Teenage pregnancy: trends, contributing factors and the physician's role
Bibliographic record
Abstract
Objective: N/A Background: Human Monocytic Ehrlichiosis (HME) can cause multi-organ dysfunction syndrome (MODS) and rarely secondary hemophagocytic lymphohistiocytosis (HLH). Here we present an immunosuppressed patient who developed clinical signs of meningoencephalitis and secondary HLH due to Ehrlichia chaffeensis (E. chaffeensis). Design/Methods: N/A Results: CASE: A 66-year-old man with a history of adult onset stills disease was admitted with fever, rigors, malaise, and worsening mentation for a week. He was on immunosuppression following a renal transplant two weeks before admission. He was started on empiric antibiotics for treatment of meningoencephalitis. Cerebrospinal fluid (CSF) analysis was not performed given severe thrombocytopenia. Electroencephalography revealed generalized slowing with no seizures and imaging of the brain was unremarkable. Pertinent laboratory workup revealed elevated ferritin, triglycerides, lactate dehydrogenase and a bone marrow biopsy demonstrating hemophagocytosis and positive serum E. chaffeensis on polymerase chain reaction (PCR) testing. He was subsequently diagnosed with hemophagocytic lymphohistiocytosis (HLH) secondary to E. chaffeensis in the setting of underlying immunosuppression. He was started on high dose steroids, however he deteriorated clinically requiring mechanical ventilation and pressor support. He was made comfort care per family and eventually passed away on the third week since admission. Conclusions: Secondary HLH is often triggered by infection, malignancy or autoimmune disease. HME caused by E. chaffeensis is an uncommon endemic tick-borne infection in certain parts of the United States. It typically causes a mild-moderate illness but can also lead to MODS and rarely secondary HLH. Specific laboratory tests for HME include DNA PCR, acute and convalescent antibody assays. Positive CSF testing is reported in less than 50% of the cases. Doxycycline is the drug of choice for HME. High clinical suspicion and treatment of the infection can be life-saving with an otherwise dismal prognosis of secondary HLH. Disclosure: Dr. Judge has nothing to disclose. Abinayaa Ravichandran has nothing to disclose. Dr. Walsh has nothing to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".