Journal of medical cases最新文献

{"title":"An Atypical Case of Superior Vena Cava Syndrome Due to Sarcomatoid Lung Cancer With Pericardial Metastasis.","authors":"Aryan Patel, Linda Akbarshahi, Jotrineesha L Walton, Hardeep Singh","doi":"10.14740/jmc5293","DOIUrl":"10.14740/jmc5293","url":null,"abstract":"<p><p>Superior vena cava (SVC) syndrome is commonly caused by malignancies from lung cancers, thrombus, and indwelling intravascular devices. Specifically, SVC syndrome is mostly associated with malignancies such as small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Pulmonary sarcomatoid carcinoma (PSC), as a rare type of NSCLC, accounts for 0.1% to 0.4% of pulmonary tumors. PSC's rapid progression, aggressive growth, and complexity to diagnose help differentiate from other thoracic malignancies, yet due to its rarity, there is limited literature documenting an association between this entity and SVC syndrome. Here we present an atypical case of SVC syndrome with a history of tobacco use and chronic right upper extremity lymphedema who developed facial swelling, dyspnea, and worsening right upper extremity swelling. Imaging revealed a large mediastinal mass compressing both the SVC and pulmonary artery. Further workup and endobronchial ultrasound (EBUS) were performed, which led to a diagnosis of poorly differentiated sarcomatoid carcinoma. Additionally, pericardiocentesis revealed features consistent with adenocarcinoma. The case was further complicated with hypoxic respiratory failure and new-onset atrial fibrillation. With extensive intensive care unit (ICU) care, the patient was discharged with a medication regiment, and referred to oncology, cardiology, and palliative care. Patient declined chemotherapy and immunotherapy, opting for hospice care. Patient stay was complicated by hypoxia respiratory failure, pleural effusions, pericardial effusion, and atrial fibrillation with rapid ventricular response (RVR). This case emphasizes that SVC syndrome can be associated with poorly differentiated sarcomatoid carcinoma.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 6","pages":"258-262"},"PeriodicalIF":0.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omental Serous Cystadenofibroma Mimicking Disseminated Malignancy: A Rare Pathology.","authors":"Chibuike Ezeibe, Loren Walwyn-Tross, Dusan Perisic","doi":"10.14740/jmc5316","DOIUrl":"10.14740/jmc5316","url":null,"abstract":"<p><p>Serous cystadenofibromas are rare benign epithelial ovarian tumors. They account for < 2% of benign ovarian tumors and typically affect individuals aged 15-65. In rare cases, these tumors present with scattered pelvic lesions resembling malignant dissemination. A 68-year-old female presented with pelvic pain. Pelvic sonogram revealed a 6 cm mass anterior to the cecum and bilateral cystic ovarian lesions measuring approximately 5 and 4 cm on the right and left, respectively. Subsequent pelvic magnetic resonance imaging (MRI) confirmed multicystic complex ovarian masses and a 6 cm multicystic mass along the cecum. Colonoscopy revealed no intrinsic rectal or sigmoid disease. She was subsequently referred to minimally invasive gynecology surgery and colorectal surgery for further management. Tumor markers and a ROMA panel were within normal limits. Computed tomography (CT) of abdomen/pelvis redemonstrated a multilobulated, cystic mass in the right lower quadrant with adjacent satellite lesions and bilateral cystic adnexal masses. Surgical intervention included robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, extensive lysis of adhesions, and infracolic omentectomy. Intraoperative findings revealed dense adhesions between the omentum, right adnexa, pelvic sidewall, and cecum. Frozen section revealed bilateral ovarian cystadenofibroma and omental tissue with benign cystic lesions resembling serous cystadenofibroma. Postoperatively, the patient had an uneventful recovery. Serous cystadenofibromas are associated with a favorable prognosis after complete resection of the tumor. The use of preoperative imaging and intraoperative frozen sections can help guide appropriate surgical management. However, these tumors pose diagnostic challenges due to their complex nature of adnexal masses with solid and cystic elements, often leading to misdiagnosis of malignancy. In rare cases, the presence of multiple lesions may be more consistent with multicentric development or independent primary lesions rather than true dissemination. Although malignancy must be carefully excluded, disseminated benign serous cystadenofibroma implants may radiologically and intraoperatively mimic peritoneal carcinomatosis, underscoring the importance of a broad differential diagnosis to guide intraoperative judgment and avoid overtreatment.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 6","pages":"292-295"},"PeriodicalIF":0.