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Frequency, clinical presentation and outcome of vigilance impairment in patients with uni- and bilateral ischemic infarction of the paramedian thalamus.

J Neurol 2021 Apr 21. Epub 2021 Apr 21.

Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.

Ischemic stroke of the paramedian thalamus is a rare differential diagnosis in sudden altered vigilance states. While efforts to describe clinical symptomatology exist, data on the frequency of paramedian thalamic stroke as a cause of sudden impaired vigilance and on accompanying clinical signs and outcome are scarce. We retrospectively analyzed consecutive patients admitted to a tertiary stroke center between 2010 and 2019 diagnosed with paramedian thalamic stroke. Read More

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Post-COVID Multisystem Inflammatory Syndrome in the Deployed Environment.

Mil Med 2021 Apr 21. Epub 2021 Apr 21.

Family Medicine Residency, Eglin AFB, Eglin AFB, FL 32542, USA.

Cases of multisystem inflammatory syndrome after current or previous SARS-CoV-2 infection have been extensively documented in children. Although there has been recent recognition of a similar adult post-COVID entity known as multisystem inflammatory syndrome in adults (MIS-A), these cases have rarely been reported. This report describes the case of a soldier in the deployed setting with a benign initial clinical presentation who rapidly developed life-threatening MIS-A. Read More

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Gynecomastia as a presenting symptom of Graves' disease in a 49-year-old man.

Endocrinol Diabetes Metab Case Rep 2021 Apr 1;2021. Epub 2021 Apr 1.

Department of Internal MedicineNorthwest Clinics, Alkmaar, the Netherlands.

Summary: Gynecomastia is a symptom with a potential high disease burden. It has a variety of underlying causes, such as malignant, drug-related or hormonal. The presence of gynecomastia can be explained in thyrotoxicosis due to a concomitant disbalance of sex hormones. Read More

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Cortical involvement determines impairment 30 years after a clinically isolated syndrome.

Brain 2021 Apr 21. Epub 2021 Apr 21.

NMR Research Unit, Queen Square Multiple Sclerosis Centre, Queen Square Institute of Neurology, University College London, London, UK.

Many studies report an overlap of MRI and clinical findings between patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), which in part is reflective of inclusion of subjects with variable disease duration and short periods of follow-up. To overcome these limitations, we examined the differences between RRMS and SPMS and the relationship between MRI measures and clinical outcomes 30 years after first presentation with clinically isolated syndrome suggestive of multiple sclerosis. Sixty-three patients were studied 30 years after their initial presentation with a clinically isolated syndrome; only 14% received a disease modifying treatment at any time point. Read More

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Swiss Cheese Loin: A Rare Initial Presentation of Pott's Spine.

Cureus 2021 Mar 15;13(3):e13912. Epub 2021 Mar 15.

Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.

Spinal tuberculosis (TB) is the most common form of skeletal TB with an exceedingly diverse set of clinical presentations. Most often, there is a slow onset of the disease with patients presenting only with back pain. Although some patients can present later with neurological deficits or with compressive symptoms of an accompanying cold abscess, an initial presentation of a spontaneous cutaneous fistulization of a paraspinal abscess is rare. Read More

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Subacute Post-Traumatic Ascending Myelopathy (SPAM) in a Spinal Cord Injured Patient - a Rare Presentation: A Case Report.

Malays Orthop J 2021 Mar;15(1):135-137

Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia.

The optimisation of blood pressure management is critical in managing hypotensive episodes in patients with spinal cord injury. Improper handling of this preventable factor will negatively impact the patient recovery prognosis. A 42-year-old man was admitted for a complete spinal cord injury after fell from height. Read More

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Complete paraplegia 36 h after attempted posterior spinal fusion for severe adolescent idiopathic scoliosis: a case report.

Spinal Cord Ser Cases 2021 Apr 20;7(1):33. Epub 2021 Apr 20.

Institute for Spine and Scoliosis, 3100 Princeton Pike, Lawrenceville, NJ, 08648, USA.

Introduction: The incidence of neurologic complications with spinal surgery for adolescent idiopathic scoliosis (AIS) has been reported to be 0.69%. This rare complication typically occurs during surgery or immediately postoperatively. Read More

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Epinephrine Auto-Injection After Allergic Reaction Leading to Gas Gangrene of the Leg.

Am J Case Rep 2021 Apr 21;22:e930889. Epub 2021 Apr 21.

Department of Pharmacy, Mercy Health - St. Elizabeth Youngstown Hospital, Youngstown, OH, USA.

