An Autobiographical Case Report on Papillary Thyroid Carcinoma with Positive Antithyroid Antibodies: Coincidence or Correlated?

The relationship between autoimmunity and cancer has been a gray area, with many theories but no solid proof so far. Hashimoto's thyroiditis is an autoimmune disorder and a major cause of hypothyroidism, while papillary thyroid carcinoma is the most common thyroid malignancy generally found in patients younger than 45 years of age. The literature on the correlation between these two disorders is somewhat based on potentially biased histopathological examination from pre-operative fine needle aspiration and post-thyroidectomy samples. Although recent studies are evaluating a possible holistic molecular, hormonal, and histopathological foundation for this correlation, a clear causal relationship has not been established yet. This report illustrates the author's case presentation, treatment, and eventual outcome of the disease when she was diagnosed with papillary thyroid cancer at the age of 25 years, with positive antithyroid peroxidase and antithyroglobulin antibodies.

Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease 2019: Updated Lung Injury Prediction Score.

OBJECTIVE: To develop and validate an updated lung injury prediction score for coronavirus disease 2019 (COVID-19) (c-LIPS) tailored for predicting acute respiratory distress syndrome (ARDS) in COVID-19. PATIENTS AND METHODS: This was a registry-based cohort study using the Viral Infection and Respiratory Illness Universal Study. Hospitalized adult patients between January 2020 and January 2022 were screened. Patients who qualified for ARDS within the first day of admission were excluded. Development cohort consisted of patients enrolled from participating Mayo Clinic sites. The validation analyses were performed on remaining patients enrolled from more than 120 hospitals in 15 countries. The original lung injury prediction score (LIPS) was calculated and enhanced using reported COVID-19-specific laboratory risk factors, constituting c-LIPS. The main outcome was ARDS development and secondary outcomes included hospital mortality, invasive mechanical ventilation, and progression in WHO ordinal scale. RESULTS: The derivation cohort consisted of 3710 patients, of whom 1041 (28.1%) developed ARDS. The c-LIPS discriminated COVID-19 patients who developed ARDS with an area under the curve (AUC) of 0.79 compared with original LIPS (AUC, 0.74; P<.001) with good calibration accuracy (Hosmer-Lemeshow P=.50). Despite different characteristics of the two cohorts, the c-LIPS's performance was comparable in the validation cohort of 5426 patients (15.9% ARDS), with an AUC of 0.74; and its discriminatory performance was significantly higher than the LIPS (AUC, 0.68; P<.001). The c-LIPS's performance in predicting the requirement for invasive mechanical ventilation in derivation and validation cohorts had an AUC of 0.74 and 0.72, respectively. CONCLUSION: In this large patient sample c-LIPS was successfully tailored to predict ARDS in COVID-19 patients.

Immune Thrombocytopenia Induced by Helicobacter pylori Infection: A Case Report and Literature Review.

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the production of autoantibodies against the platelet surface antigens. ITP is a diagnosis of exclusion and is further categorized into primary and secondary ITP. The etiology of primary ITP is idiopathic, and secondary ITP is caused by infections and autoimmune disorders. Among infectious etiology of ITP, human immunodeficiency virus, herpes virus, and hepatitis B and C virus are common. Helicobacter pylori (H. pylori) is a rare cause of ITP, and the relationship between ITP and H. pylori is highlighted in the literature. We report a case of ITP in an adult female who presented with hematemesis and petechial rash in the lower limbs. Her initial laboratory results demonstrated thrombocytopenia, and the results of her gastric biopsy and stool antigen were positive for H. pylori. She was diagnosed with ITP induced by H. pylori because additional causes of ITP were not identified. Her clinical improvement and platelet recovery after initiating H. pylori eradication therapy were consistent with H. pylori-induced ITP.

Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Renal Vasculitis After COVID-19 Infection: A Case Report.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a class of autoimmune diseases that can cause kidney failure because of mononuclear cell infiltration and the destruction of small and medium-sized blood vessels. Coronavirus disease 2019 (COVID-19) may trigger or exacerbate autoimmune diseases. We present a case of ANCA-associated vasculitis in a patient with rheumatoid arthritis after a COVID-19 infection, who presented with intermittent hemoptysis and dyspnea and was diagnosed with COVID-19 pneumonia three weeks ago. Her clinical, radiological, and serological picture was concerned with pulmonary-renal syndrome. Her serum was positive for antinuclear antibody and ANCAs, and renal biopsy showed pauci-immune crescentic glomerulonephritis. She was diagnosed clinicopathologically with pauci-immune glomerulonephritis in the setting of rheumatoid arthritis (RA) after a COVID-19 infection. Her condition improved after she was treated with rituximab and pulse dose methylprednisolone.

Promoting Research, Awareness, and Discussion on AI in Medicine Using #MedTwitterAI: A Longitudinal Twitter Hashtag Analysis.

Background: Artificial intelligence (AI) has the potential to reshape medical practice and the delivery of healthcare. Online discussions surrounding AI's utility in these domains are increasingly emerging, likely due to considerable interest from healthcare practitioners, medical technology developers, and other relevant stakeholders. However, many practitioners and medical students report limited understanding and familiarity with AI. Objective: To promote research, events, and resources at the intersection of AI and medicine for the online medical community, we created a Twitter-based campaign using the hashtag #MedTwitterAI. Methods: In the present study, we analyze the use of #MedTwitterAI by tracking tweets containing this hashtag posted from 26th March, 2019 to 26th March, 2021, using the Symplur Signals hashtag analytics tool. The full text of all #MedTwitterAI tweets was also extracted and subjected to a natural language processing analysis. Results: Over this time period, we identified 7,441 tweets containing #MedTwitterAI, posted by 1,519 unique Twitter users which generated 59,455,569 impressions. The most common identifiable locations for users including this hashtag in tweets were the United States (378/1,519), the United Kingdom (80/1,519), Canada (65/1,519), India (46/1,519), Spain (29/1,519), France (24/1,519), Italy (16/1,519), Australia (16/1,519), Germany (16/1,519), and Brazil (15/1,519). Tweets were frequently enhanced with links (80.2%), mentions of other accounts (93.9%), and photos (56.6%). The five most abundant single words were AI (artificial intelligence), patients, medicine, data, and learning. Sentiment analysis revealed an overall majority of positive single word sentiments (e.g., intelligence, improve) with 230 positive and 172 negative sentiments with a total of 658 and 342 mentions of all positive and negative sentiments, respectively. Most frequently mentioned negative sentiments were cancer, risk, and bias. Most common bigrams identified by Markov chain depiction were related to analytical methods (e.g., label-free detection) and medical conditions/biological processes (e.g., rare circulating tumor cells). Conclusion: These results demonstrate the generated considerable interest of using #MedTwitterAI for promoting relevant content and engaging a broad and geographically diverse audience. The use of hashtags in Twitter-based campaigns can be an effective tool to raise awareness of interdisciplinary fields and enable knowledge-sharing on a global scale.

Acute Pancreatitis: A Rare Complication of Colonoscopy.

Colonoscopy is a well-tolerated therapeutic and diagnostic procedure. Although colonoscopy is relatively safe, a few complications have been reported. Abdominal pain after colonoscopy is one of the most reported symptoms, and acute pancreatitis is uncommon after colonoscopy. We present a case of acute pancreatitis in a 51-year-old female who presented with a complaint of melena. She underwent colonoscopy to rule out lower gastrointestinal pathology and developed sudden onset diffuse abdominal pain and vomiting two hours after the procedure. She was diagnosed with colonoscopy-induced acute pancreatitis based on physical examination and detailed investigations after ruling out all other potential causes. She was treated conservatively with bowel rest, intravenous fluids, analgesic, and prophylactic antibiotics. Abdominal symptoms improved quickly in a few days with complete resolution of abdominal pain, fever, and normalization of serum amylase and lipase. Early recognition and diagnosis can lead to successful treatment, and the patients should be informed about the possibility of this complication before undergoing colonoscopy.

