Teenage heartache: A 14-year-old with pleuritic chest pain
Bibliographic record
Abstract
A 14-year-old transgender male presented with 1 month of worsening intermittent pleuritic chest pain, 2–3 weeks after an upper respiratory infection. A review of systems revealed mild fatigue, low appetite and mild frontal headache without red flags. Examination revealed left-sided ptosis, persistent tachycardia (max 125 bpm), pulsus paradoxus, distant heart sounds and decreased air entry at lung bases. No pericardial rub. C-reactive protein (CRP) 201.9 mg/L (high). Blood count showed microcytic anaemia (haemoglobin 77 g/L). Serum electrolytes, creatinine, urinalysis, liver enzymes and coagulation profile were normal. Troponin 4 ng/L (high). Echocardiogram showed significant pericardial effusion with right atrial collapse. Chest x-ray revealed small pleural effusions (Figure 1). Urgent pericardiocentesis was performed, and Naproxen was started for presumed viral pericarditis. ... Rheumatology was consulted after limited improvement on Naproxen and a negative infectious workup (including tuberculosis). Ophthalmic exam showed inflammatory dacryoadenitis. CT orbit revealed a left lacrimal mass (Figure 2). Biopsy showed scar tissue with few plasma cells, no granulomas or eosinophils, and negative IgG4 staining. Chest CT showed non-specific ground-glass opacities and mild diffuse interlobular septal thickening. Pulmonary function test (PFT) showed a mixed obstructive-restrictive pattern. Serum ANA and IgG4 normal. Myeloperoxidase (MPO)-ANCA was strongly positive >134 U/L, informing diagnosis and management.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".