BACKGROUND Clostridial myonecrosis, also known as gas gangrene, is a highly lethal necrotizing soft tissue infection. While commonly associated with trauma, clostridial myonecrosis may be the result of parenteral injection of medications. Epinephrine is the most commonly reported medication leading to gas gangrene. Read More

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Gender differences in clinical presentation and illicit substance use during first episode psychosis: a natural language processing, electronic case register study.

BMJ Open 2021 Apr 20;11(4):e042949. Epub 2021 Apr 20.

Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK.

Objective: To determine whether gender differences in symptom presentation at first episode psychosis (FEP) remain even when controlling for substance use, age and ethnicity, using natural language processing applied to electronic health records (EHRs).

Design, Setting And Participants: Data were extracted from EHRs of 3350 people (62% male patients) who had presented to the South London and Maudsley NHS Trust with a FEP between 1 April 2007 and 31 March 2017. Logistic regression was used to examine gender differences in the presentation of positive, negative, depressive, mania and disorganisation symptoms. Read More

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Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report.

Int J Surg Case Rep 2021 Apr 15;82:105889. Epub 2021 Apr 15.

Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania; Department of Urology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania.

Introduction And Importance: Advanced prostate cancer often presents with lower urinary tract symptoms together with features of cancer on digital rectal examination. The commonest sites of metastasis include bone, liver and lungs. Metastasis to axillary lymph nodes is extremely unusual particularly as initial presentation of the disease. Read More

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Epidemiological and Clinical Presentations of Hospitalized COVID-19 patients in Libya: an initial report from Africa.

Travel Med Infect Dis 2021 Apr 17:102064. Epub 2021 Apr 17.

Faculty of Medicine, University of Tripoli, Tripoli, Libya. Electronic address:

Background: The first case of the novel coronavirus disease 2019 (COVID-19) in Libya was diagnosed in March 2020. We aimed to determine the epidemiological, clinical, and laboratory characteristics of COVID-19 in Libya.

Method: In this retrospective descriptive study, we analyzed the demographics, initial clinical presentation, history, comorbidities, laboratory findings, complications, and outcomes of hospitalized patients with COVID-19 at several centers in the Western part of Libya between March 24, 2020, and December 3, 2020. Read More

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Prognostic value of sternal lymphadenopathy on malignancy and survival in dogs undergoing splenectomy.

Vet Comp Oncol 2021 Apr 20. Epub 2021 Apr 20.

VCA Animal Specialty and Emergency Center, 1535 S Sepulveda Blvd, Los Angeles, CA, 90025.

The purpose of this retrospective cohort study was to determine prevalence of sternal lymphadenopathy in a population of dogs undergoing splenectomy, and to evaluate if the prevalence was associated with splenic malignancy. In addition, the study investigated if survival in dogs diagnosed with hemangiosarcoma (HSA) differed between those with or without sternal lymphadenopathy at the time of surgery. Digital radiographs and medical records for dogs who underwent splenectomy from 2013 to 2016 where retrospectively reviewed. Read More

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Intracranial aneurysms in pediatric population: a two-center audit.

Childs Nerv Syst 2021 Apr 20. Epub 2021 Apr 20.

Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.

Objective: Intracranial aneurysms (IA) in children are rare, accounting for less than 5% of all IA. Due to their scarcity, the epidemiology is poorly understood and differs from adults in term of clinical presentation, size, location, and origin. Consequently, the treatment strategies are specific and cannot be only based on data from adult series. Read More

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Clinical characteristics of progressive nonarteritic anterior ischemic optic neuropathy.

Int J Ophthalmol 2021 18;14(4):517-522. Epub 2021 Apr 18.

Neuro Ophthalmology Unit, Ophthalmology Department, Rabin Medical Center, Petah Tikva 4941492, Israel.

Aim: To study whether patients with progressive nonarteritic anterior ischemic optic neuropathy (NAION) present earlier than patients with stable NAION and to describe their clinical characteristics and visual outcome.

Methods: This was a retrospective chart review. All patients with NAION seen during the acute stage from January 2012 to December 2018 were reviewed. Read More

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Clinical and Neuroimaging Outcomes of Direct Thrombectomy vs Bridging Therapy in Large Vessel Occlusion: Analysis of the SELECT Cohort Study.

Neurology 2021 Apr 19. Epub 2021 Apr 19.

The University of Tennessee Health Science Center, Memphis, USA.

Objective: To evaluate the comparative safety and efficacy of direct endovascular thrombectomy(dEVT) compared to bridging therapy(BT:IV-tPA+EVT) and assess if BT potential benefit relates to stroke severity, size and initial presentation to EVT vs. non-EVT center.

