bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autoimmunity in context of exposure to SARS-Cov2 virus
Authors: Negoescu Iris-Andreea , Moșteanu Ioana-Mădălina , Simionescu Anca , Parlițeanu Oana , Arlet Alina , Iordache Cicerone , Voinescu Daniel , Croitoru Alina , Mahler Beatrice 
Published: June 2024

Abstract

Introduction
The immune response in patients with SARS-CoV2 infection is an incompletely elucidated pathophysiological challenge. There are more and more cases in which COVID-19 vaccination induces autoimmune side effects, of course, in a selected population. What are the criteria that induce such a response? How can it be prevented? These are questions that the medical world must answer.

Material and Methods
A 28-year-old male patient presented with repeated small hemoptysis accompanied by pleuritic pain, which started suddenly 2 days prior. From the patient’s history, we note autoimmune thyrotoxicosis triggered by the administration of the second dose of the anti-SARS-CoV2 vaccine, but also a recent COVID-19 episode. At the time of hospitalization, slightly elevated serum values of D-dimers were noted, and the CT examination identified multiple unilateral filling defects in the middle and small right pulmonary arteries, accompanied by a ground-glass opacity suggestive of a pulmonary infarction and possible bilateral stenosis of the subclavian arteries. The extended immunological panel was negative, but genetic tests have identified two thrombophilic gene mutations. Functionally, a discrete decrease in lung volumes and a slight impairment of alveolo-capillary diffusion was observed. The clinical, imaging and functional evolution was favorable under anticoagulant treatment.

Discusions
The predisposition for thrombosis in COVID-19 is determined by at least two distinct processes, subsegmental and segmental vessel occlusion and microvascular in situ immunothrombosis. Pulmonary thromboembolism occurs more frequently in the first weeks after diagnosis, but cases farther from the acute moment have also been reported in literature, including in patients with mild forms of the disease.
Certain adjuvant components of the vaccines, as well as the SARS-CoV2 virus itself, can trigger autoimmune reactions in genetically predisposed individuals.

Conclusion
Patients with active or recently recovered COVID-19 should be considered at an increased risk of pulmonary embolism when they present with specific symptoms, even without the existence of other risk factors.
The use of simple pulmonary function tests in the post-COVID-19 pulmonary improvement prediction: lessons from a single-center study
Authors: Bartczak Krystian T. , Milkowska-Dymanowska Joanna , Piotrowski Wojciech J. , Bialas Adam J. 
Published: June 2024

Abstract

Introduction
Despite the evolving knowledge about COVID-19 convalescents, there is still not enough data to validate simple methods of identifying the non-improvers. Our objective: to look for bad prognostic factors in long-COVID.

Methods
We conducted a prospective observational study among previously hospitalized patients with COVID-19. Individual characteristics were gathered and pulmonary function tests - spirometry and lung transfer for carbon monoxide (TL,CO) – were performed twice, approximately one and three months after hospitalization from COVID-19. Control radiological examinations were repeated and compared at the time of the study.

Results
After dividing the study group (30 patients) according to improvement in forced vital capacity (FVC) and/or TL,CO we observed that the forced expiratory volume in the first second (FEV1) acquired from spirometry accurately indicates clinical improvement with the area under the curve (AUC) of 0.892 (95% CI 0.73 – 1). Notable differences were found in estimated total lung capacity (eTLC) and radiological score as well.

Conclusions
Our findings suggest that simple spirometry with FEV1 assessment performed in the post-COVID period helps select individuals with impaired recovery that should presumably be referred to a respiratory specialist and pulmonary rehabilitation.
Pneumocystis Pneumonia misdiagnosed as Pulmonary Tuberculosis in a patient with repeatedly false-negative HIV tests
Authors: Bodoarcă Samuel , Bodoarcă Diana , Tabacu Emilia , Strâmbu Irina 
Published: June 2024

Abstract
Pneumocystis jirovecii pneumonia, previously known as Pneumocystis carinii Pneumonia (PCP), is a fungal infection most commonly encountered in immunocompromised patients and, in some cases, can be life-threatening. Patients at risk include those with cancer, HIV positive, transplant recipients, and those under immunosuppressive therapies. There are no specific signs or symptoms for PCP and its differential diagnosis includes other viral or bacterial pneumonias and also Tuberculosis, the latter especially in high endemic areas. We present the case of a 32 year-old female patient who presented to the hospital for dyspnea and cough, treated for Pulmonary Tuberculosis, and eventually diagnosed with Pneumocystis Pneumonia, in spite of her multiple false-negative HIV tests.
Flexion Directional Preference in a Patient With Low Back Pain, Utilizing Mechanical Diagnosis and Therapy: A Case Report
Authors: Greer Brian , Tranquillo Julia , Maccio Joseph R. 
Published: June 2024

