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Bing-Neel syndrome (BNS) is a rare syndrome that occurs in patients with Waldenstrom macroglobulinemia and is characterized by lymphoplasmacytic infiltration into the leptomeningeal tissue and/or the central nervous system. It represents an extramedullary manifestation which may translate into various neurological symptoms. Accurate diagnosis of BNS can be established via histologic sampling and cerebrospinal fluid examination with molecular analysis of some genetic markers including immunoglobulin heavy locus rearrangements and MYD88 L265P mutation. The use of Bruton tyrosine kinase inhibitors such as ibrutinib resulted in promising outcomes. In this review, we discuss the pathophysiology, clinical manifestations, diagnostic characteristics, and an overview of the current treatment modalities of BNS.

The 22q11.2 Deletion Syndrome has significant impact on brain and behavior, with about 25% of individuals developing schizophrenia. The condition offers a model for prospective studies on the emergence of psychosis and advancing mechanistic hypotheses on gene-environment interactions, with magnified power for examining genome-phenome association. Here, we highlight findings that build on the International 22q11.2 Brain and Behavior Consortium and relate to several key domains in the study of psychosis-risk and schizophrenia. We examine neurocognition, olfaction and neuroimaging data that indicate similar impairment patterns in this rare syndrome and idiopathic presentation of schizophrenia. We conclude that the converging paradigms, studying psychosis dimensionally in rare and common variants samples, provide complementary approaches that will propel precision medicine in psychiatry.

Amniotic fluid embolism is a rare syndrome characterized by sudden cardiorespiratory collapse during labor or soon after delivery. Because of its rarity, many obstetrical providers have no experience in managing amniotic fluid embolism and may therefore benefit from a cognitive aid such as a checklist. We present a sample checklist for the initial management of amniotic fluid embolism based on standard management guidelines. We also suggest steps that each facility can take to implement the checklist effectively.

Cervico-thoracic vertebral subluxation (CTVS) in sheep is a collective term that is used to describe various conditions that concomitantly affect the cervical and thoracic vertebrae, leading to their collapse. The aetiology and pathophysiology of CTVS remain unknown. The objective of this study was to conduct an epidemiological farm investigation and describe the clinicopathological findings of CTVS cases occurring in a flock of sheep; as well as to determine awareness of CTVS among sheep producers and ruminant veterinarians in Australia. Diagnostic imaging revealed severe deformities in the vertebrae between C6-C7 and T1-T3. Sheep affected with CTVS were at a four times higher risk of having low body condition scores (2 based on a 5-point scale) compared with non-affected sheep, OR = 3.98, 95% CI (1.20-12.65), p = .02. Survey results revealed that only 34% (15/44) of respondents were aware of CTVS. There is a need to further explore the aetiology and pathophysiology of CTVS, and the impact it has on sheep breeding and production.

We describe a case of an elderly female with complete heart block where temporary pacemaker insertion led to diagnosis of inferior vena cava interruption, leading further to diagnosis of polysplenia syndrome.

Since 1962, when Critchley and Hoffman coined the term Kleine-Levin Syndrome (KLS) for the triad of hypersomnia, excessive eating and "often abnormal behavior" which they have observed in 11 adolescent boys, the number of patients recognized with this rare syndrome expanded, the spectrum of the clinical presentation, disease course, prognosis, gender specificity and the presence of familial cases were established. However, in spite of the progress made in neuroscience, the search for the cause, neuroanatomy, pathophysiology and drug treatment of KLS is still ongoing. In this mini-review we will describe in some detail the scientific efforts made to understand in depth the complex symptomatology of KLS and refer also to updated findings reached up till now.

Pentalogy of Cantrell is a rare syndrome consisting of a constellation of congenital anomalies including omphalocoele, lower sternal defect, sdiaphragmatic defect, diaphragmatic pericardial defect and congenital heart disease. It is reported to be usually fatal in absence of timely treatment. We present a case where an untreated patient has miraculously survived into the sixth decade.

Background Poland syndrome is a rare syndrome named by Patrick Clarkson in 1962 and described by Sir Alfred Poland in 1841. Case report The dental anomalies with pre-existing poland syndromic child were noticed by the parents during child's regular eating-chewing more obviously, after the appearance of his primary teeth. Follow-up The patient is under oro-myofunctional therapy with other strict preventive regimen and is still being monitored every 6 months since last 2 years. Conclusion Specific attention must be paid to children with pre-existing conditions with preventive measures and implementation of muscular training very early in life.