Methods: In a prospective multicenter cohort-study of imaging selection for endovascular thrombectomy[SELECT], anterior-circulation large vessel occlusion (LVO) patients presenting to EVT-capable centers within 4. Read More

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Severe metabolic ketoacidosis as a primary manifestation of SARS-CoV-2 infection in non-diabetic pregnancy.

BMJ Case Rep 2021 Apr 19;14(4). Epub 2021 Apr 19.

Obstetrics & Gynaecology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands.

We present a case of a metabolic acidosis in a term-pregnant woman with SARS-CoV-2 infection.Our patient presented with dyspnoea, tachypnoea, thoracic pain and a 2-day history of vomiting, initially attributed to COVID-19 pneumonia. Differential diagnosis was expanded when arterial blood gas showed a high anion gap metabolic non-lactate acidosis without hypoxaemia. Read More

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Clinical Profiles of Black and White Children Referred for Autism Diagnosis.

J Autism Dev Disord 2021 Apr 19. Epub 2021 Apr 19.

Department of Pediatrics, Oregon Health & Science University, Portland, USA.

Black children with autism are diagnosed at an older age. Whether or not late detection is paralleled by differing clinical presentation is not known. We evaluated symptom profiles of 245 Black and 488 sex- and age-matched White non-Hispanic participants (82. Read More

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Hemorrhagic pericardial tamponade in a peritoneal dialysis patient.

J Chin Med Assoc 2021 Apr 12. Epub 2021 Apr 12.

School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Uremic pericarditis and pericardial effusion are possible complications among patients with end-stage renal disease. The accumulation of toxic metabolites may contribute to the pathogenesis of uremic pericarditis. Bleeding diathesis in peritoneal dialysis patients raises the risk of hemorrhagic pericardial tamponade, which is a fatal complication of peritoneal dialysis. Read More

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A case of extramedullary T-lymphoblastic blast crisis as an initial presentation of chronic myelogenous leukemia.

Int J Lab Hematol 2021 Apr 18. Epub 2021 Apr 18.

Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.

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Anomalous aortic origin of the left main coronary artery associated with arterial compression-Case report.

J Card Surg 2021 Apr 19. Epub 2021 Apr 19.

Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, São Paulo, Brazil.

Background: Anomalous aortic origin of coronary artery is a rare finding, with varied presentation and symptomatology. Increasingly recognized by cardiac imaging, when found it raises questions about the appropriate approach and management.

Case Presentation: We present a case of an 11-year-old female who presented with episodes of shortness of breath, angina, and syncope during exercise. Read More

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Can vital signs recorded in patients' homes aid decision making in emergency care? A Scoping Review.

Resusc Plus 2021 Jun 10;6:100116. Epub 2021 Apr 10.

School of Medical Sciences, Bangor University, Bangor, United Kingdom.

Aim: Use of tele-health programs and wearable sensors that allow patients to monitor their own vital signs have been expanded in response to COVID-19. We aimed to explore the utility of patient-held data during presentation as medical emergencies.

Methods: We undertook a systematic scoping review of two groups of studies: studies using non-invasive vital sign monitoring in patients with chronic diseases aimed at preventing unscheduled reviews in primary care, hospitalization or emergency department visits and studies using vital sign measurements from wearable sensors for decision making by clinicians on presentation of these patients as emergencies. Read More

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Endocarditis and systemic embolization from Whipple's disease.

IDCases 2021 31;24:e01105. Epub 2021 Mar 31.

University of Vermont Medical Center, Larner College of Medicine at the University of Vermont, Burlington, VT, United States.

Whipple's disease (WD), caused by infection with the organism , is a rare disease that classically presents with diarrhea, weight loss, and polyarthralgia. Less commonly, Whipple's Disease can presentation with endocarditis or neurologic infections. The authors report a patient with Whipple's Disease endocarditis whose initial presentation was acute lower extremity arterial occlusion, and review current literature regarding the epidemiology, diagnosis, treatment, and prognosis of Whipple's Disease endocarditis. Read More

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A Case Report of Sick Sinus Syndrome as an Initial Presentation of Primary Amyloidosis.

Cureus 2021 Mar 16;13(3):e13922. Epub 2021 Mar 16.

Internal Medicine/Nephrology, McLaren Health Care, Flint/Michigan State University, Michigan, USA.

Primary light chain amyloidosis (AL amyloidosis) rarely presents as sick sinus syndrome (SSS), and only a few cases have been reported in the literature. A higher index of suspicion is needed to diagnose AL amyloidosis in patients presenting with SSS. Recognizing the electrocardiography (ECG) and transthoracic echocardiogram (TTE) findings for amyloidosis are crucial for early recognition, proper management, and to improve the patients' quality of life. Read More

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A case report on a protracted course of a hidden insulinoma.

