Similar Cases Research Articles

Intracranial Hypertension Associated With Poly-Cranio-Radicular-Neuropathies: A Case Report and Review of the Literature.

We present the case of a gentleman who developed rapidly progressive vision loss, ophthalmo-paresis, and flaccid quadriparesis in the context of severe intracranial hypertension. We reviewed the available cases in the literature to increase awareness of this rare clinical entity.Case Report:A 36-year-old man developed rapidly progressive vision loss, ophthalmo-paresis, and flaccid quadriparesis. He had an extensive workup, only notable for severe intracranial hypertension, >55cm of H 2 O. No inflammatory features were present, and the patient responded to CSF diversion. Few similar cases are available in the literature, but all show markedly elevated intracranial pressure associated with extensive neuroaxis dysfunction. Similarly, these patients improved with CSF diversion but did not appear to respond to immune-based therapies. We term this extensive neuroaxis dysfunction intracranial hypertension associated with poly-cranio-radicular-neuropathy (IHP) and distinguish it from similar immune-mediated clinical presentations. Clinicians should be aware of the different etiologies of this potentially devastating clinical presentation to inform appropriate and timely treatment.

Ethics Consult: Using Hospice as "Treatment" for Behavioral Problems of Dementia

Patients with Behavioral and Psychological Symptoms of Dementia (BPSD) are among the most challenging patients to treat; these behaviors are estimated to occur in up to 90% of patients with dementia (Aigbogun 2019); of these, one in 5 patients displays aggression (Eastley 1997). The usual treatments have only modest efficacy at best and at times are ineffective in some individuals. Some behaviors such as physical aggression make it difficult, if not impossible, to find placement for these patients. Placement in nursing homes on a hospice status have traditionally required evidence of a 6 month life expectancy; placement in an inpatient hospice setting is usually reserved for patients with even shorter life expectancies such as 2 weeks. Prognosticating life expectancy in patients with dementia is challenging and often inaccurate (Jayes 2004). Furthermore the use of terminal palliative sedation is supposed to be confined to the last 2 weeks of life and/or extreme physical suffering (Schuman-Oliver 2008, AMA Opinion 2013).This session will present 2 cases of individuals with advanced dementia who did not meet the traditional Medicare criteria for hospice, as both were ambulatory and did not have significant co-morbid medical issues. Both had significant aggressive behaviors that responded poorly to extensive trials of various medications during extended stays on a geriatric psychiatry inpatient unit. Both were referred to a local inpatient hospice where the staff use “suffering" as a hospice criteria and were “treated” with the usual hospice medications and expired in less than 3 weeks.This session will use the two clinical cases to address the following: review the issue of prognostication of advanced dementia and the challenges of defining the end of life; review efforts to define “suffering” in advanced dementia in both the medical and ethics literature; review issues concerning palliative sedation; define how this differs from medical aid in dying and euthanasia. The experience of Dutch geriatricians addressing these issues will be presented (Veldwijck-Rouenhorst 2021). A geriatric psychiatrist will present the 2 cases and set up the questions and ethical issues that these cases pose. An ethics professor-scholar from Emory University will review the ethics literature and teachings that address these issues and help lead a discussion with the audience. The overall goal is to provide a framework of steps the audience members can take if confronted with similar cases.

Learning legal text representations via disentangling elements

Recently, a rising number of works has been focusing on tasks in the legal field for providing references to professionals in order to improve their work efficiency. Learning legal text representations, being the most common initial step, can strongly influence the performance of downstream tasks. Existing works have shown that utilizing domain knowledge, such as legal elements, in text representation learning can improve the prediction performance of downstream models. However, existing methods are typically focused on specific downstream tasks, hindering their effective generalization to other legal tasks. Moreover, these models tend to entangle various legal elements into a unified representation, overlooking the nuances among distinct legal elements. To solve the aforementioned limitation, we (1) introduce a generic model, called eVec (legal text to element-related Vector), based on a triplet loss to learn discriminative representations of legal texts concerning a specific element, and (2) present a framework eVecs for learning disentangled representations w.r.t. multiple elements. The learned representations are independent of each other in terms of elements, and can be directly applied to or fine-tuned for various downstream tasks. We conducted comprehensive experiments on two real-world legal applications, the results of which indicate that the proposed model outperforms a range of baselines by a margin of up to 34.2% on a similar case matching task and 14% on a legal element identification task. When a small quantity of labeled data is accessible, the proposed model’s superior performance becomes even more evident.