Folie a deux is a rare syndrome characterized by induction of a delusion in a susceptible person in close proximity with an individual with known delusional disorder. We report a rare case of monozygotic twins with induced delusional disorder in one of the twins. The twins had experienced childhood trauma in the form of emotional neglect and physical abuse by the father. The primary case (Twin A) was diagnosed with delusional disorder and was treated with oral antipsychotic. The secondary case (Twin B) showed resolution of symptoms after separation from twin A. The case highlights the unique presentation of induced delusional symptoms in monozygotic twins and the close association between childhood trauma and psychosis.

Spontaneous heparin induced thrombocytopenia (HIT) is a rare syndrome in which anti-heparin antibodies develop without heparin exposure. Patients with spontaneous HIT are in a hypercoagulable state, often presenting with arterial or venous thromboembolism (VTE). Prompt diagnosis is important for

Haff disease is a rare syndrome characterized by rhabdomyolysis following consumption of cooked fish or crustaceans. We present the investigation of an outbreak of Haff disease in Nanjing, Jiangsu Province, China incorporating both epidemiological and chemical analysis. Structured questionnaires were sent to 20 case-patients and 25 diners who ate with case-patients. Eleven samples of crayfish ( Procambarus clarkii ) from the local markets, blood and urine samples from two case-patients were collected and sent for chemical testing. The case-control study revealed that all cases and controls had eaten crayfish during the exposure period. Consuming more than 10 pieces of crayfish was related to increased disease risk ( p

Background Posterior reversible encephalopathy syndrome (PRES) is a well-recognized complication of hypertensive encephalopathy. Recently, pre-eclampsia, connective tissue disorders, and immunosuppressive drugs have been reported to be the etiologies of this rare syndrome. Methods We evaluated 9 cases of PRES whose diagnosis were confirmed based on clinical and radiologic evidence between July 2011 and December 2013 in a tertiary center, Imam Khomeini Hospital, Tehran, Iran. Results Immunosuppressive drugs, especially cyclosporine, and hypertension were the main precipitating factors. In this study, seizure was the most common clinical presentation (100%), whereas other common clinical presentations were confusion (78%), visual loss (67%), and headaches (67%). With conservative management and elimination of predisposing factor, the patients improved gradually except for 2 cases who experienced prolonged recovery period because of delayed diagnosis. Conclusions With timely diagnosis, PRES generally has a good prognosis with complete recovery. However, in missed conditions, it could be associated with catastrophic burden especially in organ transplantation after a prolonged time spending to find matched donors or in chronic immunosuppressive conditions. Thereupon, physicians should be aware of clinical and radiologic manifestations of this preventable but potentially disabling syndrome.

This article focuses on the associated signs and symptoms of patients with partial agenesis of the corpus callosum. The orodental manifestations of such cases have been given special weightage which will prove to be of great help to oral physician when encountered with such cases. Case details Two siblings, aged 14 and 16 years, reported with a chief complaint of severe crowding of teeth with mouth breathing habit. They were low birth-weight babies and had been born to non-consanguinous parents. The distinguishing features of these children were craniofacial abnormalities, delayed developmental milestones, mild mental retardation and abnormal gait. The nosological features and the clinical manifestations of this syndrome and the plausible autosomal recessive inheritance of this rare syndrome have been elicited. The diagnosis was based on characteristic phenotype, in particular striking craniofacial and skeletal abnormalities and neuroimaging. Conclusion It is a challenge for healthcare professionals to help these youths to maximize their potential as human beings and help them achieve a meaningful adulthood. On the other hand, diagnosing such cases can be a challenge to dentistry. A systematic protocol, if adhered, can lead to a more appropriate diagnosis. Managing such cases in a clinical setup involves a multispeciality and interdisciplinary approach.

Hemiballismus–hemichorea is a rare complication of nonketotic hyperglycemia. Neuroimaging in patients with this syndrome show characteristic findings with hyperintensity in basal ganglia. We present case of a 65 year old female showing classic clinical and radiographic feature of this syndrome. We aim to illustrate the importance of prompt diagnosis of this disorder and treatment of hyperglycemia to achieve a favorable prognosis and prevent adverse outcomes.

