Simple headache revealed a rare lymphoma: Waldenstrom macroglobulinemia with unique markers: a case report and review of the literature.

BACKGROUND: Waldenstrom macroglobulinemia (WM) is a rare lymphoma with an incidence rate of 3 per million people per year, with approximately 1000 to 1500 new cases diagnosed each year in the USA. It is primarily seen in Caucasian males with a median age of 70 years old. Patients are most often asymptomatic, but WM can manifest itself with constitutional symptoms such as lethargy, bleeding, organomegaly, and neurological or fundoscopic abnormalities. WM is characterized by immunoglobulin M (IgM) monoclonal gammopathy, lymphocytic infiltration of bone marrow, and normocytic anemia due to bone marrow replacement. CASE PRESENTATION: Our patient is a Hispanic 67-year-old female that presents with one month of intermittent band-like bilateral headache accompanied by dizziness, light-headedness, nausea, and blurred vision. A thorough diagnostic workup was performed, including serum protein electrophoresis (SPEP) with serum immunofixation (SIFE) showing an M spike and IgM kappa. Bone marrow biopsy was significant for lymphoplasmacytic infiltration with nodular B cells (CD19+, CD20+, CD22+). Computerized Tomography (CT) imaging showed splenomegaly in the patient. Treatment was provided for hyperviscosity syndrome with plasmapheresis twice. The patient reported improvement of her symptoms and was then scheduled for chemotherapy. Throughout 7 months, our patient received multiple cycles of bortezomib, dexamethasone, and rituximab. While her symptoms improved her psychiatric status got progressively worse. CONCLUSION: It is important not to neglect symptoms such as a headache, which may seem small, but could serve as a clue in the diagnosis of Waldenstrom's macroglobulinemia.

Efficacy of heads-up CPR compared to supine CPR positions: Systematic review and meta-analysis.

Background and Aim: Cardiopulmonary resuscitation (CPR) in full-coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads-up CPR versus supine CPR. Methods: We searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full-text screening of 40 eligible studies, only seven studies were eligible for our meta-analysis. We used the RevMan software (5.4) to perform the meta-analysis. Results: In survival outcome, the pooled analysis between heads-up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17-5.68, p = 0.98). The pooled analyses between heads-up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03-0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92-18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71-14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads-up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well. Conclusion: Our study suggests that heads-up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads-up technique on human beings and to determine the best angle for optimization of the technique results.