Association of hypothyroidism with outcomes in hospitalized adults with COVID-19: Results from the International SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is associated with high rates of morbidity and mortality. Primary hypothyroidism is a common comorbid condition, but little is known about its association with COVID-19 severity and outcomes. This study aims to identify the frequency of hypothyroidism in hospitalized patients with COVID-19 as well as describe the differences in outcomes between patients with and without pre-existing hypothyroidism using an observational, multinational registry. METHODS: In an observational cohort study we enrolled patients 18 years or older, with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection between March 2020 and February 2021. The primary outcomes were (1) the disease severity defined as per the World Health Organization Scale for Clinical Improvement, which is an ordinal outcome corresponding with the highest severity level recorded during a patient's index COVID-19 hospitalization, (2) in-hospital mortality and (3) hospital-free days. Secondary outcomes were the rate of intensive care unit (ICU) admission and ICU mortality. RESULTS: Among the 20,366 adult patients included in the study, pre-existing hypothyroidism was identified in 1616 (7.9%). The median age for the Hypothyroidism group was 70 (interquartile range: 59-80) years, and 65% were female and 67% were White. The most common comorbidities were hypertension (68%), diabetes (42%), dyslipidemia (37%) and obesity (28%). After adjusting for age, body mass index, sex, admission date in the quarter year since March 2020, race, smoking history and other comorbid conditions (coronary artery disease, hypertension, diabetes and dyslipidemia), pre-existing hypothyroidism was not associated with higher odds of severe disease using the World Health Organization disease severity index (odds ratio [OR]: 1.02; 95% confidence interval [CI]: 0.92, 1.13; p = .69), in-hospital mortality (OR: 1.03; 95% CI: 0.92, 1.15; p = .58) or differences in hospital-free days (estimated difference 0.01 days; 95% CI: -0.45, 0.47; p = .97). Pre-existing hypothyroidism was not associated with ICU admission or ICU mortality in unadjusted as well as in adjusted analysis. CONCLUSIONS: In an international registry, hypothyroidism was identified in around 1 of every 12 adult hospitalized patients with COVID-19. Pre-existing hypothyroidism in hospitalized patients with COVID-19 was not associated with higher disease severity or increased risk of mortality or ICU admissions. However, more research on the possible effects of COVID-19 on the thyroid gland and its function is needed in the future.

Prevalence and Sociodemographic Covariates of Cervical Cancer and Its Association With Menstrual Irregularities: Findings From the 2017 National Inpatient Sample Database.

Background and objective Menstrual irregularities and sociodemographic factors such as increasing age, Hispanic race, low socioeconomic strata, and low income status are known risk factors for cervical cancer. This study aimed to examine the prevalence of cervical cancer and its association with menstrual irregularities and other known risk factors based on a large nationwide inpatient sample database. Methods We used the Nationwide Inpatient Sample (NIS) database for the year 2017 and identified cases where cervical cancer and menstrual irregularities are the primary and co-occurring diagnoses using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Pearson's chi-square test, independent-sample t-test, and multiple logistic regression were used to generate the analysis. Results A total of 15,800 (0.19%) female weighted admissions between the age group of 18-55 years reported a diagnosis of cervical cancer. Patients with a diagnosis of menstrual irregularity had a statistically significant higher odds of association [odds ratio (OR): 1.582] for being diagnosed with cervical cancer. The odds of association were also high for the Hispanic race [OR: 1.280, 95% confidence interval (CI): 1.128-1.453]. The odds of a diagnosis of cervical cancer increased with age, with the highest odds being reported for the age group of 46-55 years (95% CI: 12.107-21.171) and the population with lower median household income, with the highest odds being observed for the lowest interquartile range (95% CI: 1.418-1.892). Conclusion Based on our findings, a diagnosis of menstrual irregularity, the Hispanic race, increasing age, and lower household income are factors that significantly increased the odds of being diagnosed with cervical cancer.

A Rare Case of Vaping-Induced Spontaneous Pneumomediastinum.