Shapiro Syndrome (SS) is a rare condition of spontaneous periodic hypothermia, corpus callosum agenesis (ACC) and hyperhidrosis which can occur at any age. The variant form refers to the phenotypic SS without ACC. We reported the case of SS variant on a 4-year-old boy who presented from his first year frequent episodes of hypothermia lasting 2-3 h with core rectal temperatures

Postpneumonectomy syndrome (PPS) is a rare syndrome whereby the airway and oesophagus become obstructed due to extreme rotation of the mediastinum after pneumonectomy. Our treatment of this condition involved mediastinal repositioning and placement of a saline filled tissue expander into the pleural space. This has not been reported in the plastic surgical literature and we describe technical difficulties and how they were overcome.

Platypnea-orthodeoxia is a rare syndrome involving dyspnea and hypoxemia while upright usually due to a right to left shunt through a patent foramen ovale (PFO). It has been associated with thoracic aortic aneurysm, possibly due to anatomic effects on the atrial septum. A 65 year old female with a

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of abnormal immune activation resulting in phagocytosis of host cells and cytokine storm. This leads to systemic manifestations, such as cytopenias, hepatitis and, in very rare cases, stress-induced (Takotsubo) cardiomyopathy. We present a

Objectives Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome. The pathophysiology is poorly understood. Computed tomography (CT) and magnetic resonance imaging (MRI) findings are characteristic of the diagnosis and diffusion weighted image has been also suggested having a prognostic value. We report this unusual neurologic complication of peripartumin except any pre-existent pathology of the pregnancy. Materiel and methods CT, MR findings and relevant clinical data of the patients were retrospectively reviewed on 5 cases between 2011 and 2012 in our radiologic department. Results Eclampsia was responsible in all cases. CT finding were bilaterally symmetric low density in the posterior parietal and occipital lobes consistent with vasogenic edema on FLAIR and diffusion MR images ( Fig. 1 , Fig. 2 ). Conclusion Since PRES is often unsuspected by clinicians, radiologists may be the first to suggest the diagnosis. As this diagnosis has important therapeutic and prognostic implications, radiologists should be aware of the spectrum of imaging findings in PRES. It consists on an increasingly recognized neurologic disorder with characteristic CT and MR findings.

Resumen: La microduplicación 3q29 (MIM 611936) es un raro síndrome caracterizado por retraso mental moderado, rasgos dismórficos craneofaciales y anomalías musculoesqueléticas. La región mínima crítica tiene un tamaño de aproximadamente 1,73 Mb, está flanqueada por secuencias repetitivas y es similar en tamaño a la microdeleción recíproca 3q29, sugiriendo para ambas una recombinación homóloga no alélica (NAHR) entre las secuencias repetitivas como mecanismo de producción. Describimos una nueva familia con diferente expresividad clínica en la paciente y su madre. Abstract: 3q29 microduplication (MIM 611936) is rare syndrome characterized by moderate mental retardation, craniofacial dysmorphic features and musculoskeletal anomalies. The size of the minimal critical region is about 1.73 Mb. It is flanked by repetitive sequences and it is similar in size to the reciprocal 3q29 microdeletion, suggesting a non-allelic homologous recombination event (NAHR) at flanking LCR sequences as its aetiological mechanism. We describe a new familial case with variable expressivity.

Benign myoclonic epilepsy in infancy (BMEI) is a rare syndrome included among idiopathic generalized epilepsies (IGE) and syndromes with age-related onset. Recently, it has been shown that a few patients with BMEI later had other epilepsy types mainly IGE but never childhood absence epilepsy (CAE). We report a patient who at 11 months of age showed isolated myoclonic jerks occurring several times a day. The ictal video-EEG and polygraphic recording revealed generalized discharge of spike-wave (SW) lasting 1–2s associated with isolated bilateral synchronous jerk involving mainly the upper limbs controlled by valproic acid (VPA). At 6 years and 8 months the child developed a new electroclinical feature recognized as CAE. The ictal EEG disclosed a burst of rhythmic 3Hz generalized SW. Our case is the first patient with BMEI reported in the literature who later developed a CAE. This finding suggests a common neurobiological and genetic link between different age-related epileptic phenotypes.