Background Low back pain (LBP) is a complaint commonly seen by primary care physicians. Societal efforts to prevent LBP have led to more erect work environments to avoid excessive lumbar flexion. This case report involves an individual presenting with acute LBP after a hyperextension injury. Case Presentation The patient was assessed using Mechanical Diagnosis and Therapy (MDT), which is based on symptomatic and mechanical responses to repeated and sustained movements. The patient required movements into flexion, with modifications in loading strategies. Outcome and Follow-Up The patient was able to return to his prior level of function after 5 treatment sessions over 14 days and remained symptom free at long-term follow-ups. He was able to manage his symptoms without further health care management. Discussion This case report demonstrates that not all individuals require lumbar extension movements. It also demonstrates the clinical reasoning involved in a thorough MDT assessment, resulting in the resolution of symptoms. JOSPT Cases 2022;2(1):44–49. doi:10.2519/josptcases.2022.10006
Vestibular Physical Therapy for the Treatment of Brain Fog From Long COVID—A Case Report
Authors: Finkelstein Eric 
Published: June 2024

Background Individuals with symptoms weeks or months following COVID-19 have been deemed “long haulers” or having long COVID (LC). COVID has a primary effect on the respiratory and cardiovascular systems; however, individuals diagnosed with LC have had a wide array of symptoms that span across all other body systems, including the nervous system. Case Presentation This case study describes the presentation of symptoms and treatment through physical therapy of an individual with LC who presented with cognitive fatigue and brain fog. Outcome and Follow-up The individual demonstrated improvements in cognitive fatigue, brain fog, and concentration as well as improvements in balance and vestibular function. Discussion This case highlights the importance of a thorough examination in individuals with LC as well as the potential role of physical therapy for those suffering from LC. JOSPT Cases 2022;2(2):117–123. doi:10.2519/josptcases.2022.10790
Training Load Management in Professional Tennis Players During COVID-19 Lockdown: A Case Series Study
Authors: Méndez Diego H. , Pierobón Andrés , Gabbett Tim J. 
Published: June 2024

Background During the coronavirus disease 2019 (COVID-19) pandemic, training routines of most athletes around the world were abruptly interrupted, potentially increasing the risk of injury. The purpose of this study was to compare 3 measures of training load (TL): tennis-specific TL, physical TL, and total TL management before, during, and after lockdown of 3 professional male tennis players. Case Presentation Three professional male tennis players were monitored throughout the 2020 season. Outcome and Follow-Up The median total weekly TL (CR-10 Borg rating of perceived exertion—session length in minutes) was 5783 arbitrary units (AU). The total weekly TLs before, during, and after lockdown were 7195, 3753, and 5950, respectively. During lockdown, tennis TL was reduced to 0, while physical TL (including preventive loads) increased by 73%. All players suffered an injury/illness during tennis training resumption following lockdown, where 2 of them were musculoskeletal related and the others were due to COVID-19. There was no association between total acute:chronic workload ratio (ACWR) and injury. However, one case had a spike (>1.5) in tennisspecific ACWR 2 weeks before injury, despite maintaining total ACWR between 0.8 and 1.5. Discussion Tennis and physical differential TL monitoring should be carried out separately in order to ensure tennis-specific player readiness. If only total load is monitored during lockdown or rehabilitation from injury, subsequent increases in tennis load upon return to play could potentially increase the risk of injury. The 3 participants showed a similar pattern of total TL throughout the season with pre-lockdown loads being the highest. JOSPT Cases 2022;2(3):141–148. Epub: 21 June 2022. doi:10.2519/josptcases.2022.10863
Successful Physical Therapist Management of an Ankle Injury in the Austere Wilderness of Denali: A Case Report
Authors: Young Scott W. , Young Thomas W. , MacDonald Cameron W. , Stickler Kellie R. 
Published: June 2024