Research on Case Reasoning Multi-attribute Group Decision-making Method Based on Hesitant Fuzzy Set

In this study, a hesitant fuzzy set-based case-based reasoning integration method is proposed for the multi-attribute group decision-making problem with unknown attribute weights and mixed forms of attribute values. First, from two perspectives, traditional distance measure and information theory, a multi-objective optimization model is constructed using the distance similarity measure and information entropy of each type of attributes to determine the attribute weights. Secondly, considering the hybrid and nonlinear characteristics of case data, based on the principle of symmetric interaction entropy and TOPSIS method, a global similarity measure based on symmetric interaction entropy is proposed and a case inference algorithm suitable for hesitant fuzzy environment is designed. Finally, by analyzing the arithmetic cases of the target case in the case base, the most similar historical cases to the target case are retrieved to determine the decision-making scheme, and the practicality and feasibility of the decision-making method are verified. The results show that considering hesitant fuzzy theory for case-based reasoning research will help improve the accuracy and reliability of decision-making and provide more effective support for multi-attribute group decision management.

Primary extraskeletal intradural Ewing sarcoma with acute hemorrhage: a case report and review of the literature

BackgroundSpinal cord tumors present a challenge in diagnosis and treatment due to their varied histopathological characteristics. While Ewing sarcoma is a rare malignant tumor typically originating from skeletal bone, cases of primary intradural extraskeletal Ewing sarcoma are exceptionally rare. The similarity of its presentation to other spinal tumors further complicates its identification and management.Case presentationWe report a case of a 58-year-old Palestinian male with intradural extraskeletal lumbar Ewing sarcoma. The patient initially presented with lower back pain and bilateral S1 radiculopathy, with more severe symptoms on the left side. Magnetic resonance imaging revealed a 7 cm oval-shaped mass with homogeneous contrast enhancement, obstructing the spinal canal from L3/L4 to L5/S1 levels. Initially, a myxopapillary ependymoma was suspected, but the patient’s sensory and motor functions suddenly deteriorated during hospitalization. Repeat magnetic resonance imaging indicated heterogeneous contrast enhancement, indicating acute intratumoral hemorrhage. Consequently, the patient underwent emergent L3–L5 laminotomy, with successful gross total resection of the tumor. Histopathological and immunohistochemical analyses confirmed the diagnosis of intradural extraskeletal Ewing sarcoma. Adjuvant therapy was administered to minimize the risk of local recurrence or distant metastasis. A systematic review of relevant literature, along with retrospective analysis of medical records, operative reports, radiological studies, and histopathological findings of similar cases, was also conducted.ConclusionsIntradural extraskeletal Ewing sarcoma is an infrequently encountered condition in adult patients, emphasizing the importance of considering it in the differential diagnosis of spinal tumors. Surgeons must possess a comprehensive understanding of this rare entity to ensure accurate staging and optimal management, particularly in the early stages when prompt intervention may improve prognosis.

Pahlawan, Pengkhianat, Atau Penjahat (Hero, Traitor, or Villain): A Personal Journey Through Indonesian History

This article concerns Indonesian heroes, traitors, and villains from different regions and eras. The factors influencing the categorisation of individuals as heroes or villains are examined. Examples include regional leaders who opposed the Dutch East India Company or collaborated with it. Similar cases are examined from the period of the Netherlands Indies colonial state. Also discussed are nationalists who were members of the Indonesian Communist Party, and people now deemed heroes who collaborated with the Japanese during the Second World War. Next for consideration are individuals involved in Confrontation with Malaysia and the occupation of East Timor. The last cases come from the world of popular music and show how performers idolised by fans can be considered villains by others.

