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Myxedema Coma as the Initial Presentation of Undiagnosed Hypothyroidism: A Rare but Reversible Emergency.

Myxedema coma is a rare, life-threatening endocrine emergency representing the extreme manifestation of untreated hypothyroidism. It usually presents with nonspecific symptoms such as confusion, hypothermia, and bradycardia, which can lead to delayed recognition, particularly in elderly patients with multiple comorbidities. We report the case of a 77-year-old man with hypertension, stage 4 chronic kidney disease, anemia of chronic disease, myeloma, and prostate cancer who presented with reduced consciousness following a period of increasing lethargy and confusion. On arrival, he was hypotensiv

Exosomes liquid biopsy in Lymphoma precision medicine: applications and challenges.

Liquid biopsy is an emerging non-invasive detection technology that diagnoses tumors and provides prognostic value by analyzing samples such as circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and exosomes. Exosomes are nanoscale extracellular vesicles (EVs) secreted by cells, encapsulating a diverse array of biomolecules, including proteins, nucleic acids (e.g., mRNA and miRNA), and lipids. Lymphoma cells secrete various exosomes, whose contents carry abundant tumor-associated information and serve as messengers in the tumor microenvironment (TME). Consequently, tumor-derived ex

Pancytopenia Concurrent With Metabolic Encephalopathy.

Pancytopenia is a decrease in the number of cells in all peripheral blood cell lines and has been associated with anemias, cancers, chemotherapy, infections, and nutritional deficiencies. However, pancytopenia concurrent with encephalopathy is rare and not well-studied. We present a case of pancytopenia concurrent with metabolic encephalopathy. An 81-year-old female patient presented to the emergency department for two weeks of increased fatigue and hypersomnolence. The patient had trouble staying awake during the initial physical exam, and her laboratory results were significant for pancytope

Oral Ulceration with Bone Sequestration: Key Insights for Clinicians and Their Relevance in Contemporary Clinical Practice-A Narrative Systematic Review.

Background: Oral ulceration with bone sequestration (OUBS) is an uncommon clinical lesion characterized by painful mucosal ulceration associated with exposed and necrotic bone in the oral cavity, often without known factors inducing osteonecrosis. Despite its potential for diagnostic confusion with more serious lesions, such as medication-related osteonecrosis, OUBS remains poorly understood and underreported. Objectives: To systematically review the literature on OUBS and identify its main clinical and radiographic characteristics to assist in early diagnosis and appropriate management. Metho

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… In some cases, patients may report a history of aphthous-like ulcers with common precipitating factors such as trauma [ 17 ]. Some cases have been reported as “idiopathic” or “spontaneous”, with no identifiable precipitating factors [ 2 , 17 ]. … Although OUBS shares some clinical characteristics with the early stage of MRONJ, such as the preference for the posterior lingual region of the mandible [ 2 ] and the possibility of both occurring after a traumatic event or spontaneously without an identifiable precipitating factor, there are notable …

The Calcium Conundrum: Hypercalcemia of Unknown Etiology.

Hypercalcemia is a common clinical finding with a wide variety of clinical presentations and etiologies. The differential is broad and includes hyperparathyroidism, malignancy, medication adverse effects, endocrinopathies, and a variety of granulomatous diseases. We present the case of an 84-year-old woman with severe parathyroid hormone-independent hypercalcemia and elevated 1,25-OH Vitamin D. Non-necrotizing granulomas were identified on bone marrow biopsy. After an exhaustive workup for granulomatous disease, the patient was felt to have sarcoidosis isolated to the bone marrow and started o

Кристальная структура и каталитический механизм дрименоловой синтазы, необычная двухфункциональная терпеновая киклаза-фосфатаза.

Дрименол синтаза из Aquimarina pongiae (ASDMS) — очень необычная химера, интегрирующая two - отдельные, последовательные операции по переработке изопреноидов в рамках единой полипептидной цепи. ASDMS катализирует циклизацию фарнесилового дифосфата (FPP) класса II для образования дрименилового дифосфата, который затем подвергается гидролизу энзим-катализу для получения дрименинола, биоактивного сескитерпенового спирта с антифунгальными и антираковыми свойствами. Здесь мы сообщаем рентгеновские кристаллы ASDMS и его комплекс с сескитерпен тиол. Структура ASDMS имеет дидомаиновую архитектуру, сос

Indications and recent evidence for apheresis in children and adults with kidney diseases: a comprehensive review.

