effectively preventing the security loophole.
An effect of the COVID-19 pandemic: Significantly more complicated appendicitis due to delayed presentation of patients!
Authors: Burgard Marie , Cherbanyk Floryn , Nassiopoulos Konstantinos , Malekzadeh Sonaz , Pugin François , Egger Bernhard
Published: May 2021

Aims of the study

The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID-19 pandemic.

Methods

We retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated.

Results

A total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017–2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms (symptoms > 48h in 61% and 26%, p < 0,001), the intervention time (77 vs 61 minutes, p = 0,002), length of hospital stay (hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment (antibiotics > 3 days in 36% and 24% p = 0.001).

Conclusions

The COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.
Booster immunization of meningococcal meningitis vaccine among children in Hangzhou, China, 2014-2019
Authors: Che Xinren , Liu Yan , Wang Jun , Xu Yuyang , Zhang Xuechao , Gu Wenwen , Jiang Wei , Du Jian , Zhang Xiaoping
Published: May 2021

Background

Despite China’s Expanded Program on Immunization (EPI) provides 2 doses of group A and group C meningococcal polysaccharide vaccine (MPV-AC) for children at 3 years and 6 years old, more self-paying group ACYW135 meningococcal polysaccharide vaccines (MPV-ACYW135) have been used as an alternative to MPV-AC to prevent Neisseria meningitidis serogroup C,Y,W135. We provide recommendations for Chinese booster immunization of meningococcal meningitis vaccine by analyzing the service status of MPV-AC and MPV-ACYW135.

Methods

Reported data of routine immunization coverage from all districts of Hangzhou registered in the China Information Management System For Immunization Programming (CIMSFIP) between 2014 to 2019 were described and evaluated. Descriptive epidemiological methods were used to characterize the data. Adverse event following immunization (AEFI) were collected from Chinese national adverse event following immunization information system (CNAEFIIS) to compare the safety of MPV-AC and MPV-ACYW135.

Results

1376919 doses of booster immunization of meningococcal meningitis vaccine (MenV) in CIMSFIP were conducted in China Hangzhou from 2014 to 2019, with reported immunization coverage rates above 95%. The proportion of children using MPV-ACYW135 increased from 12.63% in 2014 to 29.45% in 2019. The incidence of AEFI of MPV-AC and MPV-ACYW135 were 49.75 per 100,000 and 45.44 per 100,000, respectively, without statistical difference.

Conclusion

Children in Hangzhou had high booster immunization of MenV coverage. The use amount and use rate of MPV-ACYW135 increased year by year, indicating more and more parents had chosen MPV-ACYW135 as an alternative to MPV-AC at their own expense for children. The use proportions of MPV-ACYW135 were different in urban, suburban and rural areas. Both MPV-AC and MPV-ACYW135 were safe for children.