Case report: Cardiac intimal sarcoma in a young child

Undifferentiated mesenchymal tumors from the intimal layer (intimal sarcomas) are rare within the ventricles and exceptional in children. A rare case of an intimal sarcoma located in the right ventricle in a young child is presented with need for urgent surgical resection due to mechanical flow obstruction. Tumor cells showed amplification of MDM2 gene and a homozygous loss of CDKN2A on 9p21. A review of the literature regarding primary cardiac malignancies and intimal sarcoma in children is provided

SERIES:eHealth in primary care. Part 2: Exploring the ethical implications of its application in primary care practice

Background: eHealth promises to increase self-management and personalised medicine and improve cost-effectiveness in primary care. Paired with these promises are ethical implications, as eHealth will affect patients' and primary care professionals' (PCPs) experiences, values, norms, and relationships.Objectives: We argue what ethical implications related to the impact of eHealth on four vital aspects of primary care could (and should) be anticipated.Discussion: (1) EHealth influences dealing with predictive and diagnostic uncertainty. Machine-learning based clinical decision support systems offer (seemingly) objective, quantified, and personalised outcomes. However, they also introduce new loci of uncertainty and subjectivity. The decision-making process becomes opaque, and algorithms can be invalid, biased, or even discriminatory. This has implications for professional responsibilities and judgments, justice, autonomy, and trust. (2) EHealth affects the roles and responsibilities of patients because it can stimulate self-management and autonomy. However, autonomy can also be compromised, e.g. in cases of persuasive technologies and eHealth can increase existing health disparities. (3) The delegation of tasks to a network of technologies and stakeholders requires attention for responsibility gaps and new responsibilities. (4) The triangulate relationship: patient-eHealth-PCP requires a reconsideration of the role of human interaction and 'humanness' in primary care as well as of shaping Shared Decision Making.Conclusion: Our analysis is an essential first step towards setting up a dedicated ethics research agenda that should be examined in parallel to the development and implementation of eHealth. The ultimate goal is to inspire the development of practice-specific ethical recommendations

Severe Pediatric COVID-19 and Multisystem Inflammatory Syndrome in Children from Wild-type to Population Immunity: A Prospective Multicenter Cohort Study with Real-time Reporting

Background: SARS-CoV-2 variant evolution and increasing immunity altered the impact of pediatric SARS-CoV-2 infection. Public health decision-making relies on accurate and timely reporting of clinical data. Methods: This international hospital-based multicenter, prospective cohort study with real-time reporting was active from March 2020 to December 2022. We evaluated longitudinal incident rates and risk factors for disease severity. Results: We included 564 hospitalized children with acute COVID-19 (n = 375) or multisystem inflammatory syndrome in children (n = 189) from the Netherlands, Curaçao and Surinam. In COVID-19, 134/375 patients (36%) needed supplemental oxygen therapy and 35 (9.3%) required intensive care treatment. Age above 12 years and preexisting pulmonary conditions were predictors for severe COVID-19. During omicron, hospitalized children had milder disease. During population immunity, the incidence rate of pediatric COVID-19 infection declined for older children but was stable for children below 1 year. The incidence rate of multisystem inflammatory syndrome in children was highest during the delta wave and has decreased rapidly since omicron emerged. Real-time reporting of our data impacted national pediatric SARS-CoV-2 vaccination- and booster-policies. Conclusions: Our data supports the notion that similar to adults, prior immunity protects against severe sequelae of SARS-CoV-2 infections in children. Real-time reporting of accurate and high-quality data is feasible and impacts clinical and public health decision-making. The reporting framework of our consortium is readily accessible for future SARS-CoV-2 waves and other emerging infections

Pembrolizumab-induced necrotizing myositis in a patient with metastatic non-small-cell lung cancer: a case report

A 57-year-old man presented with swelling and pain in the lower limbs, inability to walk and increasing dyspnea for 2 days. Because of refractory stage IV non-small-cell lung cancer, pembrolizumab was started 21 days before presentation. Since then, he experienced general discomfort, fatigue and bilateral weakness in the legs with exercise limitation. A diagnosis of pembrolizumab-induced grade III myositis was made based on muscle biopsy. Pembrolizumab is a humanized monoclonal antibody against PD-1. It has been approved for the treatment of metastatic melanoma and refractory non-small-cell lung cancer with increased expression of PD-L1 on the cell surface of tumor cells. With such a humanized monoclonal antibody, fewer adverse events are expected than with systemic chemotherapy. However, 13% of patients develop autoimmune side effects which can be severe (grade III, IV or V) in 5-10%. We discuss a case of pembrolizumab-induced myositis, with a brief overview of the literature. Only three cases of pembrolizumab-induced myositis have been reported in literature.status: publishe