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergence of a <i>Citrobacter amalonaticus</i> Strain Co-Producing Three Carbapenemases: Molecular Insights and Resistance Profiles.","authors":"Hawra Alsanna, Hussam Leskafi, Amani Alnimr, Shouq F Alghannam, Sarah S Alotaibi, Mohammad N Alomary, Hatim Almutairi, Mashael Faisal Alghuraybi, Aisha Alamri","doi":"10.14740/jmc5285","DOIUrl":"10.14740/jmc5285","url":null,"abstract":"<p><p>The emergence of carbapenemase-producing organisms poses an escalating public health risk. In this case study, we used whole-genome sequencing (WGS) to characterize the carbapenem resistance mechanisms of a multidrug-resistant <i>Citrobacter amalonaticus</i> (<i>C. amalonaticus</i>) strain recovered from a surgical site infection. The isolate was initially identified using a MALDI-TOF mass spectrometry system. Phenotypic antibiotic susceptibility testing revealed the presence of carbapenem-resistant <i>C. amalonaticus</i> isolate with high-level resistance to both imipenem and meropenem (imipenem minimum inhibitory concentration (MIC) ≥ 32 mg/L; meropenem MIC ≥ 32 mg/L). Rapid screening of the carbapenemase-encoding genes using the GeneXpert system revealed the presence of <i>bla</i>OXA-48, <i>bla</i>NDM, and <i>bla</i>KPC. WGS performed on an Illumina NovaSeq 6000 platform demonstrated the presence of <i>bla</i>NDM-1, which was chromosomally integrated. <i>In silico</i> analysis suggested that <i>bla</i>KPC-2 and <i>bla</i>OXA-48 were associated with distinct plasmid replicons (IncQ2 and IncL/M, respectively), although complete plasmid reconstruction was not possible using short-read sequencing. The convergence of multiple carbapenemase genes in <i>C. amalonaticus</i> indicates an urgent shift in the landscape of carbapenem resistance beyond that of traditional high-risk pathogens. These findings underscore the need for enhanced active surveillance of <i>Citrobacter</i> spp. as emergent reservoirs of carbapenemase genes. Early detection of these novel resistance determinants is essential for strengthening targeted infection control strategies and optimizing antimicrobial stewardship interventions at regional, national, and global levels.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 5","pages":"213-220"},"PeriodicalIF":0.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex Oncologic Surgery in a Nonagenarian With Severe Aortic Stenosis: Integration of Enhanced Recovery After Surgery Protocol, Total Intravenous Anesthesia, and Advanced Hemodynamic Monitoring.","authors":"Alert Drishti, Teuta Dedej-Kurti, Rudin Domi, Gentian Huti, Asead Abdyli, Driola Hoxha, Oliatina Demiri, Besnik Filaj, Diamant Lulaj, Krenar Lilaj, Majlinda Naco, Alma Cani, Hektor Sula, Filadelfo Coniglione, Vedat Eljezi","doi":"10.14740/jmc5279","DOIUrl":"10.14740/jmc5279","url":null,"abstract":"<p><p>The number of elderly patients presenting for major surgery is steadily increasing, and perioperative management in this population remains challenging because of frailty, multiple comorbidities, and reduced physiological reserve. Severe aortic stenosis represents a particularly high-risk condition due to fixed stroke volume and sensitivity to even brief episodes of hypotension or tachycardia. We describe the perioperative course of a 92-year-old woman who underwent combined right radical nephroureterectomy, cystectomy, and total hysterectomy with bilateral salpingo-oophorectomy, using a multimodal strategy that included total intravenous anesthesia, enhanced recovery after surgery principles, and advanced hemodynamic monitoring with MOSTCARE. Despite considerable cardiovascular and surgical risk, intraoperative hemodynamics remained stable, the patient was extubated in the intensive care unit 2 h after surgery, and postoperative recovery was uneventful. This case demonstrates that well-selected very elderly patients may successfully undergo complex oncologic surgery when care is individualized, multidisciplinary collaboration is strong, and modern perioperative strategies are rigorously applied.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 5","pages":"190-200"},"PeriodicalIF":0.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Care of a Six-Year-Old Child With Atlanto-Occipital Dislocation: A Focus on Techniques of Airway Management.","authors":"Marwan Hillis, Edison E Villalobos, Christopher Lancaster, Tariq Wani, Joseph D Tobias","doi":"10.14740/jmc5289","DOIUrl":"10.14740/jmc5289","url":null,"abstract":"<p><p>Atlanto-occipital dislocation (AOD), once regarded as a rare and almost universally fatal injury identified primarily at autopsy, is now recognized with increased frequency in surviving trauma patients. Improved diagnostic imaging, coupled with advances across the entire continuum of trauma care, has resulted in the potential survivability of this devastating injury. Despite the high mortality associated with this devastating injury, survival with successful outcome