A Case of Tizanidine Withdrawal and Road to Recovery

This case report highlights the complexities of tizanidine withdrawal in a 68-year-old woman with chronic pain. Tizanidine, a widely used imidazole-derived muscle relaxant, poses challenges due to the absence of standardized withdrawal protocols. The patient's presentation included hypertension and tachycardia following a gradual reduction in her outpatient tizanidine dose. During the de-escalation of tizanidine, the patient experienced withdrawal symptoms, including severe body aches, hypertension, and tachycardia. Management during withdrawal involved a unique approach using a one-time dose of phenobarbital, a measure that allowed the resolution of hemodynamic instability and pain with complete discontinuation of tizanidine. The ultimate decision to transition the patient to methocarbamol and stop taking tizanidine for pain control highlights the importance of individualized care. The patient has responded to this therapy upon follow-up.

Outcomes of COVID-19-Associated Hospitalizations in Geriatric Patients with Dementia in the United States: A Propensity Score Matched Analysis

Previous studies have convincingly demonstrated the negative impact of dementia on overall health outcomes. In the context of the COVID-19 pandemic, there is burgeoning evidence suggesting a possible association between dementia and adverse outcomes, however the relationship has not been conclusively established. We conducted a retrospective cohort study involving 816,960 hospitalized COVID-19 patients aged 65 or older from the 2020 national inpatient sample. The cohort was bifurcated into patients with dementia (n = 180,845) and those without (n = 636,115). Multivariate regression and propensity score matched analyses (PSM) assessed in-hospital mortality and complications. We observed that COVID-19 patients with dementia had a notably higher risk of in-hospital mortality (23.1% vs. 18.6%; aOR = 1.2 [95% CI 1.1-1.2]). This elevated risk persisted even after PSM. Interestingly, dementia patients had a reduced risk of several acute in-hospital complications, including liver failure and sudden cardiac arrest. Nevertheless, they had longer hospital stays and lower total hospital charges. Our findings conclusively demonstrate that dementia patients face a heightened risk of mortality when hospitalized with COVID-19 but are less likely to experience certain complications. This complexity underscores the urgent need for individualized care strategies for this vulnerable group.

Unraveling Bacillus Calmette-Guérin (BCG) Therapy Side Effects in Bladder Cancer: A Tale of Triumph Over Treatment Challenges

This case report presents a 66-year-old male with a complex medical history, including testicular cancer, chronic obstructive pulmonary disease, obstructive sleep apnea, tobacco use disorder, erectile dysfunction, and obesity. The patient exhibited recurrent gross hematuria, leading to a comprehensive workup. Cystoscopy revealed a bladder tumor, prompting transurethral resection and mitomycin C instillation. Subsequent intravesical Bacillus Calmette-Guérin (BCG) therapy was initiated but resulted in severe sepsis during maintenance. Despite initial suspicion of BCG-induced sepsis, further evaluation suggested a reaction with chemical cystitis. Treatment involved brief antimicrobial therapy, and the patient's condition improved. This case highlights the challenges in managing BCG therapy complications, emphasizing the need for prompt intervention, careful monitoring, and consideration of risk factors. Patient education and vigilant follow-ups are crucial for addressing potential long-term effects.

Leser-Trélat Syndrome, an Underdiagnosed Cutaneous Paraneoplastic Syndrome That Could Aid in Early Detection of Colon Cancer: A Case Report

Leser-Trélat syndrome, a rare cutaneous paraneoplastic phenomenon, has gained attention for its potential role as an early indicator of underlying internal malignancies. This article presents a comprehensive case study of a 67-year-old male with a history of alcohol and tobacco use, emphasizing the importance of recognizing this syndrome in clinical practice. The sudden onset of seborrheic keratoses on the thorax and back, retrospectively identified as Leser-Trélat syndrome, prompted investigations that led to the early diagnosis of a colon adenocarcinoma. We discuss the pathophysiology, clinical relevance, and controversies surrounding this syndrome, highlighting the need for increased awareness among healthcare professionals. Timely recognition of Leser-Trélat syndrome can significantly impact patient care, leading to improved prognoses for associated neoplasms. This case underscores the importance of comprehensive evaluations and further research to enhance our understanding and management of cutaneous paraneoplastic syndromes.