Intratorakalinis žastikaulio galvos išnirimas, esant politraumai: klinikinio atvejo aprašymas

Intrathoracic displacement of the humeral head is rarely documented due to high mortality of the trauma. As a result, there is no clear consensus about how such case should be approached. In this report we reviewed our successful case, and reviewed the literature. The patient arrived after car accident with a broken humerus and upon taking X-ray found to have the humeral head lodged in the chest cavity. After humeral head removal and arthroplasty, patient was discharged without complications. In literature several cases were found in which a patient usually suffers because of high energy trauma with arm typically in abducted position. In all cases treatment involves removing humeral fragment from chest and prosthetic arthroplasty of the glenohumeral joint. Although some authors suggest leaving humeral fragment in some cases while others suggest to always remove. Exact indications of such decision are unclear. Cases like this pose a high risk of neurological and circulatory complications, although no complications were observed in this case. Nevertheless, there have been too few similar cases described to establish a proper methodology.

Case Report: Management of COVID-19 in a Sickle Cell Anaemia Patient: A Case Report

This case report presents the management of COVID-19 in a 19-year-old female with a known history of sickle cell anaemia. The patient displayed typical COVID-19 symptoms with the feature of sickle cell anaemia, crises. Laboratory analysis confirmed COVID-19. The management involved a blood transfusion and a specific medication regimen to alleviate the patient’s symptoms. Importantly, blood transfusions could potentially contribute to the patient’s positive outcome, suggesting their importance in similar cases. This case highlights the challenges modelled by the intersection of COVID-19 and sickle cell anaemia. This combination of diseases needs early intervention and multidisciplinary care. Early identification and management of COVID-19 in sickle cell anaemia patients are crucial. Early intervention may play a vital role in optimising outcomes.

The Magnetic Field in the Colliding Filaments G202.3+2.5

We observe the magnetic field morphology toward a nearby star-forming filamentary cloud, G202.3+2.5, using James Clerk Maxwell Telescope/POL-2 850 μm thermal dust polarization observations with an angular resolution of 14.″4 (∼0.053 pc). The average magnetic field orientation is found to be perpendicular to the filaments, while showing different behaviors in the four subregions, suggesting various effects from the filaments’ collision in these subregions. With the kinematics obtained by the N2H+ observation by IRAM, we estimate the plane-of-sky magnetic field strength by two methods, the classical Davis–Chandrasekhar–Fermi (DCF) method and the angular dispersion function (ADF) method, giving B pos,dcf and B pos,adf of ∼90 and ∼53 μG. We study the relative importance between the gravity (G), magnetic field (B), and turbulence (T) in the four subregions, and find G > T > B, G ≥ T > B, G ∼ T > B, and T > G > B in the north tail, west trunk, south root, and east wing, respectively. In addition, we investigate the projection effects on the DCF and ADF methods, based on a similar simulation case, and find the 3D magnetic field strength may be underestimated by a factor of ∼3 if applying the widely used statistical B pos-to-B 3D factor when using the DCF or ADF methods, which may further underestimate/overestimate the related parameters.

Spontaneous Urethrocutaneous Fistula in Child with Spastic Cerebral Palsy: A Case Report

Urethrocutaneous fistulas are complications that usually seen after hypospadias repair. Spontaneous urethrocutaneous fistulas are extremely rare disorders unless related to the surgery of hypospadias. These fistulas are not associated with hypospadias repair, infection and trauma. While there are few cases reported in adults, there are no cases reported in children. Urethrocutaneous fistulas may rarely be encountered post-trauma, infection or due to weakness of spongious tissue of penis as well as. Children with spastic cerebral palsy often face various problems due to prolonged hospitalizations. Pressure ulcers are among the most common of these issues. Urinary catheterization is frequently performed in these patients for urine monitoring. A 6-year-old male patient with cerebral palsy developed a urethrocutaneous fistula while being monitored in the pediatric intensive care unit. Pre-existing unnoticed partial prepuce and weakness in the corpus spongiosum were present in the patient. We suspect that the development of the urethrocutaneous fistula is attributed to frequent urethral catheterization and the development of decubitus ulcer in the penile region. Since a similar case is not found in the pediatric literature, our aim is to present this case for reference.

Exploring the Feasibility of Using ChatGPT to Create Just-in-Time Adaptive Physical Activity mHealth Intervention Content: Case Study.

