Vitamin B12 deficiency presenting as neck pain and cervical radiculopathy.

Vitamin B12 is required for the formation of haematopoietic cells and the synthesis of myelin. Deficiency typically presents with fatigue and megaloblastic anaemia. Prolonged deficiency can cause neurological symptoms such as paresthesia, which can progress to subacute combined degeneration of the spinal cord. We describe an unusual presentation of B12 deficiency in a young man who was initially diagnosed and treated for cervical radiculopathy. This case highlights the challenges of diagnosing B12 deficiency in patients with neurologic but without haematologic, abnormalities. While the current incidence of B12 deficiency in developed countries is low, cases are likely to rise with the increased adoption of veganism. Clinicians should be aware of the variable presentations of B12 deficiency because delayed diagnosis and treatment increases morbidity and can cause irreversible neurological deficits.

Peritoneal dialysis-associated peritonitis: A case first for Aquamicrobium.

Aquamicrobium is an aerobic gram-negative rod which until recently had only been isolated from wastewater and contaminated soil. In 2021, two cases of Aquamicrobium infection in humans were reported. Both were cases of endophthalmitis following cataract surgery. In this manuscript, we describe the presentation and treatment of a 56-year-old immunocompetent male who has peritoneal dialysis-associated peritonitis caused by Aquamicrobium lusatiense. To our knowledge, this is the third reported case of Aquamicrobium infection in humans and the first example of this agent causing peritonitis.

Unusual Presentation of Disseminated Histoplasmosis in an Immunocompetent Host.

Histoplasmosis, a fungal infection caused by the inhalation of Histoplasma capsulatum conidia spores, has been shown to cause disseminated disease in immunocompromised individuals. Disseminated histoplasmosis manifests as multi-system involvement including pulmonary and/or neurological disease. Imaging findings, such as pulmonary focal infiltrates, cavitary nodules, mediastinal, and hilar lymphadenopathy, are common. Here, we report a rare case of disseminated histoplasmosis in a 58-year-old immunocompetent male with no occupational exposure. This patient presented with primary adrenal insufficiency, and a subsequent CT-guided biopsy of the adrenal gland was performed and revealed numerous spores containing Histoplasma capsulatum. This patient also suffered from numerous pulmonary and neurological derangements, which are likely sequelae of the disseminated fungal infection. Ultimately, the patient succumbed to their illness and died. Preventing such outcomes relies on early detection and prompt management, which are crucial in treating disseminated histoplasmosis. Increased awareness of atypical presentations can enhance patient outcomes and alleviate the impact of this severe fungal infection. This case not only underscores the importance of considering disseminated histoplasmosis in an immunocompetent patient presenting with unexplained weight loss and adrenal insufficiency but also contributes to the limited literature on disseminated histoplasmosis in immunocompetent individuals.

Wisconsin's COVID-19 Safer-at-Home Order: Perspectives on Pain, Stress, and Functioning From Pediatric Patients With Chronic Pain.

BACKGROUND: Given that enforced quarantine is associated with psychological distress, our objective was to understand factors that either helped or harmed pediatric chronic pain patients during Wisconsin's 2020 safer-at-home quarantine. METHODS: We reviewed the electronic medical records of 145 pediatric chronic pain patients seen at the Jane B. Pettit Pain and Headache Center, Children's Wisconsin, between April 1 and July 30, 2020. RESULTS: Stress and poor/disturbed lifestyle factors were primary contributors to increased pain. Over half of the sample (58.7%) reported COVID-related stressors as contributing to increased stress levels. Coping, engagement, and socialization were primary contributors to patient functioning. CONCLUSIONS: Continued access to clinicians who can help with coping and stress management techniques is necessary for the well-being of pediatric chronic pain patients during a quarantine.

Publication misrepresentation among pediatric anesthesiology fellowship applicants: A retrospective single-center cohort study.

BACKGROUND: Many medical specialties have found publication misrepresentation in residency and fellowship applications, but pediatric anesthesia fellowship application data is lacking. AIMS: We sought to determine the prevalence of publication misrepresentation among pediatric anesthesia fellowship applications. METHODS: In this retrospective cohort study, fellowship applications to Stanford University's pediatric anesthesiology fellowship program from 2009 to 2019 were reviewed. Only peer-reviewed journal articles listed as accepted or published were included. Nine additional variables were collected: applicant age, gender, citizenship status, American vs. international medical school, public vs. private medical school, allopathic doctor versus osteopathic doctor, number of years between college and medical school, additional degrees, and application year. The primary outcome was the rate of publication misrepresentation, defined as peer-reviewed journal citations listed on the application that could not be verified or on which the applicant was not listed as an author. Secondary outcomes were the associations between publication misrepresentation and the additional collected variables. RESULTS: 1280 peer-reviewed journal publications from 877 applicants were reviewed. 3.4% of all citations listed as peer-reviewed journal articles were misrepresented and 9.0% of all applicants with at least 1 publication had ≥1 misrepresented publications. 30.2% of publications labelled "misrepresented" were located in our search of databases but did not have the applicant as an author, and 69.8% could not be located using the search databases. Only one of the 9 collected variables (public vs private medical school) was significantly associated with publication misrepresentation. CONCLUSIONS: In this single-center retrospective study, publication misrepresentation was found to occur in one out of 11 pediatric anesthesia fellowship applications with at least one publication. Since residency and fellowship applicant publications may be heavily weighted during the application process, programs may want to include additional inquiries into the accuracy of applicant publications.