Late radiation-related lymphopenia after prostate stereotactic body radiation therapy plus or minus supplemental pelvic irradiation.

Introduction: Prior studies suggest lymphopenia following radiation therapy may impact toxicity and cancer control. Chronic radiation-related lymphopenia (RRL) has been noted in prostate cancer patients treated with conventionally fractionated pelvic radiation therapy. The impact of utilizing hypofractionated high integral dose therapies such as stereotactic body radiation therapy (SBRT) on RRL is less well characterized.

Comparison of Standard and Extended Dexamethasone Duration on Mortality in Patients with Severe COVID-19.

Objectives: Current guidelines recommend dexamethasone 6 mg/day for up to 10 days in patients with severe coronavirus disease 2019 (COVID-19) requiring supplemental oxygenation or mechanical ventilation. The practice has significant variation, however, and dexamethasone has been used for >10 days for many patients with severe COVID-19. The aim of this study was to assess the benefits and risks associated with standard versus extended use of dexamethasone in patients with severe COVID-19.

Paroxysmal Hypertension in Congenital Hypothyroidism: An Unusual Case of Pheochromocytoma.

Pheochromocytomas are rare tumors arising from the chromaffin cells of the adrenal medulla that result in the secretion of excessive catecholamines. They are an uncommon cause of hypertension in the pediatric population. We present a case of a six-year-old male with hypertension, rapid weight loss, palpitations, excessive sweating, and vomiting.

Under Pressure: A Case Report of a Diver's Close Encounter With the Bends.

Generalized barotrauma, also referred to as decompression sickness (DCS), is a condition that occurs when there is a sudden shift in atmospheric pressure. While typically associated with underwater excursions or deep-sea dive encounters, this process can also occur during sudden changes in high altitude or unpressurized air travel. Sudden shifts in atmospheric pressure trigger the formation of nitrogen gas bubbles in the bloodstream that fail to clear from the blood and instead accumulate, leading to an obstruction in circulation.

Barriers of the CNS transfer rate dynamics in patients with vascular cognitive impairment and dementia.

Background: Advances in MRI techniques enable cerebral barrier transfer rates (K ) measurement in patients with vascular cognitive impairment and dementia (VCID). However, a consensus has not been reached on the dynamic contribution and importance of cerebral barrier abnormalities to the differential diagnosis of dementia subtypes. Our goal was to investigate the dynamics of blood-brain barrier (BBB) and blood-CSF barrier (BCSFB) K in patients with VCID longitudinally and determine the effect of aging.

Facial Skin Manifestation of a Destructive, Nonkeratinizing Squamous Cell Carcinoma.

Nonkeratinizing squamous cell carcinoma (NKSCC) of the sinonasal tract is a rare malignancy that infrequently presents with cutaneous extension. This case describes an unusual instance of extensive facial skin involvement in an elderly male with multiple comorbidities, diagnosed with a biopsy-proven NKSCC. The tumor was p16 positive, suggesting an HPV-related etiology.

A Rare Case of Adult-Onset Bilateral Nonspecific Orbital Inflammation (NSOI) With Concomitant Unilateral Third Cranial Nerve Palsy.

Nonspecific orbital inflammation (NSOI), also known as orbital pseudotumor, is a condition characterized by inflammation in the tissues around the eye socket (orbit) without a clearly identifiable cause. This inflammatory disorder can affect various structures within the orbit, including muscles, fat, and connective tissues, leading to symptoms such as pain, swelling, and changes in vision. A 74-year-old man with a history of previous orbital trauma presented with acute-onset head and orbital pain, followed by restricted left eye movements in all directions, left ptosis, and a dilated left pupil.

Equine Pergolide Toxicity: A Case Series.

Veterinary medication exposure may result in human toxicity, with approximately 6,000 exposures to veterinary-only medications reported to poison centers in 2022. There is a paucity of literature on the management of poisoned patients secondary to pharmaceuticals intended for equine use. Pergolide is a dopamine and serotonin receptor agonist and is currently approved to treat equine Cushing's disease.

Bibliometric Analysis of the Top 100 Most Cited Papers in Mohs Surgery.

Background: Mohs micrographic surgery is a specialized tissue-sparing technique used to treat skin cancers.

Objective: By understanding the attributes that make a research paper one of the top 100 cited papers on Mohs surgery, we hope to illuminate seminal research in this field.

Methods And Materials: The global literature about Mohs surgery published between 1900 and 2023 was searched on the Web of Science.

Mind the Decimal Point: A Case of Diazoxide Overdose-Induced Ileus.

Diazoxide is the only medication approved by the United States Food and Drug Administration for the treatment of hyperinsulinism-induced hypoglycemia. Overdose is infrequently reported. This case describes a preterm four-week-old male who was prescribed diazoxide and chlorothiazide for perinatal stress-induced hyperinsulinism.

How Student and Faculty Perceptions Differ on the Stressors that Medical Students Face.