Vaping is the process of inhaling an aerosol produced by heating a liquid or wax containing substances such as nicotine, cannabinoids (e.g., tetrahydrocannabinol, cannabidiol), flavoring, and additives (e.g., glycerol, propylene glycol). The presence of air or gas in the mediastinum is pneumomediastinum. We present a rare case of vaping-induced spontaneous pneumomediastinum. A young 20-year-old female patient with a history of vaping and no past medical history presented with acute chest pain to an emergency room. The urine drug screen was positive for cannabinoids. Imaging studies - chest x-ray and computed tomography of the chest - showed pneumomediastinum. The patient was discharged after a day of observation and counseling to quit vaping.

A Spectrum of Pulmonary Complications Occurring in End-Stage Renal Disease Patients on Maintenance Hemodialysis.

Objective To investigate the trends of end-stage renal disease (ESRD) in patients undergoing maintenance hemodialysis (MHD) and find the correlation with effects on the pulmonary system in such patients. Methodology A multicentric prospective study was conducted in the city of Solapur, India. Data were collected from 250 patients through interpersonal interrogation using a questionnaire to capture basic demographic details, the history of ESRD, and relevant respiratory symptoms like breathlessness, cough, fever, etc. related to their disease. Symptoms that are likely associated with the pulmonary system were analyzed and referred to the pulmonology department. Appropriate diagnoses were made using relevant diagnostic tools like X-rays and sputum studies. The association between various disease attributes and pulmonary diagnoses was analyzed using the chi-square (χ2) test, with a p-value of value less than or equal to 0.05 considered statistically significant. Various socio-demographic variables, existing comorbidities, occupation-related risk factors, smoking history, past or current history of any respiratory conditions, the association between the causes of ESRD, time since the first dialysis and sociodemographic factors, and frequency of pulmonary complications were the other covariates in the study. Results Our study reports that 31.6% of our patients had significant impairment in their functioning due to respiratory complaints. The prevalence of respiratory complications was 27.2%. Major contributors were pleural effusion (33.8), pneumonia (25), pulmonary edema (20.58), pleuritis (11.76), collapse (8.8), tuberculosis (5.8), fibrosis (4.4), pericardial effusion (4.4), calcification (2.9), and hydrothorax (1.47). We report one case of Urinothorax as a rare cause of hydrothorax in such patients. Overall, our analysis found a significant association between non-reporting of respiratory complaints and acute admissions to the intensive care unit (ICU) with a respiratory cause at p-value 0.0076 with a greater predilection toward the rural populations. Conclusion Our study results highlight the prevalence of pulmonary complications in ESRD patients. The occurrence of pulmonary complications, irrespective of the presence of symptoms and a greater association between non-reporting of respiratory symptoms and acute admissions to the ICU, is a hallmark to consider the importance of history and clinical vigilance during patient visits.

It's All Due to the Thyroid: Lessons Learnt From a Patient's Perspective.

Symptoms associated with thyroid pathology can mimic and overlap with a myriad of other diagnostic possibilities. Based on the patient's educational status, underlying fear, anxiety, online medical search, the patient can erroneously attribute various symptoms to thyroid pathology. We present a case of a 79-year-old female with a history of Hashimoto's hypothyroidism, meningioma, who erroneously attributed many of her symptoms to hypothyroidism despite having normal thyroid labs. The patient had symptoms of fatigue, dysphagia, and proximal muscle weakness. Surprisingly the patient already had an existing diagnosis of dermatomyositis and Zenker's diverticulum which could clearly explain her above symptoms. Moreover, the patient did not follow up for whole body scan and other tests that were ordered for cancer screening, which is the standard practice for dermatomyositis. The patient helped us identify the deficiencies in the current health system regarding patient counseling. We identified factors that could act as communication barriers if not properly addressed which include: (1) patient's prior medical knowledge, (2) patient's own underlying fears about their health conditions, (3) use of effective patient education tools, (4) minimizing or avoiding use of medical jargon, (5) role switching to verify patient's understanding, (6) repetition of relevant information, and (7) involvement of the patient in shared decision making. It is important to recognize that thyroid gland dysfunction is the most commonly self-diagnosed condition by patients and the blame can be shifted to thyroid despite evidence to the contrary if effective patient education and counseling are lacking. Understanding the psychological state of the patient along with addressing the underlying fears, and effective patient education with repetition is the key for patient compliance and management.