IntroductionPlasmapheresis has been a therapeutic option in kidney diseases to eliminate disease-causing autoantibodies, circulating factors, and abnormal components involved in complement pathways. We aim to systematically review the effectiveness and adverse events associated with plasmapheresis and related apheresis therapies in treating kidney diseases in paediatric and adult populations.MethodsWe searched databases including EMBASE, CINAHL, PubMed, and Cochrane Central for studies from 2010 to October 2023. The search terms included terms related to glomerulonephritis treated with plasmap

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society.

Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but

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… External precipitation factors or triggers 6.4. The autonomic nervous system 7. Clinical presentation 8. Acute management 8.1. Initial evaluation, assessment of external precipitating factors, and reversible causes 8.1.1. History 8.1.2. Twelve-lead electrocardiogram 8.1.3. … The ECG after VA termination may also point towards precipitating factors (e.g. prolonged QT interval, Brugada pattern, signs of hypokalaemia) but may also indicate a yet undiagnosed underlying heart disease ( Tables 4 and 5 and Figure 2 ). …

Recurrent severe hypocalcemia following chemotherapy regimen changes in advanced breast cancer: two case reports.

BACKGROUND: As an oncologic emergency related to abnormalities in calcium metabolism, hypercalcemia associated with paraneoplastic syndrome and bone metastases is well known. Meanwhile, the incidence of hypocalcemia is low, except in cases associated with bone-modifying agents used for bone metastases. Hypocalcemia induced by bone-modifying agents typically occurs early after the initial administration, and its incidence can be significantly reduced by preventive administration of calcium and vitamin D3 supplements. CASE REPORT: We report two cases of recurrent severe hypocalcemia occurring d

Spontaneous Tumor Lysis Syndrome due to Uterine Leiomyosarcoma with Lung Metastases.

Tumor lysis syndrome (TLS) is an oncologic emergency characterized by a combination of metabolic derangements (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia) caused by rapid turnover from cell destruction in certain cancers. These metabolic derangements can lead to seizures, cardiac arrhythmias, renal failure, and death. TLS is usually seen after the initiation of chemotherapy for hematologic malignancies. TLS occurring spontaneously, without initiation of chemotherapy, is rare and its occurrence in solid tumors is rarer still. We report a case of spontaneous TLS in a patien

Характеристики увейта и множественный склероз фенотип пациентов с множественным склерозом, связанным с увеитом: систематический обзор и метаанализ.

Подведение итогов и мета-анализирование характеристик увеита и многократного склероза (MS) фенотипа пациентов с множественным склерозом, связанным с увеитом (MSAU), в рамках систематического обзора и метаанализа. 25, 2023, с использованием баз данных PubMed, Embase и Virtual Health Bibrary (VHL). Мы проводили исследования с участием пациентов в ССАУ, например, сериалы, 10 - пациенты, перекрестные исследования, анализ конкретных случаев и когортные исследования. Качество и риск отклонения оценивались с использованием инструментов CLARITY и проверенных параметров, таких, как инструменты Hoy et a

Погода за болью: роль температуры окружающей среды в хронических синдромах боли.

ЦЕЛЬ РАССМОТРЕНИЯ: Хроническая боль широко распространена и связана со сложным взаимодействием сенсорных, эмоциональных и когнитивных процессов, на которые в значительной степени влияет температура окружающей среды. Несмотря на успехи в борьбе с обезболиванием, многие пациенты по-прежнему испытывают недостаточное облегчение. Цель этого обзора заключается в обобщении и критической оценке текущих данных о воздействии температуры окружающей среды на такие хронические болевые условия, как фибромиалгиа (ФМ), множественный склероз (МС), сложный региональный синдром боли (КПИ) и остеоартрит (ОА).ПОСЛ

Сердечные эффекты и коморбиды неврологических заболеваний.

