Pythium insidiosum keratitis reported in China, raising the alertness to this fungus-like infection: a case series

Abstract Background The objective of this study is to report typical clinical and laboratory characteristics of three cases of keratitis caused by Pythium insidiosum in China. Case presentation Three Chinese patients of Han nationality diagnosed with Pythium keratitis from 2017 to 2019 were included. One 45-year-old female and one 55-year-old male were exposed to river water, and one 51-year-old female was burned by ash in the eyes. All of them are of Han ethnicity. Upon slit-lamp examination, subepithelial and superficial stromal opacities were observed in a reticular pattern. After conventional treatment with antifungal agents, the clinical status worsened and therapeutic penetrating keratoplasty was performed. Unfortunately, enucleation was performed to remove all infected tissue and relieve pain. Pythium insidiosum was identified in culture and confirmed by internal transcribed spacer ribosomal RNA gene sequencing analysis. Following the systemic and local antibiotic regimens, the patients were cured ultimately and no regression of infection was observed. Conclusions It is significant for ophthalmologists and microbiologist to be alert to this eye-threatening infection, especially in patients who are resistant to antifungal treatments and with water-related exposure.

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A case series of ischemic stroke with coronavirus disease 2019 in two Egyptian centers

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00259-z ◽

2020 ◽

Vol 56 (1) ◽

Author(s):

Nevine El Nahas ◽

Tamer Roushdy ◽

Eman Hamid ◽

Sherien Farag ◽

Hossam Shokri ◽

...

Keyword(s):

Ischemic Stroke ◽

Severe Acute Respiratory Syndrome ◽

Cerebrovascular Disorders ◽

Case Series ◽

Neurological Manifestations ◽

Case Presentation ◽

Novel Virus

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus that has been reported to have various neurological manifestations. Cerebrovascular disorders have been encountered as a coronavirus disease 2019 (COVID-19) presentation in our center during the pandemic. Case presentation We are presenting 10 cases with cerebrovascular manifestations after having COVID-19 few days prior to stroke. Conclusion Cerebrovascular manifestations can occur in association with COVID-19 and may have significant implications on prognosis and management.

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Thrombosed Urethral Prolapse: a case series and review of the literature

Journal of Clinical Urology ◽

10.1177/20514158211032853 ◽

2021 ◽

pp. 205141582110328

Author(s):

Abisola Oliyide ◽

Ijeoma Chibuzo ◽

Magda Kujawa

Keyword(s):

Clinical Condition ◽

Correct Diagnosis ◽

Age Distribution ◽

Case Series ◽

Review Of The Literature ◽

Level Of Evidence ◽

Case Presentation ◽

Urethral Prolapse ◽

Evidence Level

Thrombosed urethral prolapse is a rare clinical condition. In this context, we describe our experience and compare our findings with the literature, following presentation of five consecutive cases over 2 years. This will hopefully improve awareness and appropriateness of specialty referrals as a correct diagnosis is rarely established prior to the patient being seen by a urologist. We also wish to highlight a case presentation of thrombosed urethral prolapse outside the bimodal age distribution which has been recorded in the literature. Level of Evidence: Level 4

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Characterization of the clinical and genetic spectrum of autoimmune polyendocrine syndrome type 1 in Chinese case series

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01933-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ya-Bing Wang ◽

Ou Wang ◽

Min Nie ◽

Yan Jiang ◽

Mei Li ◽

...

Keyword(s):