is feasible. Airway management in patients with AOD must balance minimizing cervical spine movement to prevent exacerbation of neurologic injury, continued resuscitation and maintenance of cerebral blood flow, while securing the airway to ensure effective oxygenation and ventilation. We present a 6-year-old female patient who sustained significant polytrauma, including AOD, and who, after cervical spine fusion and instrumentation, subsequently presented for elective surgical repair of an associated brachial plexus injury. The mechanisms underlying AOD are described, key anatomical considerations of the cervical spine are reviewed, and the perioperative management of patients with this complex injury is discussed with a focus on the various techniques used for airway management during various surgical and radiologic procedures.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 5","pages":"206-212"},"PeriodicalIF":0.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of Hepatitis B Virus Reactivation and CD19 Testing Following Tafasitamab Plus Lenalidomide for Relapsed Diffuse Large B-Cell Lymphoma.","authors":"Ta-Chuan Yu, Wen-Chien Chou","doi":"10.14740/jmc5313","DOIUrl":"10.14740/jmc5313","url":null,"abstract":"<p><p>The outcomes of transplant-ineligible patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) are generally poor but much improved by novel targeted therapies and immunotherapies. Tafasitamab plus lenalidomide is an approved regimen for patients with R/R DLBCL. Nonetheless, the clinical data regarding Asian populations and hepatitis B virus (HBV) carriers are lacking in both the pivotal L-MIND and real-world studies. We present an 81-year-old HBV carrier with relapsed DLBCL, who achieved and continued a complete metabolic response (CMR) during 1.5 years of tafasitamab plus lenalidomide as second-line therapy. Notably, an episode of HBV reactivation occurred after four cycles of tafasitamab plus lenalidomide, which was early detected and successfully managed with preemptive nucleotide analogues. Interestingly, CD19 was not detectable by flow cytometry after 10 cycles of treatment despite continuous control of the disease. CD19 expression may be diminished by exams using a tafasitamab-competitive-binding clone. This case highlights not only the concern of HBV reactivation, but also the diagnostic challenge due to CD19 epitope masking following tafasitamab therapy.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 5","pages":"231-237"},"PeriodicalIF":0.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Presentation of Left Ventricular Noncompaction Cardiomyopathy Revealed by Acute Decompensated Heart Failure.","authors":"Akanksha Sirohi, Sahithi Burra, Saurav Pahal, Sridhar Mangalesh, Laura Marcela Romero Acero, Michele Nanna","doi":"10.14740/jmc5284","DOIUrl":"10.14740/jmc5284","url":null,"abstract":"<p><p>Left ventricular noncompaction (LVNC) is an uncommon genetic cardiomyopathy characterized by excessive trabeculations resulting from incomplete myocardial compaction and may remain clinically silent until adulthood. We report the case of a 62-year-old woman with no prior cardiovascular disease who presented with progressive dyspnea, orthopnea, lower extremity edema, and new-onset rapid atrial fibrillation, resulting in acute decompensated heart failure. Initial evaluation revealed elevated blood pressure, irregularly irregular rhythm, pulmonary crackles, and lower limb edema. Transthoracic echocardiography demonstrated a left ventricular ejection fraction of approximately 25%, diffuse hypokinesis, and a distinct two-layered myocardium with prominent apical and lateral trabeculations consistent with LVNC. Coronary angiography ruled out obstructive coronary artery disease, and transesophageal echocardiography confirmed severe systolic dysfunction without atrial thrombus before successful cardioversion. The patient improved with intravenous loop diuretics, initiation of guideline-directed medical therapy, and anticoagulation due to her atrial fibrillation and reduced ejection fraction. This case highlights an uncommon presentation of previously unrecognized LVNC diagnosed in the setting of acute heart failure triggered by arrhythmia, underscoring the importance of echocardiography in differentiating cardiomyopathy phenotypes. Early recognition is essential, as LVNC carries increased risks of arrhythmias, thromboembolic events, and progressive heart failure. Clinicians should maintain a high index of suspicion for LVNC in adults presenting with unexplained systolic dysfunction and excessive trabeculation on imaging, particularly when accompanied by atrial fibrillation.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 5","pages":"201-205"},"PeriodicalIF":0.