Efficacy of Daratumumab-Based Regimens Compared to Standard of Care in Transplant-Eligible Multiple Myeloma: A Meta-Analysis.

Daratumumab (dara) belongs to a class of monoclonal antibodies that target CD38 receptors expressed on multiple myeloma (MM) cells. It was first approved for MM treatment in 2015. The efficacy and safety of dara have been reported in many studies. In this analysis, we assessed the outcome of dara addition to standard of care for transplant-eligible newly diagnosed (ND) MM. We conducted a comprehensive search using PubMed, ClinicalTrial.gov, and Embase. Out of 435 articles, we included two randomized clinical trials. We computed the odds ratio (OR) of response rates and risk ratio (RR) of adverse effects using Cochrane RevMan version 5.4. A total of 1,292 patients were enrolled in both trials. The patients were randomized into the control group and the dara group. The dara group included 647 patients and the control group included 645 patients. The CASSIOPEIA trial reported the outcomes using dara, bortezomib (V), thalidomide (T), and dexamethasone (d) versus VTd. The GRIFFIN trial underlined the efficacy of dara, lenalidomide (R), and Vd in the dara group versus RVd in the control group. A pooled analysis of included studies showed an increased overall response rate (OR: 1.60; 95% CI: 1.06-2.41; p = 0.02; I 2 = 65%), stringent complete response (OR: 1.59; 95% CI: 1.24-2.05; p = 0.03; I 2 = 0%), and negative status for minimal residual disease (OR: 2.47; 95% CI: 1.97-3.10; p < 0.01; I 2 = 66%) in the dara group as compared to the control group. However, an increased risk of neutropenia (RR: 1.80; 95% CI: 1.60-2.03; p < 0.01) and decreased risk of peripheral neuropathy (RR: 0.92; 95% CI: 0.86-0.99; p = 0.02; I 2 = 52%) were observed in the dara group. Dara addition to the standard of care regimen for transplant-eligible NDMM has promising outcomes with increased efficacy and safety profile and manageable toxicity.

Intestinal Perforation: A Rare Complication of Treatment With Bevacizumab.

Bevacizumab, a monoclonal immunoglobulin-G1 antibody directed against vascular endothelial growth factor (VEGF), inhibits angiogenesis. Gastrointestinal perforation is a serious and often fatal adverse event related to bevacizumab use. Bevacizumab is indicated in the treatment of colorectal malignancies, certain subtypes of non-small cell lung carcinoma, metastatic renal cell carcinomas, and cervical cancers. It is also indicated in the treatment of recurrent glioblastoma (GBM) in adult patients as the sole treatment agent or in combination with other antineoplastic medications. We present a case of a patient on bevacizumab currently with glioblastoma multiforme and seizures, who was previously treated with radiation treatment and temozolomide. The patient presented to the emergency room with abdominal pain, seizures and was diagnosed to have an intestinal perforation.

Solitary Sign of Third Nerve Palsy in a Conscious Patient With Epidural Hemorrhage.

Epidural hematoma is a life-threatening complication of head injury, which often occurs as a result of blunt trauma to the skull. Unregulated hematoma expansion in any setting results in elevated intracranial pressure and may contribute to the compression of the oculomotor nerve among several other adversities culminating in various long-lasting complications in the future. In this case report, we present the findings of a rare, insightful case of a 47-year-old Southeast Asian male with no established prior medical history apart from being a victim of blunt trauma attributable to a fall four days before presenting to the emergency department with abrupt onset of diplopia and drooping of the left eyelid. The initial physical examination helped to establish a diagnosis of third nerve palsy. A non-contrast CT of the head was conducted, and its findings revealed the presence of a right temporal-parietal-occipital epidural hemorrhage, with no mass impact on the cerebral hemisphere. The patient later underwent a successful left temporoparietal craniotomy, during which 100-125 ml of blood was drained out. Post-surgery, a near-full reduction of ptosis was recorded at the end of the first week. This case report summarizes this ingenious depiction of a partial third nerve palsy presenting as the sole sign of the epidural hemorrhage in a cognizant patient.