Case Series ◽

Pure Red Cell Aplasia ◽

Hereditary Disease ◽

Chinese Patients ◽

Chronic Mucocutaneous Candidiasis ◽

Syndrome Type ◽

Myeloproliferative Disease ◽

College Hospital ◽

Autoimmune Polyendocrine Syndrome

Abstract Background Autoimmune polyendocrine syndrome type 1 (APS1) is a hereditary disease caused by mutations in the AIRE gene with both endocrine and non-endocrine organ involvement. The existing data from China are limited, and this study aims to describe the phenotypes and genetic characterization in Chinese APS1 patients. In this single-center, retrospective, observational study, comprehensive endocrine and extra-endocrine manifestations were collected, and genetic analysis in AIRE was conducted in patients with APS1 between the years of 1984 and 2018 at Peking Union Medical College Hospital. Results In total, 13 patients from 12 unrelated families were enrolled, seven of whom were female, with hypoparathyroidism, chronic mucocutaneous candidiasis, and Addison’s disease being the most frequently observed manifestations. Up to 84.7% presented with two or three of the above-mentioned manifestations, and nearly 4.9 ± 1.8 components presented in patients aged 21.2 ± 7.9 years old. Several less common phenotypes, such as myeloproliferative disease, pure red cell aplasia, renal tubular acidosis, asplenia, autoimmune hepatitis, and ankylosing spondylitis, were also observed in patients. Altogether, seven different AIRE mutations were found in six patients, four of which (K161fs, G208V, A246fs, and L308F) had not been previously reported in patients with APS1. Conclusion We have provided a comprehensive profile of Chinese patients with APS1, with less commonly observed features being observed in addition to more regularly seen manifestations. Additionally, different AIRE mutations that were observed have expanded the genetic spectrum, which will help with future understanding of the molecular pathogenesis of APS1.

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Mycoplasma hyorhinis as a possible cause of fibrinopurulent meningitis in pigs? - a case series

Porcine Health Management ◽

10.1186/s40813-020-00178-8 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Moritz Bünger ◽

Rene Brunthaler ◽

Christine Unterweger ◽

Igor Loncaric ◽

Maximiliane Dippel ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Clinical Signs ◽

Case Series ◽

Upper Respiratory Tract ◽

Mycoplasma Hyorhinis ◽

Case Presentation ◽

Systemic Spread ◽

In Situ Detection ◽

On Farm

Abstract Background Mycoplasma hyorhinis is an invader of the upper respiratory tract in swine that is considered to have ubiquitous distribution. It is mainly known for causing polyserositis and polyarthritis in weaned piglets, even though the mechanisms of systemic spread are not fully understood. Mycoplasma hyorhinis has also been associated with other diseases in pigs such as pneumonia or otitis media, but so far has not been known to cause central nervous disorders. This case series reports the isolation of Mycoplasma hyorhinis from cerebrospinal fluid and/ or meningeal swabs from piglets originating from four different piglet producing farms in Austria. Case presentation On farm 1, coughing, stiff movement and central nervous signs occurred in nursery piglets. Mycoplasma hyorhinis was the only pathogen isolated from meningeal swabs from two piglets showing central nervous signs. Fibrinopurulent leptomeningitis was only observed in one piglet. Only one of two nursery piglets from farm 2 showed mild central nervous signs but no histologic lesions; Mycoplasma hyorhinis was isolated from cerebrospinal fluid of the piglet with neurologic signs. Mycoplasma hyorhinis was isolated from cerebrospinal fluid of all three investigated piglets from farm 3, all of which showed central nervous signs and purulent leptomeningitis. Further, Streptococcus suis was isolated from the cerebrospinal fluid of one piglet. Fibrinopurulent leptomeningitis was detected in two piglets from farm 4 that had died overnight without showing any clinical signs and Mycoplasma hyorhinis was isolated from meningeal swabs from both piglets. Conclusion While causality has yet to be proven by experimental infection and in situ detection of the pathogen in histologic sections, the findings of this study and the absence of other pathogens suggest Mycoplasma hyorhinis as a potential causative agent of meningitis in swine.

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NUDT15 polymorphism explains serious toxicity to azathioprine in Indian patients with chronic immune thrombocytopenia and autoimmune hemolytic anemia: a case series

Drug Metabolism and Personalized Therapy ◽

10.1515/dmpt-2020-0128 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Anup J. Devasia ◽

Raveen Stephen Stallon Illangeswaran ◽

Infencia Xavier Raj ◽

Biju George ◽

Poonkuzhali Balasubramanian

Keyword(s):

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Immune Thrombocytopenia ◽

Case Series ◽

Severe Toxicity ◽

Toxic Side Effect ◽

Case Presentation ◽

Oral Ulcers ◽

Asian Patients ◽

Life Threatening

AbstractObjectivesAzathioprine (AZA) is a commonly used immunosuppressant in patients with autoimmune diseases. The toxic side effect to AZA (myelosuppression, hair loss, and oral ulcers) are highly unpredictable which can be life threatening if not identified earlier and dose adjustments made or the drug is withdrawn.Case presentationHere we report a case series of five patients with severe toxicity while on treatment with AZA for autoimmune hemolytic anemia (n=1) and Immune thrombocytopenia (n=4). The common thiopurine methyltransferase (TPMT) variants (TPMT*2, *3A, *3B) were not present in these patients. However, all these patients had the NUDT15 415C>T variant that has been reported to explain serious toxicity to thioguanine in Asian patients.ConclusionsOur report suggests pre-emptive genotype-based dosing of AZA could reduce adverse toxicity and hence better outcome.