BACKGROUND: Evaluation and management of ankle injuries is routine in traditional clinical settings. However, minimal evidence exists regarding the management of acute musculoskeletal injuries in austere high-altitude wilderness environments. CASE PRESENTATION: The patient was a 36-year-old male who sustained a right lateral ankle sprain climbing down from an elevation of 16 000 ft on Denali, the tallest mountain in North America. The baseline Lower Extremity Functional Scale (LEFS) score was 9/80 and the baseline numeric pain-rating scale (NPRS) score was 9/10. Management included manual therapy, therapeutic exercise, and sport-specific mountaineering interventions. After 3 days, his LEFS score improved to 55/80 and NPRS improved to 4/10. Before subsequent descending of 7000 ft to the base camp, ongoing management including boot fitting and gait training with crampons was provided to safely descend challenging terrain. OUTCOME AND FOLLOW-UP: The patient was able to descend to the base camp under his own control, saving substantial people power after significantly improving his functional level with physical therapist management. During a virtual follow-up visit 2 weeks after the expedition, his LEFS score was 72/80 and his NPRS score was 2/10. All improvements were maintained at 3-month follow-up. DISCUSSION: A physical therapist in an austere wilderness setting was able to effectively manage an ankle injury in a challenging environment with limited resources. Due to the patient's successful outcome, he was able to avoid the cost of a helicopter rescue and save precious national park resources. JOSPT Cases 2023;3(1):74–80. Epub: 14 December 2022. doi:10.2519/josptcases.2022.11159
Clinical Examination and Electrodiagnostic Testing in a Rare Case of Long Thoracic Nerve Palsy Following Surgeries Related to an Emergency Appendectomy: A Case Report
Authors: Savage Nathan J. , Heston Daniel J. 
Published: June 2024

BACKGROUND: Postoperative neuropathy is an infrequent but potentially serious complication of surgery and may result in significant morbidity. While mechanical injury and perioperative factors are commonly implicated, etiology of postoperative neuropathy can be unclear, particularly when the lesion is spatially remote from the surgical site. CASE PRESENTATION: A 27-year-old male Doctor of Physical Therapy student presented to his orthopaedic professor during class describing a 10-week history of significant right shoulder weakness following surgeries related to an emergency appendectomy. Examination revealed unilateral scapular winging and findings consistent with long thoracic nerve (LTN) palsy. Given the unknown etiology, electrodiagnostic (EDX) testing was subsequently performed for diagnostic clarity. OUTCOME AND FOLLOW-UP: Clinical and EDX examinations confirmed an isolated LTN palsy, while ruling out competing neurogenic and orthopaedic etiologies. Seven-month follow-up revealed minimal subjective and objective improvement in shoulder function and continued scapular winging. DISCUSSION: Orthopaedic physical therapy examination, including EDX testing, correctly identified a rare case of LTN palsy following surgeries related to an emergency appendectomy. Findings informed prognosis and guided exercise prescription. JOSPT Cases 2023;3(1):53–58. Epub: 14 December 2022. doi:10.2519/josptcases.2022.11457
Functional Assessment and Treatment of Complex Pubic-Related and Adductor-Related Groin Pain in a Division I College Soccer Player: Case Report
Authors: Chiesa Christen , Lopes Alexandre Dias , Nolan David 
Published: June 2024

BACKGROUND: Recommendations have been made concerning return-to-play interventions and testing for athletes returning from groin injuries. Physical therapists in outpatient clinics often lack standardized assessments that reflect real-time sport participation. This case study describes an objective, functional return-to-sport testing battery for rehabilitation of a soccer athlete. CASE PRESENTATION: A 22-year-old collegiate soccer player presented with groin pain after striking a ball on goal. The patient was assessed using a testing battery of strength testing, Yo-Yo Intermittent Recovery Test (IRT), Pro-Agility Test, and the maximal ball strike velocity. A visual analog scale for pain was recorded and monitored. OUTCOME AND FOLLOW-UP: The patient's pain decreased in all strength testing, and his performance on the Yo-Yo IRT was superior for adult men and male soccer players. The patient completed his collegiate season without symptom recurrence. DISCUSSION: The testing battery of strength testing, Yo-Yo IRT, Pro-Agility Test, and maximal effort strike velocity could be effective for return-to-sport assessment in soccer players with groin pain. JOSPT Cases 2023;3(2):134–143. Epub: 20 April 2023. doi:10.2519/josptcases.2023.11547
Ankylosing Spondylitis Presenting as Buttock Pain in a Military Tactical Athlete: A Case Report
Authors: Kenny Joseph T. , Fraser John J. 
Published: June 2024

