bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of herpes zoster with botanical interventions
Authors: Ferreira Vanessa , Langland Jeffrey 
Published: April 2021

Abstract

Rationale:
Herpes zoster or shingles is a viral infection caused by the reactivation of the varicella-zoster virus which lays dormant in the ganglia after a primary infection with varicella, most commonly known as chickenpox. Approximately 1 in 3 people in the United States will develop shingles in their lifetime.

Patient concerns and diagnosis:
A 26-year-old Caucasian female presented with a diagnosis of herpes zoster with small lesions on her mid-right abdomen and large weeping lesions on her mid-left abdomen and back with physical complaints of severe burning, pain and itching.

Interventions:
An alternative, botanical based topical therapy was used in this case including extracts of Melissa officinalis, Hypericum perforatum, Eleutherococcus senticosus, Lavandula officinalis, Glycyrrhiza glabra and Sarracenia spp. prepared in a Versabase gel preparation.

Outcomes:
Notably during the first few days of topical treatment, substantial improvement was observed regarding lesion size, lesion number and pain level.

Lessons:
This case demonstrates the potential efficacy of a topical botanical formulation for the treatment of an active herpes zoster outbreak.
Tuberculosis with immune thrombocytopenia
Authors: Alkhatib Mohammed , Elfert Khaled A. , Saleh Ahmed O. , Elkourashy Sarah A. , Fadul Afraa M. , Taha Ruba Y. , Imam Yahia Z. , Fareed Shehab 
Published: April 2021

Abstract

Rationale:
Immune thrombocytopenia (ITP) is a platelet disorder that is caused by antibodies against platelet cells. ITP can be either primary or secondary. One of the secondary causes of ITP is infectious diseases. Tuberculosis (TB) has been reported as a rare cause of secondary ITP.
We report 3 cases of TB that were associated with ITP with favorable response to therapy. We also compared these cases with similar published cases in the literature.

Patient concerns:
The first case was an Ethiopian female who presented with cough, fever, night sweats, and weight loss and was found to have isolated thrombocytopenia without manifestations. The second case was a Nepalese man who presented with mucocutaneous bleeding and respiratory symptoms. The third case was for a Nepalese male who presented with mucocutaneous bleeding without pulmonary symptoms but with lymphadenopathy on chest imaging.

Diagnoses:
The first and second cases were diagnosed as pulmonary TB based on positive acid-fast Bacillus smear and PCR from the sputum. In the third case, mediastinal lymph node biopsy came positive for TB PCR and culture was consistent with extrapulmonary TB. ITP diagnosis was established in the 3 cases after ruling out other causes of thrombocytopenia.

Interventions:
The first case received intravenous immunoglobulin and anti-tubercular treatment (ATT). The second case received ATT followed by prednisolone. The third case was started on intravenous Immunoglobulin and prednisolone; ATT was added after the diagnosis of TB was established later.

Outcomes:
All the cases achieved a good response to the treatment with normalization of platelets count.

Lessons:
It is important to consider TB as 1 of the causes of secondary ITP, especially in countries with a high TB burden. In our literature review, we found that ITP-specific therapy alone was not effective in treating ITP associated with TB; almost all the cases required ATT for achieving good platelet response.
A rare presentation of gastric sarcoidosis
Authors: George Ann , Guan Chelsea , Farooq Maria , Bég Shazia A. 
Published: April 2021

Abstract

Introduction:
Sarcoidosis is a multisystem inflammatory disease involving non-necrotizing epithelioid granulomas with an unknown etiology. Here we present a case of systemic sarcoidosis that involves the gastrointestinal tract.

Patient concerns:
A 45-year old Hispanic female initially presented with nonspecific symptoms including dysphagia and an unintentional weight loss of 65 lbs.

Diagnosis:
After extensive workup including endoscopy with biopsy, she was diagnosed with systemic sarcoidosis with gastrointestinal (GI), pulmonary and musculoskeletal involvement.

Interventions:
She was started on prednisone 60 mg daily and 15 mg of methotrexate subcutaneously with titration up to 22.5 mg.

Outcomes:
She has had significant improvement in symptoms. Currently her symptoms are well controlled on 22.5 mg of subcutaneous methotrexate weekly and folic acid 1 mg daily. She was seen by a pulmonologist who recommended monitoring with pulmonary function test and computed tomography chest every 6 months.