Ann Med Surg (Lond) 2021 Apr 24;64:102240. Epub 2021 Mar 24.

Endocrine Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), 47000, Jalan Hospital, Sungai Buloh, Selangor, Malaysia.

Introduction: Insulinoma is a functioning pancreatic neuroendocrine tumor primarily leading due to hypoglycemia due to hypersecretion of insulin. This case illustrates the real challenges faced in the detection of an occult insulinoma, which resulted in a protracted course of the disease.

Case Presentation: A 33-year-old female presented with recurrent hypoglycemia. Read More

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From Blocking Shots to Blocking GI Transit, This Professional Basketball Player Does It All: A Case Report on Small Bowel Obstruction.

Case Rep Med 2021 1;2021:5534945. Epub 2021 Apr 1.

Investigation Performed at the Emory Clinic, Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia.

Small bowel obstructions (SBO) are a commonly encountered diagnosis within emergency departments. Typically, these patients have evident risk factors including, but not limited to, prior abdominal surgery, personal or family history of gastrointestinal disorders, femoral and inguinal hernias, or neoplasm. In this case, we describe an SBO in a female, professional athlete whose swift, severe symptom onset, rapid resolution with conservative treatment, lack of identifiable risk factors, and prompt return to high level competition without recurrence are certainly unique. Read More

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Everolimus Related Fulminant Hepatitis in Pancreatic Neuroendocrine Tumor With Liver Metastases: A Case Report and Literature Review.

Front Endocrinol (Lausanne) 2021 1;12:639967. Epub 2021 Apr 1.

Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Background: Everolimus, an immunosuppressant, is approved for the treatment of advanced renal cell carcinoma, metastatic hormone receptor-positive breast cancer, and pancreatic neuroendocrine tumors (P-NETs) but has been reported to be related to hepatitis B reactivation. Here, we present the first case of fatal fulminant hepatitis B reactivation in a man with P-NET accompanied by multiple liver metastases who received everolimus and octreotide long-acting repeatable (LAR).

Case Presentation: A 45-year-old male had a history of chronic hepatitis B infection. Read More

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Snoring Is Associated With Increased Risk of Stroke: A Cumulative Meta-Analysis.

Front Neurol 2021 1;12:574649. Epub 2021 Apr 1.

Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China.

Several studies have suggested that snoring is associated with an increased risk of stroke; however, the results are inconsistent. We aim to conduct a systematic review and meta-analysis of observational studies assessing the association between snoring and the risk of stroke in adults. We searched PubMed for relevant studies. Read More

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Breathlessness and cough in the acute setting.

Medicine (Abingdon) 2021 Feb 17;49(2):93-97. Epub 2020 Dec 17.

is a Consultant Chest Physician at the University Hospital of Southampton and Honorary Associate Professor at the University of Southampton, UK, where he leads subspecialist services in pneumonia, tuberculosis and interstitial lung diseases. His research interests also lie in these disease areas. Competing interests: none declared.

The symptom of breathlessness is well recognized as part of the presentation of a wide range of medical conditions. It can be a manifestation of a life-threatening emergency. In acute medical settings, the priority is to quickly recognize patients who are critically unwell and require emergency treatment. Read More

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February 2021

The Role of Procalcitonin in Antibiotic Decision-Making in Covid-19 Infection.

Infect Control Hosp Epidemiol 2021 Apr 19:1-24. Epub 2021 Apr 19.

Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine.

Objective: To evaluate the role of procalcitonin (PCT) in antibiotic decisions for COVID-19 patients at hospital presentation.

Design, Setting And Participants: Multicenter retrospective observational study of patients 18 years hospitalized due to COVID-19 at the Johns Hopkins Health system. Patients who were transferred from another facility with >24 hours stay and patients who died within 48 hours of hospitalization were excluded. Read More

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Pathologic and oncologic outcomes in patients with sarcomatoid differentiation undergoing cystectomy.

BJU Int 2021 Apr 18. Epub 2021 Apr 18.

Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center.

Objective: To evaluate whether urothelial carcinoma with sarcomatoid differentiation is associated with a lower pathologic response rate to neoadjuvant chemotherapy and worse oncologic outcomes compared to urothelial carcinoma without variant histology among patients undergoing radical cystectomy.

Patients And Methods: Patients with urothelial carcinoma undergoing cystectomy from 1995-2018 at Memorial Sloan Kettering were identified. Patients with sarcomatoid differentiation at transurethral resection or cystectomy and patients without variant histology were selected. Read More

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