Postprandial abdominal pain and weight loss as the initial presentation of abdominal neuroendocrine tumor recurrence.

Key Clinical Message: Neuroendocrine tumors, rare and slow-growing, primarily affect the gastrointestinal tract, causing symptoms due to hormone secretion or mass effect. This case image described postprandial abdominal pain as an atypical initial presentation of abdominal neuroendocrine tumor recurrence in a middle-aged male. Abstract: Neuroendocrine tumors are a group of rare, slow-growing neoplasms, most commonly affecting the gastrointestinal tract. Clinical presentations include symptoms related to the mass or hypersecretion of hormones, such as flushing, diarrhea, or bronchoconstriction. Postprandial abdominal pain is most commonly related to chronic mesenteric ischemia from atherosclerotic changes but is rarely linked to external mass compression, including gastrointestinal tumors. Hereby, the authors highlight an uncommon presentation of NET, which is very challenging to diagnose and demands a high index of suspicion.

Metastatic prostatic adenocarcinoma presenting as generalized lymphadenopathy unmasked by a COVID booster vaccine.

Key Clinical Message: Lymphadenopathy following recent immunization is usually regional. Generalized lymphadenopathy should arouse suspicion for alternative underlying pathology. Prostate adenocarcinoma should be considered in the differential diagnosis for malignancy in an elderly male patient. Metastatic prostate adenocarcinoma can have good prognostic outcomes if treatment is started promptly, even in the setting of widespread disease. Abstract: Generalized lymphadenopathy is commonly attributed to infectious causes or malignancy, often lymphoproliferative disorders. We present a rare case of metastatic prostate cancer diagnosed after initially presenting as generalized lymphadenopathy following a coronavirus disease 2019 (COVID) booster vaccination. A 70-year-old Hispanic male presented with left lower quadrant abdominal pain, nausea, headache, myalgia, severe constipation, and a right-sided neck swelling that had been increasing in size since the day of his vaccination. Computed tomography (CT) scans of soft tissue neck, chest, abdomen, and pelvis with contrast showed extensive lymphadenopathy. Ultrasound-guided biopsy results of the enlarged right supraclavicular node and prostate revealed histopathology consistent with that of prostate acinar adenocarcinoma. He started on bicalutamide for 4 weeks, transitioned to gonadotropin releasing hormone analogue (leuprolide) injections every 3 months and oral androgen receptor signaling inhibitor (abiraterone with prednisone daily). PSA level declined from 121 ng/mL at diagnosis to 1.3 ng/mL after 3 months of therapy, and repeat imaging showed marked improvement in the size of his mediastinal, retroperitoneal, and pelvic lymphadenopathy. To the best of our knowledge, this is the first case reported of a COVID vaccine booster uncovering lymphadenopathy leading to the diagnosis of metastatic prostate cancer.

Nivolumab-induced fatal myocarditis: A case report.

Key Clinical Message: Baseline assessment and interval monitoring with a careful history, clinical examination, laboratory work-up, and noninvasive imaging modalities may be beneficial for early detection of immune checkpoint inhibitor-associated side effects. Abstract: Previous reports of immune checkpoint inhibitors' cardiotoxic effects include pericarditis, myocarditis, myocardial infarction, ventricular dysfunction, vasculitis, and electrical abnormalities. The authors report a case of acute heart failure caused by nivolumab-induced cardiotoxicity in a middle-aged man with advanced esophageal carcinoma with no previous cardiac history or significant cardiovascular risk factors.

Mitochondrial Myopathy in a 21-Year-Old Man Presenting With Bilateral Lower Extremity Weakness and Swelling.

Bilateral lower extremity weakness and swelling can have several causes. Although often underdiagnosed, mitochondrial myopathy is more prevalent in the general population than more commonly suspected diseases, such as Guillain-Barre syndrome. The clinical manifestations of mitochondrial disease can be broadly classified into 3 categories: chronic progressive external ophthalmoplegia, skeletal muscle-central nervous system syndromes, or pure myopathy. Cardiac abnormalities occur in 30% to 32% of cases, mostly in the form of hypertrophic cardiomyopathy, dilated cardiomyopathy, or conduction abnormalities. We report a case of a 21-year-old student who developed bilateral lower limb weakness, pain, and swelling diagnosed with mitochondrial myopathy on muscle biopsy. Initial laboratory tests revealed elevated creatinine kinase, brain natriuretic peptide, troponin, myoglobin, and lactic acid and reduced serum bicarbonate. Cardiac workup revealed systolic heart failure with a reduced ejection fraction. Endomyocardial biopsy revealed punctate foci of lymphocytic myocarditis. However, cardiac magnetic resonance imaging did not reveal either myocarditis or an infiltrative cardiac disease. An extensive autoimmune and infection work-up was negative. A muscle biopsy from the patient's rectus femoris revealed scattered ragged-blue fibers (stained with NADH dehydrogenase), scattered ragged-red fibers on modified Gomori trichrome stain, and cytochrome-c oxidase negative fibers with increased perimysial and endomysial connective tissue, consistent with active and chronic primary mitochondrial myopathy. The patient was treated successfully with furosemide, metoprolol, and methylprednisolone. Adult-onset mitochondrial myopathy is a rare clinical disorder, and our experience stresses the importance of using an inter-disciplinary team approach to diagnose uncommon clinical disorders with widely variable multisystem involvement.

