Simultaneous Coexistence of Thyrotropin-Prolactin-Secreting Adenoma and Papillary Thyroid Carcinoma

Background. The thyrotropin-secreting adenomas are very rare and even more rare when they simultaneously coexist with thyroid carcinoma. So far, only sixteen cases have been reported in the literature. Here, we present a unique case of successful management of a concurrent case of thyrotropin-prolactinoma with papillary thyroid carcinoma. Case Presentation. A 50-year-old Moroccan woman underwent a total thyroidectomy and complementary totalization by iratherapy for papillary thyroid carcinoma, who presented persistence of an inappropriate secretion of the thyroid-stimulating hormone (TSH > 4 mUI/L) despite of levothyroxine suppressive therapy (300 μg/d). After eliminating noncompliance, interfering medicines, and thyroid malabsorption, a pituitary adenoma (12 mm) was documented at magnetic resonance imaging. The patient has had transsphenoidal pituitary adenomectomy with histology confirming a thyrotropin-prolactin-secreting adenoma. After surgery and lanreotide treatment failures, we noted a complete response (TSH < 0.5) with cabergoline treatment (3 mg/week). Conclusion. The unusual association of thyroid adenocarcinoma and TSHoma enriches the hypothesis of a potential link between thyrotropic hypersecretion and thyroid carcinogenesis. Our case also illustrates the difficulty of monitoring thyroid carcinoma in nonremission of a TSHoma.

The Efficacy of Lower-Limb Screening Tests in Predicting PlayerLoad Within a Professional Soccer Academy

Context: Training exposure has been associated with injury epidemiology in elite youth soccer, where lower-limb musculoskeletal screening is commonly used to highlight injury risk. However, there has been little consideration of the relationship between lower-limb screening and the loading response to soccer activities. Objective: To quantify the efficacy of using screening tests to predict the loading elicited in soccer-specific activities and to develop a hierarchical ordering of musculoskeletal screening tests to identify test redundancy and inform practice. Design: Correlational. Setting: Professional soccer club academy. Participants: A total of 21 elite male soccer players aged 15.7 (0.9) years. Intervention: Players completed a battery of 5 screening tests (knee to wall, hip internal rotation, adductor squeeze, single-leg hop, and anterior reach) and a 25-minute standardized soccer session with a Global Positioning System unit placed at C7 to collect multiplanar PlayerLoad data. Main Outcome Measures: Baseline data on each screening test, along with uniaxial PlayerLoad in the mediolateral, anteroposterior, and vertical planes. Results: Stepwise hierarchical modeling of the screening tests revealed that dominant leg knee-to-wall distance was the most prevalent and powerful predictor of multiplanar PlayerLoad, accounting for up to 42% of variation in uniaxial loading. The adductor squeeze test was the least powerful predictor of PlayerLoad. Of note, one player who incurred a knee injury within 3 weeks of testing had shown a 20% reduction in knee-to-wall distance compared with peers, and elicited 23% greater PlayerLoad, supporting the hierarchical model. Conclusions: There was some evidence of redundancy in the screening battery, with implications for clinical choice. Hierarchical ordering and a concurrent case study highlight dominant leg knee-to-wall distance as the primary predictor of multiaxial loading in soccer. This has implications for the design and interpretation of screening data in elite youth soccer.

Concurrent Case Review and Retrospective Review Using the Matrix Method are Complementary Methods for Tracking and Improving Timeliness of Care in a Level I Trauma Center

Ensuring timely care for patients with moderate-to-severe traumatic injury has been shown to significantly reduce the rate of injury-related mortality. Using concurrent case review and the matrix method described in the 2014 version of Resources for Optimal Care of the Injured Patient, we sought to reduce direct admissions and undertriage at our institution. We believed this would optimize outcomes for patients who may have been significantly impacted otherwise. Several process improvement initiatives were implemented throughout the study period and we calculated direct admission, overtriage, and undertriage rates bimonthly for evaluation of effectiveness and to intervene, if needed. Direct admission and undertriage rates significantly declined the last six months of our study when compared to baseline (July 2014 to December 2014; 0.80% vs 6.46%, P < 0.001 and 3.72% vs 6.71%, P = 0.002, respectively). In addition, a significant increase was observed in the overtriage rate (64.36% vs 74.20%, P = 0.002).We conclude that when implemented properly, continuous tracking of adherence to triage criteria and retrospective review of fallout cases leads to significant decline in both direct admissions and undertriage, as well as concomitant increase in overtriage.