Background: “Cocaine-induced agitated delirium with associated hyperthermia” is a rare, almost uniformly fatal syndrome. The incidence of the disease is not known, however, it is believed to have markedly increased since the late 1980s with widespread popularity of crack cocaine. Objective: Recent literature is lacking regarding this rare syndrome. Although almost uniformly fatal, we present a neurologically intact survivor due to a multidisciplinary team approach. Case Report: We are reporting a 41-year-old African-American man who arrived at the trauma center with a rectal temperature of 42.6°C (108.6°F) and a toxicology screen positive for cocaine. The patient manifested many of the known complications of cocaine-induced agitated delirium with associated hyperthermia, including renal failure and coagulation panel abnormalities. With early application of cooling techniques, including ice pack, gastric lavage, and bilateral chest cavity lavage using multiple chest tubes, the patient's core temperature was quickly lowered. Conclusion: This case demonstrated how a multidisciplinary team approach, including emergency medicine and critical care specialists, and aggressive treatment of hyperthermia using bilateral tube thoracostomy and chest cavity lavage enabled our patient's core temperature to be effectively lowered. We were unable to find prior reports of using tube thoracostomy in this manner.

We describe a case of Takotsubo cardiomyopathy in a 75-year-old woman after an elective extraction of 10 teeth of the lower jaw using bilateral mandibular anesthesia. The patient complained of shortness of breath and chest pain after 24h. Coronary angiography showed smooth normal coronary arteries with thrombolysis in myocardial infarction III flow. Left ventriculography demonstrated apical ballooning. Three months later, the patient is symptom-free, with normal left ventricular function. We assume that the complex and robust procedures in dentistry together with a systemic absorption of epinephrine are sufficient triggers for the development of Takotsubo cardiomyopathy. In our case, we advocate an external catecholamine exposure rather than an internal catecholamine excess. We need more vigilance when assessing such patients. Learning objective: We describe a stress-induced cardiomyopathy with late symptom development despite an uncomplicated tooth extraction. There was only one case of Takotsubo cardiomyopathy with acute symptoms described in the literature, although after complicated tooth extraction. It could be interesting for physicians that the complex and robust procedures in dentistry together with a systemic absorption of epinephrine are sufficient triggers for the development of Takotsubo cardiomyopathy.>

We report the case of a 55-year-old man without significant medical history admitted to the ICU for a progressive paralysis mimicking life-threatening tetanus. Evolution with classical tetanus treatment was negative, with the need for ventilator support and worsening condition being life threatening. Uncommon evolution revealed a rare glycin antibody-associated hyperekplexia (progressive encephalomyelitis with rigidity syndrome). Patient dramatically improved with immunosuppressive therapy including plasmatic exchanges, cyclophasmid and high dose corticoid infusions. Intensivists should be aware of this very rare syndrome whose treatment is the opposite of tetanus while presentation is very close. Optimal and treatment could lead to prolonged survival.

Objective Penile hair tourniquet syndrome is an uncommon syndrome characterized by progressive penile strangulation by a hair tie. Complications reported include urethrocutaneous fistula, complete urethral transection, penile gangrene, and penile amputation. Prevention of such major complications depends on awareness of the etiology and presence of a high index of suspicion for early diagnosis. Patients and Methods Twenty-five children presenting with different degrees of hair coil penile strangulation syndrome have been operated on in the period from 2000 to 2007 in 2 tertiary care centers in the city of Alexandria. Eighteen boys had complete transection of the urethra at the coronal sulcus. Seven boys had partial transection of the ventral wall of the urethra at the coronal sulcus. Repair of the penis was done in all children in a single stage. Results The mean age of boys is 3 years and 9 months (2-5 years). The mean follow-up is 20.7 (6-48) months. Urethral catheter was left for a mean of 5.5 (4-7) days. In the mean follow-up period, we had 4 complications in the form of 2 tiny urethrocutaneous fistulas and 2 anastomotic urethral strictures. The fistulae were closed surgically after the primary surgery by 1 year in the 2 cases, with no recurrence. Urethral strictures were managed by endoscopic visual urethrotomy, with no recurrence. Conclusion Penile tourniquet syndrome can cause serious penile complications. Awareness of this rare syndrome can help in preventing such complications. Being familiar with the surgical reconstruction guarantees high success rate.