Неврологические расстройства охватывают сложный и неоднородный спектр заболеваний, затрагивающих мозг, спинной мозг и периферийные нервные системы, каждая из которых сопряжена с уникальными проблемами, выходящими далеко за рамки первичных неврологических симптомов. Эти расстройства оказывают глубокое воздействие на сердечно-сосудистое здоровье, что приводит к интенсивному изучению сложных взаимосвязей между неврологическими и сердечно-сосудистыми системами. В этом обзоре обобщаются текущие сведения и исследования о сердечно-сосудистых коморбидах, связанных с основными неврологическими заболева

Recent Progress of Exosomes in Multiple Myeloma: Pathogenesis, Diagnosis, Prognosis and Therapeutic Strategies.

Multiple myeloma (MM) is a hematological malignancy that is still incurable. The bone marrow microenvironment (BMM), with cellular and non-cellular components, can create a favorable environment for the survival, proliferation and migration of MM cells, which is the main reason for the failure of MM therapies. Many studies have demonstrated that exosomes play an important role in the tumor-supportive BMM. Exosomes are nanoscale vesicles that can be released by various cells. Some exosomes contribute to the pathogenesis and progression of MM. MM-derived exosomes act on different cells in the BM

Различия между мужчинами и женщинами-неврофилами, в отношении которых в полиомиках присутствуют РНК.

КОЛИЧЕСТВО: Мужчины и женщины демонстрируют различия в распространенности связанных с нейтрофильом заболеваний, таких, как системная волчанка, эритематос, ревматоидный артрит и множественный склероз, а также различия в нейтрофильных физиологических реакциях, таких, как реакция на инфекцию, повреждение тканей и химотактические факторы. Однако мало что известно об основах различий по признаку пола среди нейтрофилов. МЕТОДЫ: Начиная с людей, нейтрофилов от здоровых доноров, мы использовали RNA-seq для изучения общих профилей RNA, RNA, не связанных с рибосом и, следовательно, не переведенных, RNA

Acute Kidney Injury in the Patient with Cancer.

Over the last three decades, advancements in the diagnosis, treatment, and supportive care of patients with cancer have significantly improved their overall survival. However, these advancements have also led to a higher rate of cancer-related complications. Acute kidney injury (AKI) and chronic kidney disease (CKD) are highly prevalent in patients with cancer, and they are associated with an increased risk of all-cause mortality. This bidirectional interplay between cancer and kidney, termed "the kidney-cancer connection" has become a very active area of research. This review aims to provide

MicroRNA-125b as a valuable predictive marker for outcome after autologous hematopoietic stem cell transplantation.

BACKGROUND: Relapse is a frequent occurrence in autologous hematopoietic stem cell transplantation (AHSCT), and early relapse after AHSCT results in poor survival and low quality of life. Predictive marker determination for AHSCT outcomes could be helpful in the prevention of relapse through personalized medicine. Here the predictive value of circulatory microRNAs (miRs) expression for AHSCT outcomes was studied. METHODS: 50 MM and lymphoma candidates for AHSCT participated in this study. Two plasma samples were obtained before AHSCT from each candidate; one before mobilization and the other

Unique Presentation of Bortezomib-Associated Thrombotic Microangiopathy Responsive to Therapeutic Plasma Exchange and Eculizumab Therapy.

Thrombotic microangiopathies (TMA) are a rare group of life-threatening hematological conditions characterized by thrombocytopenia and microangiopathic hemolytic anemia. Although our understanding of the pathophysiology and the availability of diagnostic testing has improved for primary TMAs, such as thrombotic thrombocytopenic purpura, the pathophysiology underlying secondary TMAs, including drug-induced TMAs (DITMAs), remains less clear. In this case report, we present the unique case of a patient with a history of multiple myeloma that presented four months after the initiation of bortezomi

Rituximab-Associated Flare of Cryoglobulinemic Vasculitis.

BackgroundPatients with cryoglobulinemic vasculitis (CV) can develop disease flare after rituximab administration. The objective of our study was to describe the prevalence, clinical characteristics, predisposing factors, and outcomes of patients with rituximab-associated flare of CV.MethodsWe conducted a retrospective study in a tertiary referral center until March 25, 2020.ResultsAmong 64 patients with CV who received rituximab therapy in our center, 14 (22%) developed disease flare. Median age was 67.5 years. Seven patients (50%) had type II CV and the other half had either type I (n = 6) o