Pattern of Residual Submucosal Involvement after Neoadjuvant Therapy for Rectal Cancer: A Rationale for the Utility of Endoscopic Submucosal Resection.

: Full-thickness trans anal local excision for tumors with favorable response following neoadjuvant therapy for locally advanced rectal cancer (LARC) is a common strategy for organ preservation, but it could be associated with a high rate of postoperative complications. We describe the incidence and pattern of submucosal involvement in surgical specimens following neoadjuvant therapy for LARC and whether limiting local excision of the residual tumor bed to only mucosal/submucosal layers of the rectal wall is sufficient for accurately predicting the ypT status of residual cancer, providing a pathological rationale to replace full-thickness local excision by endoscopic submucosal resection. : This was a single-institution retrospective study conducted at a teaching community hospital.

Prior Sexual Trauma Exposure Impacts Posttraumatic Dysfunction and Neural Circuitry Following a Recent Traumatic Event in the AURORA Study.

Background: Prior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST.

Methods: Participants ( = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision).

Neighborhood Disadvantage and Neural Correlates of Threat and Reward Processing in Survivors of Recent Trauma.

Importance: Differences in neighborhood socioeconomic characteristics are important considerations in understanding differences in risk vs resilience in mental health. Neighborhood disadvantage is associated with alterations in the function and structure of threat neurocircuitry.

Objective: To investigate associations of neighborhood disadvantage with white and gray matter and neural reactivity to positive and negative stimuli in the context of trauma exposure.

Small Fiber Neuropathy After SARS-CoV-2 Infection and Vaccination: A Case-Based Comparison.

COVID-19-associated neuropathies, whether post-infection or post-vaccination, have not been fully described. A variety of theories exist to explain these phenomena, many of them centering on immune dysregulation. We aim to contribute to the discussion on the similarities and differences behind the two conditions and to bolster the call for further research to be done in this area.

A rare case of empyema due to in the setting of COVID-19.

Introduction: is a Gram-positive anaerobic rod that is part of the normal skin flora, as well as the oral cavity, genitourinary and gastrointestinal tracts. When detected, it is usually considered contaminant; but it is infrequently responsible for invasive infections, mainly neurosurgical and joint infections. It is rarely found as a pathogen responsible for lung infections or empyema.

Comparing Post-operative Opioid Consumption before and after a Patient-Controlled Analgesia Shortage: A Re-evaluation of Safety and Effectiveness.

This retrospective cohort study aimed to compare post-surgical opioid consumption before and after a PCA (patient-controlled analgesia) shortage. The study evaluated patients who received PCA nurse-administered opioid analgesia (non-PCA). Two hundred and twenty-four patients ≥18 years who were initiated on analgesia within 24 h of surgery were included.

A Simple Vitamin Deficiency With Life-Threatening Complications: A Case of B12 Deficiency and Hyperhomocysteinemia-Induced Thrombosis.

While macrocytic anemia is common in vitamin B12 deficiency, rarely, pancytopenia and hemolytic anemia can occur. Homocysteine levels are elevated in severe B12 deficiency, and this is linked to thrombus formation with potentially life-threatening complications. We present a patient with severe vitamin B12 deficiency complicated by hyperhomocysteinemia and obstructive shock from pulmonary embolism.

Reversible Dysphagia Associated With Risperidone Presenting With a Choking Episode.

Dysphagia has been associated with antipsychotic drug use. This case report describes the management of dysphagia in a psychiatric patient who presented to the emergency department from a psychiatric facility after choking on a hot dog. The patient was on risperidone 4 mg, initiated a month prior to treat acute psychosis.

Gallbladder Empyema and Epidural Abscess Due to Enteritidis After Treatment of Primary Infection: Case Report and Review of the Literature.

Nontyphoidal can cause gallbladder empyema and disseminated disease in patients with suppressed immune systems. We are reporting a unique case of concomitant gallbladder empyema and epidural abscess due to subsp serovar Enteritidis in a patient who was appropriately treated for the primary infection complicated by bacteremia. A high degree of suspicion is needed in high-risk patients as timely intervention can avoid life-threatening complications.

Evaluation of standard versus prolonged magnesium infusion rates in hospitalized patients: a retrospective cohort study.

Background: Hypomagnesemia is a common electrolyte abnormality in hospitalized patients. Prolonging the infusion rate of magnesium has been hypothesized to increase retention of magnesium, however, there is limited evidence to support prolonging the rate of infusion.

Aim: To compare the absolute change in serum magnesium levels from baseline to levels drawn within 24 hours after the end of infusion between two groups receiving standard or prolonged infusion.

Evaluation of High-dose Standard-dose of Dexamethasone on Mortality among the Mechanically Ventilated COVID-19 Patients.

Introduction: Anti-inflammatory agents like dexamethasone (DEX) are a mainstay of treatment for COVID-19. Despite randomized trials demonstrating that a 6 mg daily dose of DEX improved patient outcomes in hospitalized COVID-19 patients receiving oxygen, clinicians often prescribe higher doses of corticosteroids without evidence to support this practice. The purpose of this study was to compare outcomes of ventilated COVID-19 patients who received standard dose (SD) versus high dose (HD) DEX.