Rotational vertebrobasilar insufficiency (RVBI) is a rare syndrome presenting with vertigo, dizziness or syncope when the patient rotates their head. A 65-year-old man presented to medicine with presyncope while he was backing up his truck to put his boat in the water. This only occurred when he

Pai syndrome is a rare form of frontonasal dysplasia, first described in 1987. It is a triad consisting of midline cleft of the upper lip, facial skin polyps and central nervous system lipomas. Only 14 cases have been reported in the literature. The authors describe the clinical features, diagnostic workup and treatment of two patients. A review of all cases reported in literature is presented to show the phenotypic variability of this rare syndrome.

Summary Rubinstein–Taybi syndrome is a rare genetic disease characterized by mental deficiency, broad thumbs and toes, short stature, and characteristic facial features. The syndrome has been linked to microdeletion at 16p13.3 encoding CREB-binding protein gene (CREBBP). Most reported cases of Rubinstein–Taybi syndrome are sporadic, with no firm evidence of Mendelian inheritance. We report a case of a 26-year-old male patient of Rubinstein–Taybi syndrome with pulmonary tuberculosis. The occurrence of respiratory infections in patients with this syndrome has been mentioned in the past. Systemic problems involving the respiratory system, feeding and the cardiovascular system have been noted in some individuals with this rare syndrome.

Platypnea-orthodeoxia is a rare syndrome characterized by the occurrence of dyspnea and hypoxemia on adoption of an upright posture (i.e., orthodeoxia) and by the absence of symptoms and hypoxemia in decubitus. This syndrome is frequently related to patent foramen ovale and right-to-left shunting. We describe two patients in whom patent foramen ovale with right-to-left shunting was observed on transthoracic and transesophageal echocardiography and who had platypnea-orthodeoxia in the absence of pulmonary disease. They underwent transcatheter closure using an Amplatzer device. The echocardiographic diagnosis and closure procedure are discussed. These case reports demonstrate that closure of patent foramen ovale is an effective treatment for platypnea-orthodeoxia.

Summary This is a rare syndrome which affects monochorio-nic twin pregnancies due to different vascular placen-tary connections. It gives rise to a deficient perfusion in one of the twins and an increase in perfusion in the other with a mixture of the ciculatory systems. Diagnosis is made by ultrasound, following signs of foetal compromise although the physiopathology is unclear. Foeto-foetal transfusion syndrome is very serious, with high rates of foetal morbimortality. Treatment has still to be defined, amnioreduction being the treatment of choice, although nowadays laser coagulation of placental anastomoses using fetos-copy is becoming more common. There are also possibilities, in the future, of ultrasound treatment of this syndrome. We describe a couple of cases and make a bibliography review.

Stevens-Johnson syndrome is a rare acute process with a mortality rate of 20%. Stevens-Johnson syndrome is a reactive dermatosis consisting of an erythema multiforme with the presence of vesicles and or blisters in the mucosa (particularly oral). Its more severe presentation is toxic epidermal necrolysis. The most frequent cause is hypersensitivity to multiple drugs, followed by infections, connective tissue diseases, and neoplasms. Although it is a rare syndrome, we must consider it, as the rapid installation of an appropriate treatment, as well as the rapid withdrawal of the triggering drug, can considerably reduce the morbidity and mortality.

Posterior nutcracker syndrome is caused by compression of the left renal vein between the abdominal aorta and the vertebral column. We present the case of a 14-year-old girl with vague left loin pain, mild haematuria and proteinuria. Diagnosis of this rare syndrome was achieved using color Doppler US and multidetector computed tomography (MDCT) angiography.SommarioLa sindrome da schiaccianoci posteriore è dovuta alla compressione della vena renale sinistra tra l’aorta addominale e la colonna vertebrale. Viene presentato il caso di una ragazza di 14 anni con lombalgia sinistra, lieve ematuria e proteinuria, in cui la diagnosi di questa rara sindrome è stata ottenuta con Eco-color Doppler e con l’Angio-TC.

Sulcal artery syndrome is a rare cause of spinal cord infarction. We describe a case of sulcal artery syndrome due to traumatic vertebral artery dissection and review the known literature on this rare syndrome.