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A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics

The Bone & Joint Journal ◽

10.1302/0301-620x.100b11.bjj-2018-0720 ◽

2018 ◽

Vol 100-B (11) ◽

pp. 1409-1415 ◽

Cited By ~ 1

Author(s):

B. A. Marson ◽

S. R. Deshmukh ◽

D. J. C. Grindlay ◽

B. J. Ollivere ◽

B. E. Scammell

Keyword(s):

Systematic Review ◽

Wound Healing ◽

Surgical Management ◽

Case Series ◽

Diabetic Patients ◽

Local Antibiotics ◽

Wound Breakdown ◽

Patients With Diabetes ◽

Local Antibiotic ◽

Antibiotic Delivery

Aims Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery. Materials and Methods Databases were searched to identify eligible studies and 13 were identified for inclusion. Results Overall, the quality of the studies was poor. A single trial suggested that wound healing is quicker when a gentamicin-impregnated collagen sponge was implanted at time of surgery, with no difference in length of stay or rate of amputation. Results from studies with high risk of bias indicated no change in wound healing when a gentamicin-impregnated sponge was implanted during transmetatarsal amputation, but a reduction in the incidence of wound breakdown (8% vs 25%, not statistically significant) was identified. A significant cost reduction was identified when using an antimicrobial gel to deliver antibiotics and anti-biofilm agents (quorum-sensing inhibitors) compared with routine dressings and systemic antibiotics. Analyses of case series identified 485 patients who were treated using local antibiotic delivery devices. The rates of wound healing, re-operation, and mortality were comparable to those that have been previously reported for the routine management of these infections. Conclusion There is a lack of good-quality evidence to support the use of local antibiotic delivery devices in the treatment of foot infections in patients with diabetes. Cite this article: Bone Joint J 2018;100-B:1409–15.

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Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1217 ◽

2017 ◽

Vol 9 (3) ◽

pp. 79-87 ◽

Cited By ~ 1

Author(s):

Marilla Dickfos ◽

Robert Franz

Keyword(s):

Total Thyroidectomy ◽

Surgical Management ◽

Medical Therapy ◽

Clinical Status ◽

Case Series ◽

Primary Treatment ◽

Surgical Removal ◽

Efficient Treatment ◽

Select Group ◽

Small Subgroup

ABSTRACT Introduction Amiodarone can be a life-saving medication; however, it can also cause amiodarone-induced thyrotoxicosis (AIT). Though rare, AIT is a complex and life-threatening side effect, which can cause significant cardiac dysfunction and lead to cardiac failure. Primary treatment is with thionamides, perchlorates, and steroids. However, a small subgroup does not respond and their cardiovascular function continues to deteriorate. This select group is referred for a semi-elective total thyroidectomy. Without surgical removal of their thyroid gland, these patients will continue to deteriorate, with a 30 to 50% mortality rate for those not operated on. Aim The aim of this case series was to assess for any indicators as to when these patients should be referred for total thyroidectomies and the efficacy of this method of treatment. Materials and methods A case series of patients with AIT treated with a total thyroidectomy from 1998 to 2015 was used to assess the efficacy of and indicators for surgery. Results Total thyroidectomy results in efficient and significant improvement in the patient's biochemistry and symptoms. The patient's symptoms and options for medical therapy have an influence on the duration of the trial of medical therapy. Conclusion Surgery is an effective and efficient treatment for AIT. However, there does not appear to be a specific indicator for when this treatment should be instigated. A case-by-case approach should be adopted when treating these complicated patients. Clinical significance Clinicians should see surgery as an effective and efficient treatment for AIT. The timing of surgery should be assessed on a case-by-case basis considering the patient's clinical status and therapeutic options and not as a last resort. How to cite this article Dickfos M, Franz R. Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis. World J Endoc Surg 2017;9(3):79-87.

