key: cord-0713838-4ykoijv5
authors: Devoy, Benjamin O.; Bennett, Peter J.; Coles, Alasdair J.; Mousa, Hani S.
title: Case reports in the Lancet: From neurophobia to global pandemics
date: 2022-04-21
journal: Clin Case Rep
DOI: 10.1002/ccr3.5693
sha: b196573caaeae1a6edecbecd4cae06afe6642148
doc_id: 713838
cord_uid: 4ykoijv5

While neurology remains the best‐represented specialty, it was Hematology and Rheumatology cases that were more often reported by non‐specialists. The overall distribution by country has also changed, reflecting recent outbreaks of infectious agents.[Image: see text]

Specialty using the thirteen-organ system classification the last case report in its original format was published, examining a total of 352 cases. Similar to previous studies, cases were analyzed based on the patient's clinical signs and symptoms and primary diagnosis. To allow comparison with previous studies, we used two different classification systems: the thirteen-organ system classification that we used in our original analysis of 2003 ( Figure 1 ) and a second expanded classification taking into account primary and secondary specialties as used in a subsequent study that reached similar results 1 (Figure 2 ). At the outset, two trends were evident: first, the excess of case reports that do not fit under one discrete category of the original organ-based classification (shown under "other" in Table 1 ). Some of these case reports are of infectious etiology, while others mirror recent advancements in biomedical research that are not, by definition, organspecific (such as genomic medicine and immunotherapy).

These patients and their multifaceted stories highlight more than anything the multidisciplinary nature of modern-day medical practice-one that incorporates different areas of expertise and a range of diagnostic methods and technologies. This also underscores the need for comprehensive patient care and a complementary strategy to medical practice and post-graduate medical education that goes beyond the single-disease single-specialty paradigm [7] [8] [9] The second evident trend was the wider representation of countries from where case reports were submitted (Figure 3 ) when compared to the analysis of 2010. This echoes a growing interest that followed recent outbreaks of infectious pathogens (such as Ebola and Zika viruses), as well as a conscious decision on the part of the editors to publish cases pertaining to medical care in low-and middle-income countries. 1 The importance of this cannot be overemphasized especially in this period-when the world is still in the midst of a global pandemic that has taken a great toll on patient lives and healthcare resources. Perhaps unsurprisingly, neurology remains the bestrepresented specialty among all cases assessed. However, when compared to the two previous analyses and using the same organ-based classification system, the percentage of neurological cases has decreased and the overall distribution by specialty has significantly changed as confirmed by Chi-square test, even when the "other" category was excluded (Table 1) . Moreover, unlike our previous analysis, the proportion of neurological cases reported by nonspecialists was not significantly different from the overall average (42% vs. 40%). Interestingly, it was Hematology and Rheumatology that had a tendency to be reported by non-specialists, with only 13% and 15% of cases reported by specialists in the respective field ( Figure 1 ).

The landscape of medical practice has expanded dramatically since the first case report appeared in the Lancet in 1995. Increasing mechanistic understanding of disease processes, along with the multi-morbidity that characterizes our aging population pose new challenges to the way medicine is structured and taught. Emerging infectious agents, coupled with increased human mobility, underscore the global nature of modern medical practice-which can no longer be defined within strict geographic boundaries. This is evident more than ever now, as countries across the globe are registering record numbers of COVID-19-related deaths more than a year after the first cluster of cases was reported in Wuhan City in the Hubei Province of China.

clinical education, global medicine, Lancet Case Reports, multimorbidity, neurophobia

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We thank all the patients whose published case reports were reviewed for this manuscript.

AJC received personal fees, honoraria for consulting and travel expenses for attending meetings from Genzyme. BOD, PJB, and HSM have nothing to disclose.

AJC and HSM conceived the idea and planned the analysis. BOD, PJB, and HSM reviewed the cases, analyzed the data, interpreted the results, and drafted the original manuscript. HSM critically revised the final manuscript and supervised the project.

None. Cases reviewed for this manuscript have already been published.