Conclusion:
In patients with known pulmonary sarcoidosis, nonspecific GI symptoms, and inconclusive tests, sarcoidosis with GI tract involvement should be considered.
Recto-vaginal fistula after laparoscopic rectal cancer resection through natural orifice specimen extraction surgery and transvaginal specimen extraction combined with hysterectomy
Authors: Zhao Zimin , Chen Qingkuang , Zheng Honghong , Li Jianjun , Zheng Shuai , Zhao Enhong 
Published: April 2021

Abstract

Introduction:
Laparoscopic rectal cancer resection is currently the most common surgical procedure for treating colorectal cancer. The surgical technique of natural orifice specimen extraction surgery (NOSES) for colorectal cancer is becoming common but post-operative complications occur. In this article, we present a patient with rectal cancer who underwent trans-vaginal NOSES laparoscopic rectal cancer resection combined with hysterectomy and developed a recto-vaginal fistula after the surgery.

Patient Concerns:
The patient was a 56-year-old female with complaint of blood in the stool 7 months before without obvious cause, with aggravation in the last one month. Colonoscopy revealed a mass located 6 cm from the anus.

Diagnoses:
Colonoscopy findings and pathology results suggested mesenchymal ulcerative adenocarcinoma of the rectum.

Interventions:
Patient underwent trans-vaginal NOSES laparoscopic rectal cancer resection combined with hysterectomy.

Outcome
s: The patient recovered well but developed anastomotic fistula on postoperative day 11. An enterostomy was performed urgently. The patient was in stable condition at 1 month follow-up.

Conclusion:
NOSES has the advantage of reduced trauma, quick recovery time, and aesthetics. However, for patients with advanced tumors, especially cancers that invade adjacent organs, expanded resection will increase the risk of postoperative complications. Routine digital rectal examination after ultra-low rectal anastomosis can aid in diagnosing anastomotic leakage early in patients with obscure clinical features.
Malignant bilateral anterior and ipsilateral posterior cerebral artery infarction following traumatic brain injury
Authors: Chang Panpan , Li Fang , Zhu Fengxue , Wang Tianbing 
Published: April 2021

Abstract

Introduction:
Posttraumatic cerebral infarction often occurs following traumatic brain injury (TBI) and is frequently associated with a poor outcome. Although infarctions commonly occur in the posterior cerebral artery (PCA) distribution, they are also relatively common in the middle cerebral artery, anterior cerebral artery (ACA), and vertebrobasilar region. In this study, we report a case of malignant bilateral ACA and ipsilateral PCA infarction following TBI.

Patient concerns:
A 34-year-old man was presented to the emergency room 3 hours after a road accident. His Glasgow Coma Score (GCS) was 8 (E2, M3, V3); his pupils were equal (2.5 mm: 2.5 mm) and slightly reactive.

Diagnosis:
CT scan showed a supratentorial acute subdural hematoma of left frontal and temporal lobes, left frontal lobe contusion and laceration, and a 1 cm (midline) shift. The patient's left pupil was dilated during the scan. All these findings supported the diagnosis of severe TBI, an acute subdural hematoma, contusion and laceration of the brain, and tentorial herniation.

Intervention:
Emergency decompressive craniectomy was performed, correcting the midline; however, a low-density area was found with regular, clear boundaries in the right occipital and bilateral frontal regions. One week post-surgery, the patient's intracranial pressure increased to 25 to 30 mm Hg, with right pupil dilation due to malignant infarction, edema, and midline shift. Decompressive craniectomy on the right frontal, parietal, and temporal regions corrected the midline shift, but infarction and edema persisted. The GCS was 3T (E1, M2, VT).

Outcome:
This patient remained vegetative with GCS 3 and was transferred to a rehabilitation facility.

Conclusion:
In this paper, we report a patient who developed malignant bilateral ACA and ipsilateral PCA infarction following TBI. Posttraumatic cerebral infarction is a severe complication of primary TBI and should be treated as soon as it is detected.
A protocol for randomized, controlled study of baloxavir marboxil compared with oseltamivir in patients with influenza virus infection aged 75 years and older
Authors: Hosogaya Naoki , Takazono Takahiro , Miyazaki Taiga , Furukawa Masashi , Tanaka Shintaro , Kinoshita Masahiro , Mukae Hiroshi 
Published: April 2021

Abstract

Introduction:
Early treatment with antiviral therapy is recommended for patients with severe influenza or those who are at high risk of influenza complications. Baloxavir marboxil is a cap-dependent endonuclease inhibitor approved for treatment of uncomplicated influenza in otherwise healthy adults and adolescents >12 years in the United States and for influenza infection in adults, adolescents ≥12 years, and in children <12 years weighing ≥10 kg in Japan. Analysis of the subgroup of patients ≥75 years in the CAPSTONE-2 trial suggests that the median time to improvement in influenza symptoms is numerically shorter in elderly patients treated with baloxavir or oseltamivir compared with placebo. The current study is designed to extend these findings and compare the efficacy and safety of baloxavir and oseltamivir in Japanese patients ≥75 years with acute influenza virus infection.