Achieving physical activity (PA) guidelines' recommendation of 150 minutes of moderate-to-vigorous PA per week has been shown to reduce the risk of many chronic conditions. Despite the overwhelming evidence in this field, PA levels remain low globally. By creating engaging mobile health (mHealth) interventions through strategies such as just-in-time adaptive interventions (JITAIs) that are tailored to an individual's dynamic state, there is potential to increase PA levels. However, generating personalized content can take a long time due to various versions of content required for the personalization algorithms. ChatGPT presents an incredible opportunity to rapidly produce tailored content; however, there is a lack of studies exploring its feasibility. This study aimed to (1) explore the feasibility of using ChatGPT to create content for a PA JITAI mobile app and (2) describe lessons learned and future recommendations for using ChatGPT in the development of mHealth JITAI content. During phase 1, we used Pathverse, a no-code app builder, and ChatGPT to develop a JITAI app to help parents support their child's PA levels. The intervention was developed based on the Multi-Process Action Control (M-PAC) framework, and the necessary behavior change techniques targeting the M-PAC constructs were implemented in the app design to help parents support their child's PA. The acceptability of using ChatGPT for this purpose was discussed to determine its feasibility. In phase 2, we summarized the lessons we learned during the JITAI content development process using ChatGPT and generated recommendations to inform future similar use cases. In phase 1, by using specific prompts, we efficiently generated content for 13 lessons relating to increasing parental support for their child's PA following the M-PAC framework. It was determined that using ChatGPT for this case study to develop PA content for a JITAI was acceptable. In phase 2, we summarized our recommendations into the following six steps when using ChatGPT to create content for mHealth behavior interventions: (1) determine target behavior, (2) ground the intervention in behavior change theory, (3) design the intervention structure, (4) input intervention structure and behavior change constructs into ChatGPT, (5) revise the ChatGPT response, and (6) customize the response to be used in the intervention. ChatGPT offers a remarkable opportunity for rapid content creation in the context of an mHealth JITAI. Although our case study demonstrated that ChatGPT was acceptable, it is essential to approach its use, along with other language models, with caution. Before delivering content to population groups, expert review is crucial to ensure accuracy and relevancy. Future research and application of these guidelines are imperative as we deepen our understanding of ChatGPT and its interactions with human input.

Rare disease research workflow using multilayer networks elucidates the molecular determinants of severity in Congenital Myasthenic Syndromes

Exploring the molecular basis of disease severity in rare disease scenarios is a challenging task provided the limitations on data availability. Causative genes have been described for Congenital Myasthenic Syndromes (CMS), a group of diverse minority neuromuscular junction (NMJ) disorders; yet a molecular explanation for the phenotypic severity differences remains unclear. Here, we present a workflow to explore the functional relationships between CMS causal genes and altered genes from each patient, based on multilayer network community detection analysis of complementary biomedical information provided by relevant data sources, namely protein-protein interactions, pathways and metabolomics. Our results show that CMS severity can be ascribed to the personalized impairment of extracellular matrix components and postsynaptic modulators of acetylcholine receptor (AChR) clustering. This work showcases how coupling multilayer network analysis with personalized -omics information provides molecular explanations to the varying severity of rare diseases; paving the way for sorting out similar cases in other rare diseases.

Ischémie du segment antérieur de l’œil secondaire à une cryoglobulinémie de type 1 : à propos d’un cas et revue de la littérature

IntroductionType 1 cryoglobulinemia is characterized by a large number of clinical signs. The lack of specificity of these signs can make diagnosis difficult. Ocular manifestations are rarely described across medical literature. Only 15 cases of ophthalmological involvement secondary to cryoglobulinaemia have been reported. CommentWe report the case of a 69-year-old patient with cutaneous type 1 cryoglobulinaemia. He presented with bilateral anterior segment ischemia without retinal involvement with unilateral neovascularisation. Treatment of the B lymphocyte clone with rituximab and bendamustine and plasma exchange were initiated with successfully. Two similar cases describing ischaemic damage to the iris during type 1 cryoglobulinemia have been reported in the literature. ConclusionIrial ischaemia should be considered as a potential in type 1 cryoglobulinaemia.

