Cliff diving leading to commotio cordis in a patient with Ebstein's anomaly.

In this case report, we describe a 23-year-old male with Ebstein's anomaly who experienced out-of-hospital cardiac arrest due to commotio cordis following cliff diving. The patient previously underwent a Cone procedure and re-do reduction tricuspid valvuloplasty. Comprehensive investigations revealed no new ischemic events or structural abnormalities. He received an implantable cardioverter-defibrillator during an uneventful outpatient visit. This is the first reported case of commotio cordis in a patient with Ebstein's anomaly, suggesting a potential increased risk in individuals with congenital heart diseases. This highlights the significance of tertiary prevention in such cases. Learning objective: Through this case, readers may be able to review the incidence and electrical abnormalities leading to sudden cardiac death in patients with commotio cordis, the clinical presentation and mechanism of injury, and the current consensus regarding the management of commotio cordis.

Eosinophilic myocarditis: systematic review.

OBJECTIVE: In clinical practice, patients with eosinophilic myocarditis (EM) may forgo the gold standard diagnostic procedure, endomyocardial biopsy (EMB), although it is highly recommended in guidelines. This systematic review aims to summarise current approaches in diagnosing and treating EM with a particular emphasis on the utilisation and value of alternative diagnostic methods. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using the keywords "eosinophilic myocarditis" from their inception to 10 September 2022. RESULTS: We included 239 articles, including 8 observational studies and 274 cases, in this review. The median patient age was 45 years. Initial presentations were non-specific, including dyspnoea (50.0%) and chest pain (39.4%). The aetiologies of EM were variable with the most common being idiopathic (28.8%) and eosinophilic granulomatosis polyangiitis (19.3%); others included drug-induced (13.1%) and hypereosinophilic syndrome (12.8%). 82.4% received an EM diagnosis by EMB while 17.6% were diagnosed based on clinical reasoning and cardiac MRI (CMR). CMR-diagnosed patients exhibited a better risk profile at diagnosis, particularly higher left ventricular ejection fraction and less need for inotropic or mechanical circulatory supports. Glucocorticoids were the primary treatment with variability in dosages and regimens. CONCLUSION: EMB is the mainstay for diagnostic testing for EM. CMR is potentially helpful for screening in appropriate clinical scenarios. Regarding treatment, there is no consensus regarding the optimal dosage of corticosteroids. Large clinical trials are warranted to further explore the utility of CMR in the diagnosis of EM and steroid regimen in treating EM.

Signalling by senescent melanocytes hyperactivates hair growth.

Niche signals maintain stem cells in a prolonged quiescence or transiently activate them for proper regeneration1. Altering balanced niche signalling can lead to regenerative disorders. Melanocytic skin nevi in human often display excessive hair growth, suggesting hair stem cell hyperactivity. Here, using genetic mouse models of nevi2,3, we show that dermal clusters of senescent melanocytes drive epithelial hair stem cells to exit quiescence and change their transcriptome and composition, potently enhancing hair renewal. Nevus melanocytes activate a distinct secretome, enriched for signalling factors. Osteopontin, the leading nevus signalling factor, is both necessary and sufficient to induce hair growth. Injection of osteopontin or its genetic overexpression is sufficient to induce robust hair growth in mice, whereas germline and conditional deletions of either osteopontin or CD44, its cognate receptor on epithelial hair cells, rescue enhanced hair growth induced by dermal nevus melanocytes. Osteopontin is overexpressed in human hairy nevi, and it stimulates new growth of human hair follicles. Although broad accumulation of senescent cells, such as upon ageing or genotoxic stress, is detrimental for the regenerative capacity of tissue4, we show that signalling by senescent cell clusters can potently enhance the activity of adjacent intact stem cells and stimulate tissue renewal. This finding identifies senescent cells and their secretome as an attractive therapeutic target in regenerative disorders.

Eosinophilic Myocarditis Presenting as Cardiac Tamponade: A Diagnostic Challenge.

Eosinophilic myocarditis (EM) is a rare cause of acute heart failure. It can occur secondary to drug hypersensitivity, autoimmune diseases such as vasculitis, idiopathic hypereosinophilic syndrome (HES) or malignancy, but is often under-recognized and underdiagnosed, being confused with other causes of heart failure. While EM is associated with various clinical symptoms, it is rarely associated with cardiac tamponade that requires urgent pericardiocentesis. Here we describe a patient with EM who presented with cardiac tamponade and decompensated heart failure likely secondary to autoimmune disease. LEARNING POINTS: Work-up for hypereosinophilia should include the identification of treatable causes as well as end-organ dysfunction requiring urgent treatment.In patients presenting with acute heart failure and cardiac tamponade of unclear aetiology, eosinophilic myocarditis should be considered whether or not hypereosinophilia is present on presentation.When invoking the diagnosis of eosinophilic myocarditis, extensive efforts should be made to identify primary causes, such as autoimmune conditions including vasculitis.

SARS-CoV-2 and Streptococcus pneumoniae Coinfection in a Previously Healthy Child.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in December 2019 in Wuhan, China. This novel coronavirus has been responsible for a pandemic that continues to devastate nations worldwide. COVID-19, like other viruses, causes pneumonia. However, unlike other viral respiratory tract infections such as influenza, bacterial coinfection in COVID-19 patients has uncommonly been described in adult and pediatric patients. We report a case of Streptococcus pneumoniae and COVID-19 coinfection in a previously healthy 4-year-old child.

Risks and complications of thyroglossal duct cyst removal.