Von Hippel-Lindau Syndrome: Multi-Organ Involvement Highlighting Its Diverse Clinical Spectrum in Two Adult Cases.

There is an assortment of disorders that have multisystem involvement. Von Hippel-Lindau (VHL) syndrome, a rare autosomal dominant disease, falls in that category. VHL syndrome is associated with the formation of benign and malignant tumors in the central nervous system (CNS), adrenal gland, kidney, and eyes. In this report, we present two unusual cases of VHL syndrome presenting with multisystem engagement. The first case is of a 27-year-old male exhibiting multiple manifestations, which included hemangioblastoma of the spine, pheochromocytoma, pancreatic cyst, and retinal hemangioblastoma. The second case pertains to a 25-year-old male with various presentations ranging from retinal hemangioblastoma and pancreatitis to spinal and cerebellar hemangioblastoma. These cases emphasize the value of radiologic imaging and genetic assessment early in life when the presentation of the disease is in its preliminary stage. When an individual presents with a condition characterized by unexplained multifarious organ involvement of CNS, adrenal glands, and kidneys in the span of a few years, a differential diagnosis of VHL syndrome should be considered.

Metastatic Pancreatic-Biliary Cancer Presenting as Intramuscular Fluid Collections: A Case Report.

At a certain juncture, when clinicians are unable to gather information about a particular disease especially due to patient's unobtrusive findings, the presence of an aberrant connection might yield a diagnosis. Herein we present the findings of an unusual enlightening case of an 81-year-old Caucasian male with a history of bowel resection, poor appetite, generalized weakness, ptosis, and two weeks of weight loss. The computerized tomography scan revealed several sets of an abdominal intramuscular fluid collection with enhancements in the surrounding, indicative of several abscesses, and brain and spine magnetic resonance imaging indicated right-orbital metastasis in the superior rectal muscles. A biopsy of the cystic lesion of the anterior abdominal wall revealed poorly differentiated metastatic adenocarcinoma, most consistent with the primary pancreaticobiliary origin. This case report sums up this innovative portrayal of metastatic cancer as an intramuscular fluid collection.

Novel and Controversial Therapies in COVID-19.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease (COVID-19) pandemic, which has led scientists all over the world to push for the identification of novel therapies for COVID-19. The lack of a vaccine and specific treatment has led to a surge of novel therapies and their publicity in recent times. Under these unprecedented circumstances, a myriad of drugs used for other diseases is being evaluated and repositioned to treat COVID-19 (example- Remdesivir, Baricitinib). While multiple trials for potential drugs and vaccines are ongoing, and there are many unproven remedies with little or no supporting evidence. Presently, discussions are revolving around the use of multivitamins (Vitamin, C, D, A), minerals (selenium, zinc), probiotics, flavonoids, polyphenols, and herbal remedies (curcumin, artemisinin, herbal drinks). Our review delves further into the details of some of these controversial therapies for COVID-19.

Intracranial Abscess and Proteus mirabilis: A Case Report and Literature Review.

An intracranial abscess caused by Proteus mirabilis is rarely reported in adults. A 17-year-old girl presented with generalized tonic-clonic seizure, high-grade fever, headache, and vomiting with a history of slowly progressing apathy, clumsiness, and disorientation. She had meningeal signs and altered sensorium with a Glasgow Coma Scale of 10. The laboratory analysis revealed leukocytosis and elevated erythrocyte sedimentation rate. Brain computed tomography (CT) revealed a cystic lesion in the left temporal lobe with perilesional edema and a slight midline shift. She was commenced on empiric ceftriaxone, amikacin, and metronidazole. The non-foul smelling pus was drained through a craniotomy, and pus culture showed P. mirabilis. Culture sensitivity revealed extended-spectrum B-lactamase production, and she was commenced on intravenous carbapenem in addition to existing drugs. A repeat CT revealed a significant reduction in abscess size, and improvement in her condition was observed. On her recent follow-up visit, she was doing well.