Reports, Volume 2, Issue 3 (September 2019) – 6 articles

Anaplastic thyroid carcinoma (ATC) is a fatal disease with a poor prognosis. Lenvatinib is an oral multi-targeted tyrosine kinase inhibitor (TKI) which is approved in Japan for the treatment of ATC. Data of treatment response and adverse effects of lenvatinib in ATC patients is still relatively scarce, especially in non-Japanese patient populations. Here we report dramatic treatment effects of lenvatinib in two patients with stage IVc ATC, who later developed significant morbidities including tracheal perforation and fistula formation. Our cases demonstrate the efficacy and provide cautionary information for treatment of ATC. In treating advanced ATC patients with lenvatinib, close monitoring is highly recommended. Full article

A 78 year old Caucasian woman, was admitted to the hospital for evaluation of a mass to the anterior surface of the left mandibular angle and left submandibular area present for the past year with rapid acceleration of growth over three weeks prior to admission. An incisional biopsy was performed and initial diagnosis of poorly differentiated neuroendocrine carcinoma (small cell carcinoma) was made. Dermatological evaluation revealed lesion was suspicious for Merkel cell carcinoma and the pathology specimen was re-analyzed and differential diagnoses was made for Merkel cell carcinoma. Patient was educated and discharged to a nursing home with plan for irradiation, chemotherapy, and outpatient follow up. This case study serves to raise awareness of a rare condition and describe how Merkel cell carcinoma may be mistaken for similarly presenting neuroendocrine tumors. Full article

Background: Multi-component interventions in large communities such as Philadelphia can effectively lower childhood obesity rates. It is less clear whether this type of intervention can be successful in smaller communities with more limited resources. Norwood, Ohio is a small Midwestern city with a population of 19,207. In 2010, Ohio passed a school health law requiring Body Mass Index (BMI) screening of students in kindergarten and grades 3, 5 and 9 along with restrictions on competitive foods and vending machine products and a physical education requirement of 30 min per day. In 2014, Norwood implemented a multi-component childhood obesity prevention and treatment bundle of interventions. Our objective was to describe the effects if this bundle on childhood overweight/obesity (OW/OB) rates. We hypothesized that implementation of the bundle would lower the prevalence of OW/OB in Norwood school children. Methods: In 2012, the Healthy Kids Ohio Act was fully implemented in the Norwood City School District (NCSD). In 2014 a comprehensive bundle was implemented that included: 1. A student gardening program; 2. Supplementation of fresh produce to a local food pantry and a family shelter; 3. A farmers market; 4. A health newsletter; 5. Incentives in the school cafeterias to promote healthy food selection; 6. A 100-mile walking club; 7. “Cook for America” (a “cooked from scratch” intervention for school cafeterias); 8. A school-based obesity treatment clinic; Results: The OW/OB rate in the NCSD was 43% at the time of the Bundle implementation in 2014 and 37% in 2016 (p = 0.029). Conclusions: A childhood OW/OB prevention bundle can be implemented in a small city and is associated with a favorable change in BMI. Full article

In this paper, we present a review of the intra-aortic balloon pump, as well as the usage of it in the medical field today. An intra-aortic balloon pump (IABP) is a biomedical device that can assist the heart during unstable angina or after a heart attack. This pump is typically used in patients who suffer from ischemia of the heart tissue, due to an unbalanced level of myocardial oxygen supply or demand. Through counterpulsation, which is a technique to synchronize the external pumping of blood with the heart’s cycle, the device can balance the supply and demand of blood that is necessary for the heart to pump properly. The IABP is comprised of the following four components: a polyurethane balloon, a polyethylene or fiber-optic catheter, a transducer, and the intra-aortic balloon pump console. In the past, researchers have used other materials that have low biocompatibility and can cause complications within the body. This analysis will explain the complications and state changes that occurred due to them. Limitations of past designs and advantages of current designs will be acknowledged, for they can be used by researchers to enhance designs for the future. Consequently, the analysis of this device may lead to improved designs and treatment in the future for patients with cardiac conditions. Full article

Lineage switch in acute leukemias is a well-reported occurrence; however, most of these cases involve a switch from either lymphoid to myeloid or myeloid to lymphoid lineage. Here, we report a case of a 14-year-old male with B-cell acute lymphoblastic leukemia (B-ALL) who initially responded well to standard chemotherapy but then later developed mixed phenotype acute leukemia (MPAL) at relapse, likely reflecting a clonal evolution of the original leukemia with a partial phenotypic shift. The patient had a del(9)(p13p21) in his leukemia blasts at diagnosis, and the deletion persisted at relapse along with multiple additional cytogenetic aberrations. Interestingly, the patient presented with an isolated testicular lesion at relapse, which on further analysis revealed both a lymphoid and myeloid component. Unfortunately, the patient did not respond well to treatment at relapse and eventually succumbed to his disease. To our knowledge, an isolated extramedullary MPAL at relapse in a patient with previously diagnosed B-ALL has not been reported in the literature before. Full article

Sepsis is still related to high mortality and hospitalization rates in the paediatric population despite medical progress. Prompt recognition of sepsis and consequent initiation of an appropriate treatment are essential elements in securing a positive outcome in adults and children. In such scenario, various biomarkers have been studied to support the clinician in the diagnosis of severe infections, in the identification of patients at risk of progression towards sepsis as well as in the evaluation of the response to treatment. In children, the performance of C-reactive protein and procalcitonin has been largely investigated, whereas data on newer biomarkers of sepsis are scant. The aim of the present review is to summarise the available data on the use of pro-adrenomedullin in the paediatric age. Full article