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PET–CT for the diagnosis and treatment of primary musculoskeletal tumors in Chinese patients - experience from 255 patients in a single center

British Journal of Radiology ◽

10.1259/bjr.20210785 ◽

2021 ◽

Author(s):

Aikeremujiang Muheremu ◽

Tianlin Wen ◽

Xiaohui Niu

Keyword(s):

Soft Tissue ◽

Case Series ◽

Soft Tissue Sarcomas ◽

Standardized Uptake Value ◽

Chinese Patients ◽

Histopathological Study ◽

Low Grade ◽

High Grade ◽

Musculoskeletal Tumors ◽

Pet Ct

Objective: The current study was carried out to assess the value of positron emission tomography (PET)/CT on the diagnosis and staging of primary musculoskeletal tumors. Methods: PET–CT test results and histopathological study reports of all the patients with primary musculoskeletal tumors in our department from January 2006 to July 2015 were retrospectively reviewed. Maximum standardized uptake value (SUVmax) in these PET–CT reports were recorded and analyzed respectively for each type of sarcoma. Results: A total of 255 patients were included in the final analysis. Sensitivity of SUVmax based diagnosis was 96.6% for primary malignant osseous sarcomas and 91.2% for soft tissue sarcomas. SUVmax of high-grade osseous sarcomas (average 8.4 ± 5.5) was significantly higher (p < 0.001) than low-grade osseous sarcomas (average 3.9 ± 1.8); based on current case series, SUVmax of high-grade soft tissue sarcomas (7.5 ± 5.1) was not significantly different (p = 0.229) from that of low-grade soft tissue sarcomas (5.3 ± 3.7). Significant decrease of SUVmax value after chemotherapy was associated with favorable prognosis in patients with osteosarcoma. Conclusion: Results of the current study indicate that, the SUVmax based application of PET–CT can be a valuable supplementary method to histopathological tests regarding the diagnosis and staging of primary musculoskeletal sarcomas. Advances in knowledge: SUVmax based application of PET–CT is a highly sensitive method in diagnosis of primary osseous and soft tissue sarcomas in Chinese patients.

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A case of severe SARS-CoV-2 infection with negative nasopharyngeal PCR in pregnancy

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2020-0075 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Anna Fuchs ◽

Lauren Harris ◽

Ashley Huber ◽

Mia Heiligenstein ◽

Cassandra Heiselman ◽

...

Keyword(s):

Clinical Presentation ◽

Clinical Status ◽

Igg Antibodies ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Case Presentation ◽

Preterm Premature Rupture ◽

High Clinical Suspicion ◽

Maternal Status

Abstract Objectives SARS-CoV-2 remains a pressing issue for our obstetric community during the current pandemic. We present a case of a 22-year-old nulliparous woman 31 weeks pregnant, with significant clinical SARS-CoV-2 disease, in the setting of negative nasopharyngeal PCR testing but positive IgG antibodies. Case presentation This was a 22-year-old patient 31 weeks pregnant who presented with fever, tachycardia, and subsequently preterm premature rupture of membranes (PPROM) and pulmonary emboli with multifocal pneumonia. The patient underwent three negative SARS-CoV-2 tests via nasopharyngeal PCR testing during her hospital stay as well as a negative workup for fever. After a cesarean section for worsening maternal status after 7 days of hospitalization, the patient was admitted for worsening clinical status to the SICU. At the time of SICU admission patient was found to have serum IgG positive antibodies and was managed with intubation, antibiotics, and anticoagulation. Patient eventually left hospital against medical advice on hospital day 16 on oral antibiotics but was found to be recovering well at later outpatient follow up. Conclusions Diagnosis of SARS-CoV-2 remains a complicated picture in the setting of testing limitations. This case highlights an antepartum clinical presentation of severe SARS-CoV-2 and recommends a high clinical suspicion for diagnosis of SARS-CoV-2 and initiation of treatment in the pregnant population, even in the presence of negative nasopharyngeal PCR testing.

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Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series

Skin Appendage Disorders ◽

10.1159/000519016 ◽

2021 ◽

pp. 1-3

Author(s):

Dana Sous ◽

Michela V.R. Starace ◽

Lu Chen ◽

Elizabeth L. Nieman ◽

Milan J. Anadkat ◽

...

Keyword(s):

Risk Factors ◽

Side Effects ◽

Treatment Strategy ◽

Viral Infections ◽

Nail Plate ◽

Case Series ◽

Drug Side Effects ◽

Case Presentation ◽

Nail Bed ◽

Physical Trauma

Introduction: Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. Case Presentation: We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. Discussion/Conclusion: For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.

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