First report of a p.Cys484Tyr Notch3 mutation in a CADASIL patient with acute bilateral multiple subcortical infarcts—case report and brief review

BackgroundCADASIL(Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)is an inherited small vessel disease caused by mutations in NOTCH3 gene. Although NOTCH3 has numerous hotspots of gene mutations, mutations in exons 9 are rare. The p.C484T gene mutation type associated with it has not been reported in any relevant cases yet. Furthermore, CADASIL patients rarely present with acute bilateral multiple subcortical infarcts.Case presentationWe report the case of a Chinese female patient with CADASIL who experienced “an acute bilateral subcortical infarction” because of“hemodynamic changes and hypercoagulability”. In genetic testing, we discovered a new Cys484Tyr mutation in exon 9, which has also been found in the patient’s two daughters.ConclusionsIt is important to note that this discovery not only expands the mutation spectrum of Notch3 mutations in CADASIL patients, but also examines the mechanism behind acute bilateral subcortical infarction in CADASIL patients via case reviews and literature reviews, in order to provide some clinical recommendations for early intervention, diagnosis, and treatment in similar cases in the future.

A 28-year-old male patient with asymptomatic and multi-drug-resistant HBV infection: a case report

Chronic hepatitis B virus (HBV) infection poses a significant global health challenge, impacting millions of individuals and elevating the risk of morbidity and mortality. Antiviral therapies are the primary treatment for chronic HBV infection, but treatment resistance can occur, leading to poor clinical outcomes and an increased risk of liver complications. This case report presents the clinical trajectory of a 28-year-old male diagnosed with asymptomatic HBV infection in 2016 under the auspices of the Hepatitis Control Program, Government of Azad Jammu and Kashmir, Pakistan. Over 6 years, persistent HBsAg, HBV, and HBeAg were observed, with absent acute markers and co-infections. Initial HBV DNA viral load was 1 × 104 copies/mL in 2016, escalating despite entecavir and pegylated interferons therapy, indicating multi-drug resistance. Tenofovir therapy initially reduced viral load but later exacerbated it, reaching 1.86 × 106 copies/mL in 2022. Liver function abnormalities and lipid profile irregularities persisted. Urine examination consistently showed abnormalities. Pending HBV DNA sequencing results may offer insights into treatment resistance. This case underscores the need for an adaptive approach in managing chronic HBV infections within public health programs. Continuous monitoring, integration of virological and biochemical data, and a tailored treatment strategy are essential for optimizing outcomes in similar cases, stressing the importance of refining therapeutic approaches against chronic HBV infection.

Microvascular decompression of a vertebral artery loop causing cervical radiculopathy: illustrative case.

Vertebral artery loops are a rare cause of cervical radiculopathy. Surgical options for nerve root decompression include an anterior or posterior approach, with or without additional microvascular decompression. The authors describe a case of a 49-year-old man with a long-standing history of left-sided neck pain and migraines, who was found to have a vertebral artery loop in the left C3-4 neural foramen compressing the left C4 nerve root. The patient underwent a posterior cervical decompression with instrumented fusion and macrovascular decompression of the left C4 nerve root via Teflon felt insertion. In a literature review, we identified 20 similar cases that had also been managed surgically. Although the anterior approach is more frequently described in the literature, a posterior approach for nerve compression by a vertebral artery loop is also a safe and effective treatment. The authors report the third case of this surgical approach with a good outcome.