BACKGROUND: Ankylosing spondylitis (AS) is an inflammatory condition that most commonly affects the spine. In the absence of spinal symptoms, consideration of atypical symptom behavior and the use of diagnostic criteria can be helpful in recognizing this condition. The purpose of this case was to detail AS presenting as buttock pain in a military tactical athlete. CASE PRESENTATION: A 20-year-old white male military intelligence specialist was referred to physical therapy for reports of right buttock pain. Symptoms developed during recruit training, which led to an initial diagnosis of overuse syndrome. He was managed by multiple health care providers, including physical therapists, during recruit training and a year following onset while deployed overseas. OUTCOME AND FOLLOW-UP: Lack of treatment response and presence of atypical symptoms necessitated further medical workup, including radiography, laboratory, and rheumatology referrals. Following consultation with a rheumatologist, a diagnosis of AS was confirmed and the patient was provided definitive and appropriate management that resulted in improved outcomes. DISCUSSION: Spinal pain is often associated with AS. Indicators of AS such as an insidious onset of nonresolving symptoms, night disturbances, patient demographics, a positive HLA-B27 laboratory value, and evidence of active inflammation or sacroiliitis on imaging may help guide detection in the absence of spinal pain or absence of specific criteria established to assist in the identification of inflammatory spondyloarthropathies. Diagnostic accuracy is essential for appropriate care earlier in the disease process. In this case, a definitive diagnosis led to improvement in the management of this patient. JOSPT Cases 2023;3(2):110–116. Epub: 13 April 2023. doi:10.2519/josptcases.2023.11596
Early Initiated Multimodal Postoperative Physical Therapy Program for Anterior Cervical Discectomy and Fusion: A Case Report With 2-Year Outcomes
Authors: Derian Joseph M. , Evaristo Jessica , Wang Jeffrey C. , Lantz Justin M. 
Published: June 2024

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for cervical radiculopathy. While postoperative physical therapy (PT) has been shown to be effective after many orthopaedic surgeries, there is limited evidence available regarding postoperative PT after ACDF for cervical radiculopathy. CASE PRESENTATION: A 61-year-old male initiated early in-person PT 2 weeks following 2-level ACDF, which utilized a multimodal PT program (manual therapy, patient education, therapeutic exercise, self-management, HEP, modalities) guided by tissue healing, achievement of clinical objective milestones, and clinical reasoning. OUTCOME AND FOLLOW-UP: Significant improvement in outcome measures (numeric pain-rating scale, neck disability index, 36-item short-form health survey, global rating of change, fear avoidance beliefs questionnaire, cervical active range of motion) was achieved 12 weeks postoperatively and maintained up to 2 years with no adverse events. DISCUSSION: Early initiated in-person multimodal postoperative PT may be safe and effective for patients at all stages of healing after ACDF. Further research is needed to address the benefits to larger patient populations. JOSPT Cases 2023;3(3):163-173. Epub: 20 June 2023. doi:10.2519/josptcases.2023.11608
Examining Lower Quadrant Overuse Injury Using Wearable Sensors: A Case Series in Indoor Team-Based Court Sports
Authors: Kupperman Natalie , Tymkew Jennifer A. , Curtis Michael A. , Saliba Susan A. , Hart Joseph M. , Hertel Jay 
Published: June 2024

BACKGROUND: There is increasing literature about using wearable sensors to predict sports-related injury at the team- or league-level; however, minimal research has focused on single cases. Sports-related injury involves a complex interaction of multiple variables, and analysis should also be explored on the individual level. The purpose of this case series is to evaluate differences in on-court volume, as measured by whole-body accelerometry, of 3 court-sport athletes who sustained lower quadrant overuse musculoskeletal injuries to respective healthy matched controls. CASE PRESENTATION: A retrospective review of 3 collegiate athletes (2 males, 1 female) who developed lower quadrant overuse injuries and comparisons to healthy matched controls. OUTCOME AND FOLLOW-UP: The injured female volleyball athlete had greater accumulated player load per minute, jumps per minute, and duration of on-court time compared to the healthy athlete across the 8 weeks prior to injury. For basketball, both injured male athletes had greater player load per minute compared to their controls; however, jumps per minute were less than the healthy athletes over the 8 weeks prior to injury. DISCUSSION: Differences in accelerometer data were found between injured athletes and healthy matched controls. Analyzing the data to focus on single cases in a longitudinal framework allows for contextual factors to be included and temporal precedence to remain intact. JOSPT Cases 2023;3(3):174-184. Epub: 10 July 2023. doi:10.2519/josptcases.2023.11636
The Curious Case of a Glioblastoma Disguised as Lumbar Pathology in Orthopaedic Physical Therapy Practice
Authors: Ballay Cody , Gulla Nicholas , Mansfield Cody , Briggs Matthew S. 
Published: June 2024