Methods:
In this open-label, multicenter, randomized, active-controlled trial, 100 Japanese patients ≥75 years with acute influenza virus infection will be randomly allocated (1:1) to receive a single oral dose of baloxavir 40 mg/80 mg (body weight–based) or twice-daily oral oseltamivir 75 mg for 5 days. At the time of allocation, patients will be stratified by their Influenza Symptom Severity Scale total scores (≤14, ≥15) on Day 1. The primary efficacy endpoint is the time to improvement of influenza symptoms, from the time of first administration of study drug to the time when the severity of each symptom is improved or absent for at least 21.5 hours in the intention-to-treat infected population (all randomized patients with an reverse-transcriptase polymerase chain reaction -confirmed influenza virus infection on Day 1 and who receive at least 1 dose of study drug). Safety will be assessed in all randomized patients who received at least 1 dose of study drug.

Discussion:
Because of the long life expectancy in Japan, the Japanese population presents a unique opportunity in which to investigate the efficacy and safety of antiviral drugs in patients ≥75 years with influenza. The outcomes from this trial will be clinically relevant for Japan and other developed countries that have rapidly aging societies who are at high risk of influenza-associated complications.

Trial registration:
jRCTs071200034
Conservative treatment for patients with high-risk massive pulmonary embolism
Authors: Hasibuan Fani Suslina , Octora Tan Nicko , Intan Ryan Enast , Putro Fikri Samodro , Jonatan Michael , Alkaff Firas Farisi 
Published: April 2021

Abstract

Rationale:
Acute pulmonary embolism (PE) is the most serious complication of venous thromboembolism. A high-risk PE is associated with high mortality as it may manifest as shock. Although there is a guideline, sometimes it cannot be implemented optimally. Therefore, conservative treatment is given. In this article, we report 2 cases of high-risk PE treated conservatively with anticoagulants.

Patient concerns:
In the first case, a 54-year-old woman presented with a chief complaint of sudden dyspnea. She had a history of open left supracondylus femur fracture. In the second case, a 53-year-old woman presented with chief complaints of sudden dyspnea and atypical right sided chest pain. She had a history of neglected right collum femur fracture.

Diagnoses:
Diagnosis of PE was made in both cases based on the results from electrocardiogram, chest X-ray, and echocardiography evaluation. In addition, computed tomography pulmonary angiography was also performed in the first case.

Interventions:
Conservative treatment with anticoagulant was chosen because of limited resources for surgery or intervention since both patients refused thrombolytic therapy and refused to be referred.

Outcomes:
The symptoms of both patients were resolved, and the clinical condition was improved. Imaging evaluation with TEE and duplex ultrasound 1 week later showed good results. Follow-up 3 months afterwards showed that both patients were alive and well without any complaints.

Lessons:
Acute PE with high-risk condition is life-threatening, that is sometimes difficult to diagnose as it varies in clinical symptoms. Sudden onset dyspnea with signs of shock indicates higher mortality. Echocardiography and computed tomography pulmonary angigraphy evaluation are reliable tools for diagnosis. With Conservative treatment using anticoagulant and routine follow up, patients with acute PE can be managed well.
Acquired factor XI inhibitor with immune system disorder
Authors: Mi Jian , Liu Chaonan , Huang Xunbei , Ling Liqin , Zhou Jing 
Published: April 2021

Abstract

Rationale:
Acquired haemophilia is a bleeding disorder caused by inhibitors developed against endogenous coagulation factors in patients, disrupting the normal haemostasis. Most of the cases with acquired haemophilia present with acquired FVIII inhibitors and FIX inhibitors. Acquired FXI inhibitors in patient without inherited FXI deficiency have rarely been reported. Here, we report a case of acquired factor XI inhibitors with primary Sjögren's syndrome.

Patient concerns:
A woman presented with dizziness and headache following a fall, and was diagnosed with skull fracture and epidural hematoma by computed tomography.

Diagnoses:
Acquired haemophilia with acquired factor XI inhibitor and primary Sjögren's syndrome.