An Approach to Gynecomastia in Primary Care Clinics.

Gynecomastia is a more common finding in primary care clinics than is recognized. Because this finding can be easily overlooked, appropriate investigation and management often are missed. The workup of gynecomastia is highly individualized, based on the patient's presentation and related factors. It should be guided by thorough history taking and physical examination. Unless the patient has associated symptoms, or there is suspicion for an underlying clinical disorder causing the gynecomastia, the patient need not be investigated further. A breast ultrasound is not routinely recommended. Gynecomastia is a benign finding that will spontaneously regress in most patients; however, patients who are concerned with their physical appearance can be treated either medically or surgically. Patients who have had gynecomastia for more than 1 year tend to have fibrosis, which may be more difficult to treat. Management of gynecomastia is highly patient centered, following a detailed discussion about treatment goals and should be started early. Gynecomastia is not considered a premalignant condition; routine screening is not cost-effective, and imaging studies should be pursued only if physical examination findings suggest malignancy.

The shortcomings of tocilizumab in COVID-19.

Not available.

Comprehensive review of mask utility and challenges during the COVID-19 pandemic.

Masks are widely discussed during the course of the ongoing COVID-19 pandemic. Most hospitals have implemented universal masking for their healthcare workers, and the Center for Disease Control currently advises even the general public to wear cloth masks when outdoors. The pertinent need for masks arises from plausible dissemination of the SARS-CoV-2 through close contacts, as well as the possibility of virus transmission from asymptomatic, pre-symptomatic, and mildly symptomatic individuals. Given current global shortages in personal protective equipment, the efficacy of various types of masks: N95 respirators, surgical masks, and cloth masks are researched. To accommodate limited supplies, techniques for extended use, reuse, and sterilization of masks are strategized. However, masks alone may not greatly slow down the COVID-19 pandemic unless they are coupled with adequate social distancing, diligent hand hygiene, and other proven preventive measures.

Tanner's Target Height Formula Underestimates Final Height in Asian Indians - A Cross-sectional Observational Study.

INTRODUCTION: Target height (TH) calculation by Tanner's formula has been shown to be inaccurate in many countries However, there is no published data on the accuracy of TH calculation by Tanner's formula in Indians. Hence, this study was conducted to assess whether Tanner's TH formula is an accurate tool to predict final height in Asian Indian population and to identify new TH formulae or models to better fit Indian population. MATERIAL AND METHODS: This is a cross-sectional, questionnaire-based study conducted in a tertiary care hospital from South India. A total of 396 questionnaires were randomly distributed to undergraduate medical students who were instructed beforehand to get their heights and heights of their parents and siblings between the age of 18 to 24 years of age measured by a nearby pediatrician. From 396 questionnaires, data of 481 young adults and their parents were obtained. Target height was calculated by Tanner's formula and compared with attained height. RESULTS: The study comprised of 197 males and 284 females. Sons and daughters were 2.34 ± 7.19 cm and 1.58 ± 5.68 cm taller than TH. Son's height had best correlation with TH (r = 0.408), whereas daughter's height had best correlation with maternal height (r = 0.560). Both males (0.263 vs 0.365) and females (0.319 vs 0.560) had relatively weaker correlation with paternal heights than maternal heights. Target height explained 29.7% and 16.7% of variance in daughter's and son's height, respectively. Using the parental heights as variables, multiple regression yielded 50.03 + 0.172 (father's height) +0.510 (mother's height) and 74.09 + 0.236 (father's height) +0.377 (mother's height) as the best models to predict daughter's and son's height, respectively. CONCLUSION: Our study suggests that Tanner's TH formula underestimates final attainable height in Asian Indians.

A Case Report: An Acute Thrombus in the Femoral Artery following Total Hip Arthroplasty.

INTRODUCTION: Vascular complications post-operative to a total hip arthroplasty are a very rare phenomenon. Only a few isolated cases have been reported to date. Diagnosis of such a case in a timely manner so as to preserve the limb is also difficult due to the subtle signs with which the patient presents. We report a case of complete occlusion of the common femoral artery following total hip arthroplasty due to acute thrombus formation. CASE PRESENTATION: A 56 year old Indian male patient underwent a cemented total hip replacement. Three hours post-operatively, the patient's left lower limb was found to be pale and pulseless. Angiography showed complete occlusion of the left common femoral artery. Thrombectomy was carried out immediately and the patient recovered well. CONCLUSION: Vascular injuries are highly unusual findings following a total hip arthroplasty. Careful pre-operative and immediate post-operative monitoring of the patient is essential. Signs such as limb ischemia, absence of pulses, etc. must be recognized as early as possible and the necessary investigations and procedures should be carried out without any delay.