Bibliographic record
Abstract
Background Raynaud’s phenomenon (RP) is a condition characterized by episodic vasospasms in end arterioles, typically affecting the fingers and toes.[1] It is categorized into primary (idiopathic) and secondary types; secondary RP is often associated with underlying autoimmune or vascular disorders.[2,3] While RP commonly presents with transient color changes in the extremities, severe complications such as digital ulceration and gangrene are rare and usually suggest a secondary form of the disease. Case The report highlights the case of a 46-year-old female with a complex medical history, including ankylosing spondylitis, and psoriatic arthritis, who presented with gangrenous changes in the second toe in each foot with the right side more severely affected than the left. The patient initially reported symptoms suggestive of chilblains, for which she was treated which progressed to severe digital ischemia and necrosis, ultimately leading to the amputation of both toes. She did not have any RP symptoms in her other toes or in her hands. When her initial symptoms did not respond to treatment she was diagnosed and treated for vasculitis. Despite comprehensive diagnostic investigations, including imaging, autoantibody profiling and other laboratory studies, the diagnosis of vasculitis was never proven. She did not respond to any of the treatments for vasculitis. Ultimately her diagnosis was that of severe RP with gangrene of the affected toes. This case presentation highlights the importance of early recognition and multidisciplinary management of RP, especially in patients with other overlapping autoimmune conditions. Conclusion This case highlights a rare and progressively severe manifestation of RP, emphasizing the need for a raised index of suspicion for secondary RP in patients with complex autoimmune backgrounds. The progression to gangrene and the necessity for toe amputation illustrate the potential severity of RP. Early diagnosis and intervention in patients with severe RP is critical but in the case of our patient did not prevent her developing gangrene. [1.] Choi E. Vasc Med 2021;1:56-70. [2.] Clements W. J Clin Rheumatol 2022;28(6):e693-4. [3.] Dubey S. Rheumatology (Oxford) 2022;61(12):4631-42.
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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) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 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".