Traumatic gluteus maximus femoral insertion tear

With hip fracture dislocation, there is a wide variety of injuries, and one of the least and rarely to be seen is a gluteus maximus femoral insertion tear. We report this case to encourage further sharing of similar cases, establish a treatment protocol, and avoid such potential complications. We present this rare case of a 36-year-old male, a victim of a severe motor vehicle collision, who presented with a head contusion, right gluteus maximus femoral insertion tear, right hip dislocation with closed posterior wall acetabulum fracture, intra-articular incarcerated fragment, and multiple fractures. After the reduction of his hip and splinting of his concomitant fractures and optimization of the general condition, he underwent open reduction internal fixation of the posterior acetabulum wall. Intraoperatively, he found to have a rupture of gluteus maximus and short external rotators for which he had gluteus maximus direct repair to its insertion and partial repair for his severely damaged external rotators. The patient developed a surgical site infection post operation, treated by multiple sessions of irrigation and debridement and culture-based intravenous venous antibiotics for six weeks. At the 7-month outpatient clinical follow-up, the patient function was able to mobilize with a limping gait using a cane and extreme limitation of his abduction, external rotation, and extension due to the development of heterotopic ossification, which could be due to prolonged intensive care unit admission due to head injury or hip external rotators rupture or multiple surgeries that he underwent. This rare finding of gluteus maximus ruptur is the first of a kind in our institute, and such a finding to be considered before treatment of such severe injuries and questioning the need for magnetic resonance imaging for traumatic hip dislocations plus prophylactic treatment of heterotopic ossification to optimize the functional outcome post-operative.

Hybrid Framework To Exclude Similar and Faulty Test Cases In Regression Testing

Regression testing is a crucial phase in the software development lifecycle that makes sure that new changes/updates in the software system don’t introduce defects or don’t affect adversely the existing functionalities. However, as the software systems grow in complexity, the number of test cases in regression suite can become large which results into more testing time and resource consumption. In addition, the presence of redundant and faulty test cases may affect the efficiency of the regression testing process. Therefore, this paper presents a new Hybrid Framework to Exclude Similar & Faulty Test Cases in Regression Testing (ETCPM) that utilizes automated code analysis techniques and historical test execution data to identity and exclude redundant, similar and faulty test cases from the given regression suite. Our experimental results clearly show the benefits of the ETCPM framework in terms of reduction in the testing time, optimization of the resource allocation, and improvement in the overall quality of regression test suite. ETCPM enables software development teams to achieve faster and reliable regression testing by intelligent exclusion of similar and fault test cases, which yields in reduction in the software delivery cycles and better end user satisfaction.

Takotsubo syndrome linked to paroxysmal sympathetic hyperactivity as a postoperative complication after brain tumor removal: a case report and literature review.

Paroxysmal sympathetic hyperactivity (PSH) is a relatively common syndrome typically observed following traumatic brain injury (TBI). It manifests through a combination of non-specific symptoms that collectively define its presentation. Linked to sympathetic hyperactivity, takotsubo syndrome is a cardiomyopathy marked by left ventricular dysfunction and may coincide with PSH. While various factors can lead to the simultaneous occurrence of these syndromes, a notably rare scenario involves their manifestation after brain tumor removal. The nonspecific nature of PSH symptoms and of the cardiac dysfunction in takotsubo syndrome pose challenges in accurately diagnosing these conditions in an intensive care unit (ICU) setting. They often overlap with more prevalent diagnoses like sepsis, pulmonary embolism, and acute heart failure. Thus, it is crucial for clinicians dealing with these patients to be aware that symptoms indicating sympathetic activity surge and left heart failure might prompt consideration of takotsubo syndrome and PSH. This study presents the case of an 8-year-old girl who developed takotsubo syndrome associated with sympathetic hyperactivity following the surgical removal of a bulbar tumor. To the best of our knowledge, this is the tenth case of PSH following brain tumor removal in a pediatric patient and the first reported case of occurrence of takotsubo linked to PSH after brain tumor removal. We offer a detailed account of the patient's clinical journey in the ICU, accompanied by a comprehensive review of relevant literature to identify similar cases. The significance of this case study lies in emphasizing the potential occurrence of takotsubo syndrome due to PSH and underscores the importance of early diagnosis and management due to their association with unfavorable clinical outcomes.

Political and economic instrumentalisation of science: Towards an extended concept of corruption

AbstractPopular perception holds that science has been distorted by the pressure of expectations of economic utility or political desirability. Grounded in Niklas Luhmann's system theory, this paper examines the interplay of the political, economic and scientific subsystem of society to scrutinise the idea that science has been corrupted by economy and politics. To this end, we extend the notion of corruption beyond the common, predominantly legal meaning. As a result, we identify organisations as loci of corruptions that can occur at the interfaces of economy, politics and law as much as at the interfaces of science, education and economy or science, politics and health. We conclude that further conceptual and empirical research on these and similar cases of corruption is a worthy scientific goal.