Interventions:
She was treated with fresh frozen plasma and tranexamic acid for the first two days, and prednisolone (1 mg/kg/d) for 4 weeks, and a pulse infusion of cyclophosphamide, 750 mg/kg/dose, on the seventh day from the day of admission.

Outcomes:
Symptoms were improved without bleeding events. The inhibitor levels became undetectable and computed tomography revealed that the epidural hematoma was partly absorbed.

Lessons:
Factor XI inhibitor are rare, and the majority cases of the FXI inhibitors are associated with immune disorders and seem to respond well to immunosuppressive therapy.
Acute liver failure caused by metastatic malignant melanoma of liver
Authors: Aierken Yiliyaer , Zhu Yun-Feng , Yang Jia-Yin 
Published: April 2021

Abstract

Introduction:
Malignant melanoma of liver is an exceedingly rare cause of acute liver failure (ALF), whether primary or metastatic. Only few cases have been reported in the worldwide literature, and all the patients with ALF secondary to diffuse hepatic infiltration by melanoma subsequently died within days.

Patient concerns:
The patient was a 70-year-old man admitted to our hospital for abdominal distention and progressive jaundice for 15 days.

Diagnoses:
Ultrasonography and computed tomography findings indicated the presence of hepatomegaly with homogeneous normal echogenicity without focal lesions. Due to the history of alcohol consumption, acute liver failure (ALF) caused by alcoholic live disease was suspected.

Interventions:
After 4 time artificial liver treatment, the patient continued to deteriorate and deceased donor liver transplantation was performed after discussion with the next-of-kin.

Outcomes:
Postoperative pathology revealed clusters of malignant melanoma cells that had diffusely infiltrated the liver parenchyma. The patient was discharged on the eleventh day post-operation. Three months post-transplantation, he was readmitted because of elevated liver enzymes, and died of acute liver failure 9 days later.

Conclusions:
To our knowledge, this is the first report of liver transplantation for ALF due to diffuse hepatic melanoma. When the etiology of liver failure is unclear, diffuse metastatic tumor infiltration should be considered and early liver biopsy would be helpful in establishing the diagnosis and guiding treatment, particularly when liver transplantation is a treatment option as a metastatic malignancy is a contraindication for liver transplantation.
Successful treatment of idiopathic tracheobronchial inflammatory polyposis using endoscopic argon plasma coagulation
Authors: Inoue Yuzuru , Imamura Yohei , Murakami Daigo , Tanikawa Ken , Kamimura Tomoko , Kinoshita Takashi , Nishiyama Mamoru , Kawayama Tomotaka 
Published: April 2021

Abstract

Introduction:
Development of airway polyps is likely associated with underlying diseases such as systemic inflammatory diseases and malignancies. We present a rare case of tracheobronchial benign inflammatory polyposis of unknown origin.

Patient concerns:
A 75-year-old, female, non-smoker was emergently admitted to our hospital with chief complaints of shortness of breath and wheezing. She had suffered from sporadic episodes of shortness of breath and wheezing throughout the past 2 years and was treated with a combination of an inhaled corticosteroid and a long-acting beta 2 agonist for asthma by her physician for the last year. Spirometry revealed that the patient was likely affected by a combination of severe obstructive and restrictive ventilatory defects.

Diagnoses:
Histological findings of polyp biopsies showed non-specific inflammation with predominant cell differentiation 20 positive cell proliferation without granulation, hyperplasia, malignant cells, amyloid deposition, or microorganisms. Neither human papillomavirus nor Epstein-Barr viral DNA were detected from biopsy specimens via polymerase chain reaction and southern hybridization techniques.

Interventions:
Intravenous administration of methylprednisolone, but not regular use of inhaled corticosteroids/ long-acting beta 2 agonists combination therapy, temporarily improved the patient's respiratory symptoms to a moderate degree. However, systemic corticosteroids did not effectively remedy tracheobronchial polyposis. Repeated argon plasma coagulation (APC) of tracheobronchial polyposis improved the respiratory symptoms and lung function of the patient.

Outcomes:
The tracheobronchial polyposis did not recur throughout the year that followed the last APC intervention.

Conclusion:
APC may be used to treat the patients with idiopathic inflammatory tracheobronchial polyposis, particularly symptomatic patients with ventilation disorders and non-responders to anti-inflammatory medicines. However, APC should be carefully considered after analyzing the benefits and risks.
Primary hyperaldosteronism presenting as resistant hypertension
Authors: Pelle Maria Chiara , Tripolino Cesare , Ricchio Marco , Ruffo Mariafrancesca , Zaffina Isabella , Tassone Bruno , Cavallo Michela , Bertucci Bernardo , Arturi Franco 
Published: April 2021

Abstract

Introduction:
Primary hyperaldosteronism is a secondary cause of drug resistant hypertension. This condition is frequently underdiagnosed due to absence of typical features.