Radiative and climate impacts of a large volcanic eruption during stratospheric sulfur geoengineering

Both explosive volcanic eruptions, which emit sulfur dioxide into the stratosphere, and stratospheric geoengineering via sulfur injections can potentially cool the climate by increasing the amount of scattering particles in the atmosphere. Here we employ a global aerosol-climate model and an earth system model to study the radiative and climate impacts of an erupting volcano during solar radiation management (SRM). According to our simulations, the radiative impacts of an eruption and SRM are not additive: in the simulated case of concurrent eruption and SRM, the peak increase in global forcing is about 40 % lower compared to a corresponding eruption into a clean background atmosphere. In addition, the recovery of the stratospheric sulfate burden and forcing was significantly faster in the concurrent case since the sulfate particles grew larger and thus sedimented faster from the stratosphere. In our simulation where we assumed that SRM would be stopped immediately after a volcano eruption, stopping SRM decreased the overall stratospheric aerosol load. For the same reasons, a volcanic eruption during SRM lead to only about 1/3 of the peak global ensemble-mean cooling compared to an eruption under unperturbed atmospheric conditions. Furthermore, the global cooling signal was seen only for 12 months after the eruption in the former scenario compared to over 40 months in the latter. In terms of the global precipitation rate, we obtain a 36 % smaller decrease in the first year after the eruption and again a clearly faster recovery in the concurrent eruption and SRM scenario. We also found that an explosive eruption could lead to significantly different regional climate responses depending on whether it takes place during geoengineering or into an unperturbed background atmosphere. Our results imply that observations from previous large eruptions, such as Mt Pinatubo in 1991, are not directly applicable when estimating the potential consequences of a volcanic eruption during stratospheric geoengineering.

First documented case of human infection with ovine Shiga-toxin-producingEscherichia coliserotype O52:H45

We report a concurrent case of infection with non-O157 Shiga-toxin-producing Escherichia coli (STEC) strain in an 8-month-old child. Laboratory and epidemiological investigations indicated child exposure to contaminated sheep meat following the Muslim feast of sacrifice (Eid al-Adha). Microbiological and molecular typing confirmed that the ovine strain O52:H45 (stx1+, eae–, hlyA–) was the causal agent. This is the first documented case of human infection to this STEC serotype.

Morgellons: a novel dermatological perspective as the multisystem infective disease borreliosis

Morgellons disease (MD) is a term that has been used in the last decade to describe filaments that can be found in human epidermis. It is the subject of considerable debate within the medical profession and is often labeled as delusions of parasitosis or dermatitis artefacta. This view is challenged by recent published scientific data put forward between 2011-2013 identifying the filaments found in MD as keratin and collagen based and furthermore associated with spirochetal infection. The novel model of the dermopathy put forward by those authors is further described and, in particular, presented as a dermal manifestation of the multi-system disease complex borreliosis otherwise called Lyme disease. A differential diagnosis is drawn from a dermatological perspective. The requirements for a diagnosis of delusional disorder from a psychiatric perspective are clarified and the psychological or psychiatric co-morbidity that can be found with MD cases is presented. A concurrent case incidence is also included. Management of the multisytem disease complex is discussed both in general and from a dermatological perspective. Finally replacement of the term ‘Morgellons’ by ‘borrelial dermatitis’ is proposed within the profession.

The serotype case-case design: a direct comparison of a novel methodology with a case-control study in a national Salmonella Enteritidis PT14b outbreak in England and Wales

SUMMARYSocietal and technological changes render traditional study designs less feasible for investigation of outbreaks. We compared results obtained from case-case and case-control designs during the investigation of a Salmonella Enteritidis PT14b (SE14b) outbreak in Britain to provide support for validation of this approach. Exposures of cases were compared to concurrent non-Enteritidis Salmonella cases and population controls recruited through systematic digit phone dialling. Infection with SE14b was associated with eating in oriental restaurants [odds ratio (OR) 35·8, 95% confidence interval (CI) 4·4–290·9] and consuming eggs away from home (OR 13·8, 95% CI 1·5–124·5) in the case-case study and was confirmed through a concurrent case-control study with similar effect estimates and microbiological findings of SE14b in eggs from a specific chicken flock on a Spanish farm. We found that the case-case design was feasible, quick and inexpensive, potentially minimized recall bias and made use of already interviewed cases with subtyping results. This approach has potential for use in future investigations.