Objectives: Medical education is notorious for the stress that students face as they strive to succeed both academically and clinically. This stress has been linked to declining academic performance and worsening mental health. To combat these negative outcomes, it is essential for medical school faculty and administration to address common stressors among medical students.

From Wheelchair Bound to Working: A Case Study of Intravenous Ketamine Infusions in Treating Stiff Person Syndrome.

Stiff Person Syndrome (SPS) is a rare autoimmune condition marked by extremely painful muscle spasms, stiffness, and rigidity throughout the body. Its rarity often translates to limited treatment options for patients and, occasionally, challenges in obtaining a definitive diagnosis. SPS also impacts patients' mental health, social and economic involvement, and overall quality of life.

Novel Use of Clonidine Patch to Treat Tizanidine Withdrawal.

Tizanidine is commonly prescribed for muscle spasticity and pain. Yet, withdrawal is rarely reported. Tizanidine stimulates presynaptic α-2 adrenergic and imidazoline receptors decreasing norepinephrine release.

A Recurrent Case of Mesothelial Pericardial Cyst.

This is a case of a 37-year-old female patient with past medical history of mitral valve prolapse and benign mesothelial pericardial cyst status post laparoscopic resection who presented to the emergency department with a chief complaint of right-sided sharp non-radiating chest pain due to recurrent case of benign mesothelial pericardial cyst. Though this is not a common pathology, it does overlap with common cardiovascular symptoms/conditions; not limited to but including chest pain, dyspnea, palpitations, pericardial effusions, infections and arrhythmias. It is crucial to have appropriate history and physical exam and appropriate evaluation to rule out pericardial cysts as well as their locations and their potential lethal mechanical implication on crucial nearby structures.

Evaluation of an Intravenous Acetaminophen Protocol in the Emergency Department.

Background: Acute pain is a leading reason for Emergency Department (ED) evaluation, accounting for nearly half of all ED visits. Therefore, providing effective non-opioid analgesics in the ED is critical. Oral acetaminophen (APAP) is commonly administered in the ED but is limited to patients tolerating oral intake.

Abnormalities in microbiota/butyrate/FFAR3 signaling in aging gut impair brain function.

Aging-related abnormalities in gut microbiota are associated with cognitive decline, depression, and anxiety, but underlying mechanisms remain unstudied. Here, our study demonstrated that transplanting old gut microbiota to young mice induced inflammation in the gut and brain coupled with cognitive decline, depression, and anxiety. We observed diminished mucin formation and increased gut permeability ("leaky gut") with a reduction in beneficial metabolites like butyrate because of decline in butyrate-producing bacteria in the aged gut microbiota.

Atypical Presentation and Diagnosis of Multiple Myeloma: A Case Report.

Chronic neck pain is a common, seemingly benign condition that typically does not warrant an urgent workup, in contrast to acute onset neck pain. Vertebral artery dissection (VAD) is a relatively rare presentation of acute onset neck pain and often presents in the context of blunt trauma. Due to the risk of subsequent clot formation and stroke, patients who present with symptoms suggestive of VAD must be promptly screened, most often first with computed tomography angiography (CTA) followed by magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA) for further evaluation.

Coexistence of Diffuse Large B-Cell Lymphoma With Chronic Tubulointerstitial Nephritis: A Case Review and Pathophysiology.

There is an association between lymphomas and kidney disease with renal abnormalities found both in patients with direct infiltration by lymphoma as well as in patients without gross or microscopic evidence of renal involvement. Multiple mechanisms to explain the link between lymphomas and renal disease have been proposed, ranging from direct renal metastasis by the lymphoma to chemokine signaling pathways. In addition, there is a correlation between certain genetic mutations and an increased risk of lymphoma metastasizing to other organs.

F198S Gerstmann-Sträussler-Scheinker Syndrome With Parkinsonism, Dyskinesia, and Abnormal (I-123)-FP-CIT Single-Photon Emission Computed Tomography: A Case Report.

Gerstmann-Sträussler-Scheinker syndrome (GSS) is an autosomal dominant neurodegenerative disease caused by point mutations in the prion protein gene (PRNP) While variable, the clinical presentation typically encompasses progressive cerebellar ataxia, pyramidal signs, and cognitive impairment. Here, we report a case of F198S-associated GSS manifesting levodopa-responsive parkinsonism, levodopa-induced dyskinesia, and an abnormal (I-123)-FP-CIT single-photon emission computed tomography (DaT-SPECT). A 66-year-old male patient presented with six years of progressive recall and language impairment, with an initial impression of primary progressive aphasia.

Emergency Physician-Performed Point-of-Care Ultrasound of a Renal Mass.

Emergency physicians (EPs) frequently integrate point-of-care ultrasound (POCUS) into the initial bedside evaluation of patients presenting to the emergency department with acute flank pain. A POCUS-first diagnostic approach can allow EPs to promptly assess for life-threatening pathologies of the aorta and gallbladder. POCUS is also a critical bedside tool to determine renal causes of acute flank pain, such as hydronephrosis in the setting of nephrolithiasis, subcapsular hematomas, renal abscesses, pyelonephritis, and renal masses.