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Urticarial Reaction Above the Site of an Intravenous Cannula: Possible Allergy to Remimazolam in a Fourteen-Year-Old Adolescent.","authors":"Caleb Blake, Marco Corridore, Sarah Khan, Brittany L Willer, Joseph D Tobias","doi":"10.14740/jmc5296","DOIUrl":"10.14740/jmc5296","url":null,"abstract":"<p><p>Remimazolam is an intravenous, ultra-short acting benzodiazepine that has been most commonly used for procedural sedation. It received approval for procedural sedation in adults by the United States Food and Drug Administration (FDA) in 2020. Despite an overall favorable safety profile, anecdotal experience has suggested a potential for allergic phenomena, including anaphylaxis. We present a 14-year-old patient who developed a localized reaction with urticaria in an extremity following the administration of remimazolam. Although we cannot definitively identify remimazolam as the cause of the hypersensitivity reaction and no formal allergy testing was completed, the temporal association of its administration with the development of the local reaction suggests a possible relationship. Previous reports of allergic reactions following the administration of remimazolam are reviewed, mechanisms discussed, and guidelines for clinical care presented.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 5","pages":"226-230"},"PeriodicalIF":0.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Philadelphia Chromosome-Negative B-Cell Acute Lymphoblastic Leukemia Following Prolonged Lenalidomide Maintenance in Multiple Myeloma.","authors":"Jessica Thomas, Yagnapriya Ammakola, Waqqas Tai, Afoma Anyadibe, Anuoluwa Oyetoran, Sarang Khan, Ishmael Jaiyesimi","doi":"10.14740/jmc5274","DOIUrl":"10.14740/jmc5274","url":null,"abstract":"<p><p>Lenalidomide maintenance significantly improves survival in multiple myeloma (MM) but increases the risk of second primary malignancies (SPMs), with the most common hematologic SPMs being myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Secondary B-cell acute lymphoblastic leukemia (B-ALL) is rare. We describe a 62-year-old woman diagnosed with immunoglobulin G lambda MM with extramedullary disease. She achieved remission following induction with lenalidomide, carfilzomib, and dexamethasone, followed by autologous stem cell transplantation. Lenalidomide maintenance was continued for over 4 years, then discontinued due to fatigue. Nearly 1 year later, she presented with bruising and thrombocytopenia. Bone marrow biopsy confirmed Philadelphia chromosome-negative B-ALL with a complex karyotype. She achieved remission with mini-hyper-CVD (cyclophosphamide, vincristine, dexamethasone) plus inotuzumab ozogamicin and rituximab, followed by allogeneic transplantation. This case illustrates lenalidomide-associated B-ALL as a rare late complication of maintenance therapy in MM, underscoring the need for vigilance and early diagnostic evaluation.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 5","pages":"183-189"},"PeriodicalIF":0.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Treatment of Overlapping Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease and Glial Fibrillary Acidic Protein Astrocytopathy With Plasma Exchange.","authors":"Chisa Ashida, Tomohiro Suzuki, Jun Sawada, Ryo Yuzawa, Syuichi Tetsuka, Koji Hosoya, Tomoko Ogawa, Ritsuo Hashimoto","doi":"10.14740/jmc5290","DOIUrl":"10.14740/jmc5290","url":null,"abstract":"<p><p>Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) and glial fibrillary acidic protein (GFAP) astrocytopathy are distinct autoimmune inflammatory disorders of the central nervous system (CNS) that occasionally overlap. A 69-year-old man presented with acute gait disturbance, followed by progressive impairment of consciousness, myoclonus, cerebellar ataxia, and hyponatremia. Initial brain magnetic resonance imaging (MRI) revealed a high-intensity lesion in the left thalamus on diffusion-weighted imaging (DWI) and multiple white matter lesions on fluid-attenuated inversion recovery (FLAIR) imaging. While serum anti-MOG antibodies were positive, the clinical features, including progressive impairment of consciousness and hyponatremia, were atypical for MOGAD alone, leading to the identification of anti-GFAPα antibodies in the cerebrospinal fluid (CSF). High-dose corticosteroid therapy (three courses of intravenous methylprednisolone pulse) resulted in only partial clinical improvement. However, subsequent simple plasma exchange (PE) with fresh frozen plasma (FFP) led to marked neurological recovery. The mechanism of recovery is thought to involve the removal of both pathogenic antibodies and pro-inflammatory mediators. By day 82 of hospitalization, the patient was able to ambulate independently. This case suggests that in overlapping autoimmune syndromes, early escalation to PE should be considered when conventional steroid therapy is insufficient.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"17 5","pages":"221-225"},"PeriodicalIF":0.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}