Patient concerns:
We reported a case of a 65 years old woman with high blood pressure despite multiple antihypertensive regimens.

Diagnosis:
After careful examination, she was diagnosed as adrenal adenoma.

Interventions:
The patient underwent laparoscopy adrenalectomy and the histopathological examination confirmed the presence of adrenocortical adenoma.

Outcomes:
The patient had no complications during the surgery and after 3 months of follow-up we observed a significant reduction of blood pressure.

Conclusion:
This case highlights the importance to maintain a high index of suspicion and consider screening for secondary causes of high blood pressure in patients with resistant hypertension.
Observational study of efficacy, safety, and tolerability of fentanyl in Korean cancer patients (OASIS)
Authors: Choi Youn Seon , Koh Su-Jin , Bae Woo Kyun , Kim Se Hyung , Shin Seong Hoon , Oh So Yeon , Bae Sang Byung , Yang Yaewon , Song Eun-Kee , Cho Yoon Young , Lee Pyung Bok , Oh Ho-Suk , Park Sang Won , Ahn Jin Seok 
Published: April 2021

Abstract

Background:
Sublingual fentanyl (Abstral) has been developed to provide rapid-onset analgesia in breakthrough cancer pain (BTcP). While the efficacy and safety of the fentanyl tablet have been already confirmed in clinical trials, there is no real-world evidence regarding the effectiveness and safety of this agent in the control of BTcP.

Aims:
To observe the effectiveness, safety and tolerability of Abstral for the alleviation of BTcP in Korean patients.

Methods:
The study is a non-interventional, observational study conducted in 13 hospitals in the Republic of Korea. Cancer patients (targeted number: 309), prescribed with Abstral due to the inability to control BTcP with other fentanyl products, are to be followed up for 12 weeks to collect the information about dose titration, pain status, quality of life, and adverse events.

Conclusions:
The list of inclusion and exclusion criteria is relatively short, which will likely make the study group more representative for the entire population of cancer patients with BTcP. All treatment-related decisions are left solely on the investigator's discretion, which will enable to analyze the treatment outcomes in various clinical scenarios, unlikely to be tested in a traditional clinical trial. These two features seem to be essential for the successful management of BTcP, a highly heterogeneous condition requiring an individualized approach. Further, the study includes patients who did not respond to other fentanyl formulations, and hence, it might explain whether switching from one immediate-release fentanyl to another is associated with a clinical benefit and/or specific risk.

Trial registration:
ClinicalTrials.gov with the identifier NCT03895762.
Neonatal lupus erythematosus with diffuse iron deposition in the liver on magnetic resonance imaging
Authors: Suzuki Yuto , Uzuki Yutaka , Kato Hirotaka , Kudo Kyohei , Yakuwa Satoshi , Nasu Takashi , Uetake Kimiaki , Yamada Masafumi 
Published: April 2021

Abstract

Rationale:
Neonatal lupus erythematosus (NLE) is caused by transplacental transfer of maternal autoantibodies against SS-A, SS-B, and/or RNP. Symptoms include heart block, skin lesions, cytopenia, liver dysfunction, and occasionally hydrocephalus. Hepatobiliary disease in NLE should be closely monitored, since severe liver failure has been reported.

Patient concerns:
A 0-day-old female patient presented with nonspecific systemic erythema, liver dysfunction, and hyperferritinemia at birth, and abdominal magnetic resonance imaging indicated diffuse iron deposition in the liver but not in extrahepatic tissues. The patient had no maternal complications or findings indicating intrauterine growth retardation, oligohydramnios, or fetal ascites.

Diagnoses:
The patient was diagnosed with NLE based on the presence of anti-SS-A and SS-B antibodies in the maternal and cord blood.

Interventions:
No intervention was required.

Outcomes:
Her symptoms improved spontaneously. The titers of anti-SS-A and SS-B antibodies became undetectable levels on day 379, while serum anti-double stranded DNA antibody became positive without any clinical symptoms.

Lessons:
Since NLE with hepatobiliary disease could present with diffuse iron deposition in the liver mimicking neonatal hemochromatosis, we need to carefully evaluate and monitor this condition.