OBJECTIVES/HYPOTHESIS: Thyroglossal duct cysts (TGDCs) are the most common congenital neck cyst and typically present in childhood or adolescence, although a subset remains asymptomatic until adulthood. Although treatment involves surgical excision, few large-scale studies exist regarding the risks of surgical treatment of TGDCs in adults. This study aims to describe the characteristics of adult patients undergoing TGDC excision and to analyze risk factors associated with reoperation or other postoperative complications. STUDY DESIGN: Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. METHODS: Patients age ≥ 18 years in the NSQIP database who underwent TGDC removal from 2005 to 2014 were included. Covariates included patient demographics, comorbidities, preoperative variables, and intraoperative variables. Outcomes included reoperation, complications, and length of hospital stay. RESULTS: A total of 793 cases met inclusion criteria. Patients were predominantly female (57.0%) and white (64.3%), with a mean age of 44.3 years. Thirty-day mortality did not occur in this cohort, but 3.0% of patients experienced at least one complication. Forty-eight patients (6.1%) underwent reoperation. Wound infection rates were higher in revision operations compared with primary operations (8.3% and 0.9%, respectively; P = .003). Low preoperative sodium was associated with reoperation (P = .047). Additionally, length of hospital stay was associated with increased total operative time (P = .02). CONCLUSIONS: TGDC excision is a safe and well-tolerated procedure in the adult population, with low complication rates. However, the risk of reoperation, surgical-site infections, and medical complications should be taken into consideration during preoperative planning. LEVEL OF EVIDENCE: NA Laryngoscope, 130:381-384, 2020.

Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre-Prosthetic Phase: A Retrospective Cohort Study.

BACKGROUND: Falls in individuals with lower limb amputations (LLAs) pose significant health concerns. The literature is limited regarding falls during the preprosthetic phase of rehabilitation for persons with LLAs. OBJECTIVE: To determine the incidence of falls and identify factors associated with falls during the preprosthetic recovery phase. DESIGN: Retrospective chart audit. SETTING: Inpatient rehabilitation program. PARTICIPANTS: Four hundred forty individuals with LLAs (age ± SD = 61.93 ± 14.53 years, 73.18% male) who attended inpatient rehabilitation from 26 July 2011 to 21 August 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASUREMENTS: The number of self-reported falls was recorded from the time of surgery to admission for inpatient rehabilitation. Outcomes of interest were any fall (1+ fall) and recurrent falls (2+ falls). A retrospective chart audit was performed on consecutive admissions to an inpatient rehabilitation program. RESULTS: The incidence of falls was 8.37 per 1000 patient-days. Falls were sustained by 60.9% of the sample. Unilateral transtibial amputation was independently associated with an increased risk of recurrent falls (relative risk [RR] 1.59, 95% confidence interval [CI] 1.13-2.23, P = .008). Diabetes mellitus was independently associated with an increased risk of any fall (RR 1.18, 95% CI 1.01-.38, P = .03). Finally, bilateral transtibial amputation was independently associated with a reduced risk of any fall (RR 0.59, 95% CI 0.39-0.90, P = .014). CONCLUSIONS: Consistent with the current literature, diabetes mellitus and a unilateral transtibial amputation were risk factors for falling, whereas a bilateral transtibial amputation and increasing age presented new findings as factors associated with decreased falling. LEVEL OF EVIDENCE: III.

Medical Malpractice of Vestibular Schwannoma: A 40-Year Review of the United States Legal Databases.

OBJECTIVES: To analyze medical malpractice lawsuit trends pertaining to cases of vestibular schwannomas (VS). METHODS: Two major computerized legal databases (LexisNexis and WestLaw) were queried and reviewed for evaluation of all the US state and federal court records from civil trials alleging malpractice between 1976 and 2016. RESULTS: A total of 32 VS cases were identified. Allegations were divided into four categories: misdiagnosis/delayed diagnosis (47%), postoperative complications (44%), failure of informed consent or information sharing (16%), and other (3%). Postoperative complications included facial nerve paralysis, myocardial infarction, meningitis, and intracranial hemorrhage. Judgment amounts ranged from $300,000 to $2,000,000. The specialist type was specified for 24 of the 32 cases (75%): neurosurgeons (n = 9; 37%), neurotologists (n = 6; 25%), general otolaryngologists (n = 5; 21%), primary care physicians (n = 4; 17%), neurologists (n = 3; 12%), radiologists (n = 3; 12%), anesthesiologists (n = 2; 8%), radiation oncologists (n = 1; 4%), and general surgeon (n = 1; 4%). Of these 24 cases, (n = 9; 37%) two or more physicians were named as defendants in the lawsuit. CONCLUSIONS: Enhanced physician-patient communication, ensuring proper and adequate patient consent procedures, and proper documentation are good practices that may decrease the likelihood of lawsuits.

An Analysis of the Open Payment Database in Neurotology.

Since the introduction of the Sunshine Act in 2010 and Open Payments Database (OPD) in 2013, a significant amount of data has been collected on physicians and the payments received through ties with pharmaceutical and medical device companies. To date, a study within the field of otology and neurotology using data from the 2015 OPD has not been conducted. As such, we assessed the validity and accuracy of OPD information for otologists and neurotologists (O&Ns). Of the 126 physicians listed as O&Ns in the OPD, 25 were actually general otolaryngologists, and 1 was a cardiologist. In addition, 88 O&Ns were misclassified by the OPD as general otolaryngologists. A total of 1156 payments, summing $1,966,204, were made to O&Ns as a whole, with 646, 507, and 3 payments classified as general, research, and ownership/investment interests, respectively. Analysis of OPD data for O&Ns demonstrates a significant financial relationship between O&N physicians and industry, as well as noteworthy inaccuracies in the OPD that likely affect other subspecialties.