Understanding the Role of Human Papillomavirus in Head and Neck Cancer of Unknown Primary: A Systematic Review

This systematic review aims to provide a comprehensive understanding of the role of human papillomavirus (HPV) in head and neck cancer of unknown primary (HNCUP). HNCUP is a rare type of cancer with an unknown primary site, which makes it difficult to diagnose and treat. The review includes articles published between 2013 and 2023 that investigated the prevalence of HPV in HNCUP, its association with clinical outcomes, and its potential implications for diagnosis and treatment. The search was conducted in 11 electronic databases, and the gray literature: Cochrane, Cumed, IBECS, JAMA Network, LILACS, MEDLINE Ovid, MEDLINE-EBSCO, PubMed, Scopus, SciELO, and Taylor & Francis Online; a total of 23 studies met the inclusion criteria. The review found that HPV is present in a significant proportion of HNCUP cases, ranging from 15.5% to 100%. HNCUP incidence is increasing, and the presence of HPV was associated with improved clinical outcomes in some studies, such as overall survival and disease-free survival; but was found to have no association with outcomes in others. This may have implications for diagnostic and treatment strategies. The findings of this review suggest that further research is needed to better understand the role of HPV in HNCUP and to develop targeted therapies for this disease.

Tuberous Sclerosis Associated With Aortic Stenosis and Endocarditis: A Case Report

Tuberous sclerosis (TS) is a multisystem neurocutaneous disorder with an autosomal dominant pattern of inheritance. It is characterized by hamartomas that damage the skin, kidneys, lungs, heart, and central nervous system, among other organs. Rhabdomyomas, benign tumors of aberrant myocytes, are common in affected patients at birth. Depending on their size and location, these lesions might create valvopathies, which can cause heart failure or malignant arrhythmias, or they can cause obstruction of the outlet or inlet tract. Before making the diagnosis, a long time-even years-often passes. Early diagnosis can help prevent permanent irreversible complications. Differential diagnoses may include neurofibromatosis type 1, Sturge-Weber syndrome, and von Hippel-Lindau disease, among others. Diagnostic aids, such as MRI, CT scans, and genetic testing, can be useful in confirming a diagnosis of TS. Histological findings may include the presence of hamartomas, which are benign tumors composed of abnormal cells. Treatment for TS is mainly supportive and may involve medications to manage symptoms, and surgery to remove tumors. We present the case of a 23-year-old woman with TS who was admitted with macroscopic hematuria and fever, with further workup revealing tumor-like cardiac lesions associated with infective endocarditis.

Cardiac Myxomas As Chameleons: A Scoping Review of Their Paraneoplastic Presentations

This scoping review aims to explore the relationship between cardiac myxomas (CMs) and paraneoplastic syndromes (PS). CMs are the most common tumors in the heart, with the majority located in the left atrium, and are often associated with a triad of obstructive, embolic, and constitutional symptoms. However, they can also present with unrelated symptoms that are part of a PS. This study performed a thorough literature search of 11 databases and included 12 papers in the final review. All of the patients were diagnosed with atrial myxoma, which initially presented as a PS. Surgery was the curative measure in all cases and resulted in remission in every case, with patients reporting resolution of symptoms at follow-up. The majority of patients in the study were female, with comorbid rheumatologic conditions often present. This study highlights the heterogeneity of presentations of CMs and their associated PS.

[Psychiatric approach to problems of pain]

The problem of pain is presented from a liaison-psychiatric point of view. Pain is a frequent symptom of medical illness but may also be a manifestation of a psychiatric disorder or a psychological condition, as in the somatization of affect. Pain is not only a symptom but also a set of behaviors, an expression of personality traits, and a personal way of coping. Hence pain as such affects the patient's interaction with his environment, including the medical staff. Psychiatric approaches to treating pain include explorative and supportive psychotherapy, behavioral and cognitive therapy, hypnosis, relaxation, biofeedback and group therapy. 4 cases are presented which demonstrate the physician's understanding of the patient's psychological condition, the combined treatment of the pain problem and related limitations and applications.