The Participant Journey Map: Understanding the design of interactive Augmented Play Spaces

Augmented Play Spaces (APS) are (semi-) public environments where playful interaction isfacilitated by enriching the existing environment with interactive technology. APS canpotentially facilitate social interaction and physical activity in (semi-)public environments. Incontrolled settings APS show promising effects. However, people’s willingness to engagewith APSin situ, depends on many factors that do not occur in aforementioned controlledsettings (where participation is obvious). To be able to achieve and demonstrate thepositive effects of APS when implemented in (semi-)public environments, it is important togain more insight in how to motivate people to engage with them and better understandwhen and how those decisions can be influenced by certain (design) factors. TheParticipant Journey Map (PJM) was developed following multiple iterations. First,based on related work, and insights gained from previously developed andimplemented APS, a concept of the PJM was developed. Next, to validate and refinethe PJM, interviews with 6 experts with extensive experience with developing andimplementing APS were conducted. Thefirst part of these interviews focused oninfluential (design) factors for engaging people into APS. In the second part, expertswere asked to provide feedback on thefirst concept of the PJM. Based on the insightsfrom the expert interviews, the PJM was adjusted and refined. The Participant JourneyMap consists of four layers: Phases, States, Transitions and Influential Factors. There aretwo overarchingphases:‘Onboarding’and‘Participation’and 6statesa (potential)participant goes through when engaging with an APS:‘Transit,’‘Awareness,’‘Interest,’‘Intention,’‘Participation,’‘Finishing.’Transitionsindicate movements between states.Influential factorsare the factors that influence these transitions. The PJM supportsdirections for further research and the design and implementation of APS. Itcontributes to previous work by providing a detailed overview of a participant journeyand the factors that influence motivation to engage with APS. Notable additions are thedetailed overview of influential factors, the introduction of the states‘Awareness,’‘Intention’and‘Finishing’and the non-linear approach. This will support taking intoaccount these often overlooked, key moments in future APS research and designprojects. Additionally, suggestions for future research into the design of APS are given

Massive Adult Adenoviral Adenoiditis Mimicking Lymphoma

Hypertrophy of the adenoid is a rare condition in adults, often suspicious of malignancy. We present a case of a 31-year-old female with a clinical presentation of a giant nasopharyngeal mass, clinically suspicious for malignancy, given the size and greyish discoloration. She presented with left-side otalgia, hearing loss, and nasal obstruction. After broad investigations on adenoid tissue following adenectomy, a reassuring diagnosis of adenovirus-related adenoiditis could be made. This case demonstrates the importance of broad microbiological testing in ruling out malignancies. The patient recovered completely.&nbsp

Serum S100B:A proxy marker for grey and white matter status in the absence and presence of (increased risk of) psychotic disorder?

Contains fulltext : 170070.pdf (publisher's version ) (Open Access

Breast implant associated EBV-positive Diffuse Large B-cell lymphoma: an underrecognized entity?

Abstract Breast-implant associated (BIA) lymphoma is an infrequent type of cancer occurring in the fluid and fibrous capsule around a textured breast implant. Recently, both the 2022 WHO 5th edition classification of Haematological tumours (WHO HAEM5) and 2022 International Consensus Classification of Mature Lymphoid Neoplasms (22ICC), recognized breast implant-associated Anaplastic Large Cell Lymphoma (BIA-ALCL) as a definitive entity, defined as a mature CD30-positive T-cell lymphoma, confined by a fibrous capsule, in a breast implant setting. Only few B-cell lymphomas have been reported in the literature to be associated with breast implants. Here we report two EBV-positive Diffuse Large B-cell lymphomas (EBV + DLBCL) in relation to a breast implant, both expressing CD30 as well as EBV latency type 3. Both lesions were considered as DLBCL associated with chronic inflammation (CI-DLBCL), but one presented as a 7 cm solid mass, while the other presented as a fibrin-associated DLBCL (FA-DLBCL) in an HIV patient. Clinically, both are in complete remission 6 months or longer after capsulectomy and graft removal, without additional chemotherapy. Such cases, characterized by large CD30-positive cells, can easily be misdiagnosed as BIA-ALCL if the cell of origin is not further established. Therefore, a diagnostic panel including lineage-specific B-and T-cell markers and EBER in situ hybridization is essential to recognize this rare entity, to understand lymphomagenesis, to predict outcome and to define clinical approach