A 3 year old girl presented with a three week history of lethargy, constipation, and joint swelling. Investigation showed primary hypothyroidism associated with immunological changes including thyroglobulin antibodies. Reassessment several months after beginning thyroxine treatment confirmed persisting hypothyroidism. Primary hypothyroidism may present as a rapid onset disorder.

A 74 year old women presented with lethargy and weight loss and was found to have profound adrenal insufficiency and bilateral adrenal mass lesions. Histological examination revealed non-Hodgkin's lymphoma. There was no evidence of lymphoma outside the adrenal glands. Isolated bilateral adrenal masses may rarely be due to primary adrenal non-Hodgkin's lymphoma, which is often associated with ad...

Case 1. Robert Davies, a 50-year-old man, presents with tiredness and lethargy. Examination demonstrates pallor and jaundice. Investigations reveal anemia that is consistent with warm autoimmune hemolytic anemia (AIHA; Figure 1). He has no evidence of any other autoimmune disease or chronic lymphocytic leukemia (CLL) and is not taking any medications; these factors suggest idiopathic AIHA. How ...

• Is there a state of optimal nutrition beyond what is commonly accepted as adequate nutrition? • Does marginal vitamin deficiency have any clinical significance? • Can nutritional status affect behavior and personality? • Can vague symptoms such as irritability, insomnia, and lethargy be caused by vitamin depletion? • Are marginal deficiencies a widespread problem? At what point does such a pr...

A 6-year-old male, Belgian shepherd dog was presented with lethargy, oliguria, hematuria, and reluctance to move. The dog developed hypertrophic osteopathy secondary to renal pelvis transitional cell carcinoma. A nephrectomy was performed and after a year, the dog was completely asymptomatic, and no evidence of metastatic disease was present.

A 12-year old boy suffered episodes of vomiting, lethargy, and hypoglycaemia from the age of 1 year. Adhering to a vegetarian diet caused an increase in frequency and severity of the attacks. It was found that he was suffering from systemic carnitine deficiency that responded promptly to treatment with L-carnitine.

Hookworm infection is common but has rarely been reported in neonates or infants. Two cases of hookworm infestation in early infancy are described. The infants presented with malena, severe pallor, lethargy and failure to gain weight. Initial stool examination was non-contributory and diagnosis was made by upper gastrointestinal endoscopy.

Case 1. Robert Davies, a 50-year-old man, presents with tiredness and lethargy. Examination demonstrates pallor and jaundice. Investigations reveal anemia that is consistent with warm autoimmune hemolytic anemia (AIHA; Figure 1). He has no evidence of any other autoimmune disease or chronic lymphocytic leukemia (CLL) and is not taking any medications; these factors suggest idiopathic AIHA. How ...

BACKGROUND AND OBJECTIVES Blood culture is the gold standard to diagnose bloodstream infection but is usually time-consuming. Prediction models aim to facilitate early preliminary diagnosis and treatment. We systematically reviewed prediction models for health care-associated bloodstream infection (HABSI) in neonates, identified superior models, and pooled clinical predictors. DATA SOURCES Li...

Acute hyperammonemic encephalopathy is generally associated with severe liver disease, manifesting neuropsychiatric symptoms including confusion, lethargy, seizure, coma, and even death. Electroencephalogram (EEG) a proven diagnostic, prognostic, therapeutic tool in patients acute chronic encephalopathies. EEG changes are background slowing theta to delta ranges, accompanied by presence of trip...