Platypnea-orthodeoxia is a rare syndrome presenting with dyspnea and cyanosis induced by an upright position and relieved by recumbency. We report a patient with an excessively enlarged aortic root who had critical hypoxia due to a paradoxical shunt through the patent foramen ovale only when seated. The postural changes of the shunt, caused by changes in posture, were dynamically detected by transesophageal Doppler echocardiography. We believe that this syndrome should be considered when patients with aortic root dilatation present with inexplicable hypoxia, and that transesophageal Doppler echocardiography in the sitting position can be useful for detecting platypnea-orthodeoxia syndrome.

Landau-Kleffner is currently considered a rare syndrome that combines acquired aphasia and epilepsy in children. We present two cases and discuss evidence in the literature that suggest how this syndrome is actually only part of a more generalized situation in which epilepsy (a paroxysmal disorder) produces or is accompanied by a prolonged or permanent derangement of neuronal circuits responsible for higher cortical functions, including language. This reappraisal of the identity of the syndrome could have interesting consequences not only for the study of epilepsy but also for the study of higher cortical functions.

Platypnea-orthodeoxia (POD) is a rare syndrome described by dyspnea and hypoxemia while upright that improves on recumbence. It is associated with an intracardiac shunt, pulmonary AVM, ventilation-perfusion mismatch or a combination of these. A 53-year-old woman was referred for unexplained hypoxia

Multiple endocrine neoplasia type 2B/3 is characterized by multiple mucosal neuromas, a marfanoid appearance, medullary thyroid carcinoma, pheochromocytoma, gastrointestinal ganglioneuromatosis, and thickened corneal nerves. This rare syndrome is inherited in an autosomal dominant pattern. Early recognition followed by appropriate screening and treatment can be life-saving.

Platypnea is a rare syndrome of orthostatic dyspnea frequently caused by an interatrial right-to-left shunt. The diagnosis is difficult. Assessment of arterial blood gases reveals orthostatic desaturation. In the past, definite diagnosis necessitated catheterization in the supine and upright position. Now transesophageal echocardiography on a tilt table combined with a peripheral venous contrast study provides correct diagnosis in a safe and easy way.

Platypnea-orthodeoxia is a rare syndrome that is often associated with interatrial shunting through a patent foramen ovale or atrial septal defect. we describe the case of a 65-year-old woman with progressive dyspnea and hypoxia when standing and walking, which was relieved by assuming the recumbent position. The diagnosis was confirmed by tilt-table transesophageal echocardiography demonstrating a large right- to-left shunt through a patent foramen ovale while the patient was in a semiupright position and no significant shunt while in a recumbent position. This case demonstrates that platypnea-orthodeoxia caused by a patent foramen ovale can be clearly demonstrated by the technique of contrast transesophageal echocardiography performed on a tilt table.

Bannayan-Zonana syndrome (BZS) is a genetic disorder with autosomal dominant inheritance characterized by macrocephaly and multiple hamartomas of mesodermal origin. Here we present a patient with BZS manifested by many of the classic features, as well as a high-flow upper extremity arteriovenous malformation (AVM). Although this rare syndrome was initially described in 1971, to our knowledge, this is the first report showing an association of AVM with BZS and the first report of this syndrome in the radiologic literature.

We report here the case of a 20-year-old man with POEMS syndrome ( p olyneuropathy, o rganomegaly, e docrinopathy, M proteins, kin changes). This rare syndrome followed a 3-year history of a syndrome that mimicks a chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with cyclophosphamide induced regression of the syndrome and improved peripheral nerve conduction.

The rare syndrome of the agnathia with microstomia, aglossia, synotia (the external ears approaching one another in the midline) and brain malformation (agnathia-holoprosencephaly) was reported by Pauli et al . (1983) as a developmental field defect. This syndrome has two subgroups. One is more severe with brain malformation (holoprosencephaly), and the other is less severe without brain malformation. This report presents a long surviving case of this syndrome without brain malformation.

Traumatic asphyxia has often been described as a rare syndrome with little prognostic significance. In the authors' series, however, all cases secondary to deceleration injury or compression of the anterior thorax were associated with puimonary injury. The signs of venous congestion of the face and anterior thorax are not always recognized in the emergency department where they should be most cinically evident. Increased awareness of this syndrome by emergency physicians will result in better reporting and understanding of its clinical implications.