Hybrid staged approach to subclavian artery aneurysm repair with aberrant dominant left vertebral artery.

Intrathoracic subclavian aneurysms are a rare entity, accounting for only a small percentage of all repaired aneurysms. These are repaired to alleviate symptoms and prevent complications of rupture, thrombosis and distal embolization. Most of these are amenable to thoracic endovascular aneurysm repair (TEVAR), which has resulted in an associated reduction in operative mortality.

Incretin Analogs for Weight Management in Adults Without Diabetes.

Objective: This is a narrative review of incretin analogs and their effect on weight management in adult without diabetes.

Data Sources: Randomized controlled trials were identified by English language. PubMed/MEDLINE, Scopus, and Embase databases were searched from inception through June 2023 to identify all pertinent trials reporting outcomes on efficacy and safety search using the terms: tirzepatide, semaglutide, liraglutide, and obesity.

Hepatic Vein Pylephlebitis as a Cause of Bilateral Pyopneumothorax.

Pylephlebitis is a rare complication of intra-abdominal infections and has a significant mortality rate, necessitating early recognition for optimal treatment. Here, we present the case of a 36-year-old male with fever, shortness of breath, cough, and epigastric pain. He was ultimately diagnosed with hepatic vein pylephlebitis along with multiple pulmonary and hepatic lesions believed to be septic emboli and hepatic abscess.

Accuracy of Leg Length and Hip Offset Measurements Using a Fluoroscopic Grid During Anterior Approach Total Hip Arthroplasty.

Background: Minimizing leg length (LLD) and hip offset (OD) discrepancies is critical for tissue tension and implant longevity in total hip arthroplasty (THA). The direct anterior approach (DAA) helps surgeons recreate these values under fluoroscopy. Several methods to accomplish this have been described, with no consensus on which is superior.

Cervical Health in Systemic Lupus Erythematosus.

Objective: A health disparity exists for African American (AA) women with systemic lupus erythematosus (SLE) who have increased prevalence of human papilloma virus (HPV) infection and cervical neoplasia. We used a self-sampling brush to obtain cervical cells to assess cytology, HPV infection, and vaginal cytokine production in AA women with SLE.

Methods: Thirty AA women with SLE ages 18-50 years consented to participate.

Percutaneous Transaxillary Impella Device Placement Resulting in Iatrogenic Subclavian Artery Pseudoaneurysm.

Subclavian artery pseudoaneurysm (PSA) is a rare complication arising from transaxillary Impella device placement during high-risk percutaneous coronary intervention (PCI). Despite the increasing prevalence of Impella use, literature addressing this complication is scarce. This case emphasizes the limited existing evidence on subclavian artery PSA and highlights the importance of recognizing it as a potential risk.

Design and Rationale of the Safe Surveillance of PCI Under Mechanical Circulatory Support With the Saranas Early Bird Bleed Monitoring System (SAFE-MCS) Study.

Background: High-risk percutaneous coronary intervention (PCI) with mechanical circulatory support (MCS) has been associated with varying rates of bleeding due to variable bleeding definitions, incomplete data relative to site-specific bleeding, and inclusion of variable patient populations.

Study Design And Objectives: SAFE-MCS (NCT05077657) is a multicenter, single-arm, open-label study designed to evaluate the safety of complex high-risk PCI using Impella and surveillance with the Saranas Early Bird Bleed Monitoring System (EBBMS). The study aims to enroll 184 evaluable subjects at up to 15 US centers.

Atraumatic Exertional Compartment Syndrome of the Medial Foot: Case Report.

Introduction: Acute compartment syndrome is a surgical emergency that is mainly diagnosed clinically. Acute exertional compartment syndrome of the medial compartment of the foot is a rare condition most often result from strenuous exercise. Early diagnosis is most often a clinical examination, however, laboratory and magnetic resonance imaging (MRI) can assist in the diagnosis if clinician uncertainty persists.

Virtual Anesthesiology Medical Student Learning Program Pilot Designed in Response to COVID-19.

Background: This learning opportunity was designed to provide an interactive, virtual, educational anesthesiology program for interested medical students and to offer an opportunity to learn more about an institutional culture through a question and answer (Q&A) with program faculty preceptors for the 2020-2021 anesthesiology residency application cycle. We sought to identify if this virtual learning program was a valuable educational tool through a survey.

Methods: A short Likert-scale survey was sent to medical students before and after participation in a session using REDCap electronic data capture tool.

Podcasts and videos and slides…oh my!: Traditional vs. nontraditional teaching methods in remote settings.

Introduction: Nontraditional teaching methods are student-centered and motivate students to participate in class activities. Some studies have shown benefit in using various teaching activities; however, data are limited regarding students' perspective and performance after implementation of nontraditional learning strategies. The study compared student preference and performance assessment with traditional and nontraditional presentation methods.