BACKGROUND: Glioblastoma is a primary brain tumor that shares symptoms with orthopaedic conditions like low back pain with radiating pain. The purpose of this case study was to describe a patient referred to physical therapy (PT) and subsequently diagnosed with a glioblastoma.CASE PRESENTATION: A 64-year-old male was referred to PT with right foot numbness and lower back pain. Initially, the patient was diagnosed with chronic low back pain with radiating pain (International Classification of Diseases and Related Health Problems, 10th Revision) related to lumbar spinal stenosis, and initial treatment resulted in significant reduction of foot numbness. After initial improvement, he reported an insidious onset of fasciculations and lacked response to therapy interventions, which warranted referral for imaging.OUTCOME AND FOLLOW-UP: Magnetic resonance imaging of the brain revealed high-grade glioblastomas, and the patient underwent a craniotomy for tumor resection with subsequent chemotherapy and radiation.DISCUSSION: Glioblastoma is an underreported condition in PT literature, and increased awareness of symptoms can improve recognition and appropriate referral. JOSPT Cases 2023;3(4):219-226. Epub 25 September 2023. doi:10.2519/josptcases.2023.11913
Variability in Outcome After Bilateral, Fluoroquinolones-Associated Achilles Tendon Rupture: A Case Report
Authors: Zellers Jennifer A. , Czuppon Sylvia , Brophy Robert 
Published: June 2024

BACKGROUND: Achilles tendon rupture can be debilitating, and there is substantial variability in outcomes after Achilles tendon rupture. Patient- and tissue-level characteristics are beginning to emerge as healing indicators with the potential of identifying impaired healing earlier in recovery. CASE PRESENTATION: Patient with fluoroquinolone-induced, bilateral Achilles tendon rupture managed nonoperatively. OUTCOME AND FOLLOW-UP: Tendon tissue level outcomes on ultrasound, strength, range of motion, and patient-reported outcomes are reported. With similar treatment of bilateral tendons, the patient achieved good healing outcomes (evidenced by limited tendon elongation and walking capacity) on one side but had limited healing (evidenced by tendon retraction and need for bracing with walking) on the other side. DISCUSSION: The findings from this case report highlight the variability of patient outcomes after Achilles tendon rupture, even when treatment and the systemic healing environment is similar. This report also demonstrates the potential clinical utility of routine ultrasound imaging to assess early tendon healing before strength and other functional outcomes can be assessed. JOSPT Cases 2024;4(1):12-18. Epub 13 November 2023. doi:10.2519/josptcases.2023.12109
Comprehensive Rehabilitation Protocol Integrating TECAR Therapy and Exercise for Postoperative Meniscal Tear – A Case Study
Authors: Babu V. Sarath , Katage Goutami Amit , Chopade Shamal 
Published: June 2024

BACKGROUND: A prevalent concern, meniscal tears impact a substantial portion of the population, frequently necessitating surgical intervention due to severe pain. Attaining physical and functional fitness following meniscal surgery presents a notable challenge for both patients and physiotherapists. This case underscores the importance of effective rehabilitation strategies along with application of transfer energy capacitive and resistive (TECAR) therapy. CASE PRESENTATION: A 51-year-old female, after arthroscopic surgery for a meniscal tear, sought a focused 4-week rehabilitation program. Integrating TECAR therapy and targeted exercises addressed pain, range of motion, muscle strength, gait, and balance. OUTCOME AND FOLLOW-UP: Significant improvements were observed, including pain reduction, increased knee flexion, enhanced muscle strength, improved gait, and balance. Knee injury and Osteoarthritis Outcome Score results reflected comprehensive improvement in knee-related domains. DISCUSSION: TECAR therapy played a pivotal role in pain management, while mobilization and targeted exercises positively impacted knee range of motion and muscle strength. Gait analysis and the Star Excursion Balance Test highlighted improved gait parameters and balance, affirming the effectiveness of a multidisciplinary rehabilitation approach. JOSPT Cases 2024;4(2):84-93. Epub 18 April 2024. doi:10.2519/josptcases.2024.0033