Late subsequent Merkel cell carcinoma after 21 years of the first primary diagnosis: When to de-escalate surveillance?

Key Clinical Message: Merkel cell carcinoma (MCC) presents challenges in surveillance due to varied recurrence rates and uncertain follow-up protocols, especially in late recurrent cases. These cases need personalized monitoring strategies beyond traditional timelines, such as clinical and molecular factors, in order to optimize patient outcomes.

Abstract: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with neuroendocrine differentiation with a propensity for recurrence following initial treatment.

Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research.

Building a framework to decolonize global emergency medicine.

Background: Global emergency medicine (GEM) is situated at the intersection of global health and emergency medicine (EM), which is built upon a history of colonial systems and institutions that continue to reinforce inequities between high-income countries (HICs) and low- and middle-income countries (LMICs) today. These power imbalances yield disparities in GEM practice, research, and education.

Approach: The Global Emergency Medicine Academy (GEMA) of the Society for Academic Emergency Medicine formed the Decolonizing GEM Working Group in 2020, which now includes over 100 worldwide members.

"Cold feet": A qualitative study of medical students who seriously considered emergency medicine but chose another specialty.

Introduction: Emergency medicine (EM) has historically been among the most competitive specialties in the United States. However, in 2022 and 2023, 219 of 2921 and 554 of 3010 respective National Resident Matching Program positions were initially unfilled. Medical students' selection of a medical specialty is a complex process.

Anesthesia for office-based facial plastic surgery procedures.

Objective: The objective of this study is to provide a state-of-the-art review on the use of anesthetics for in-office facial plastic procedures.

Methods: A search was performed on PubMed, Embase, Web of Science, and Cochrane Review using the keywords "anesthesia," "office-based procedures," "local anesthesia," "facial plastics," "oral sedation," "moderate sedation," and "deep sedation."

Results And Conclusions: Over the past few decades, the shift toward in-office invasive procedures has increased patient convenience and decreased hospital resource utilization.

COVID-19 and tobacco products use among US adults, 2021 National Health Interview Survey.

Background: Smoking and vaping are linked to lung inflammation and lowered immune response.

Objective: Examine the prevalence of coronavirus disease 2019 (COVID-19) cases, testing, symptoms, and vaccine uptake, and associations with tobacco product use.

Methods: Data came from the 2021 National Health Interview Survey.

Excision of massive left branchial cleft cyst with secondary hypertension.

Branchial anomalies are heterogeneous congenital malformations that form secondary to incomplete closure of pharyngeal clefts and pouches. There have been no reports of branchial cleft cysts causing carotid artery compression and hypertension. We report a large branchial cleft cyst causing suspected secondary hypertension from carotid artery compression.

Age-based centiles for diastolic blood pressure among children in the out-of-hospital emergency setting.

Objective: To compare Pediatric Advanced Life Support (PALS) diastolic blood pressure (DBP) criteria to empirically derived DBP criteria for the prediction of out-of-hospital interventions in children.

Methods: We performed a retrospective study of pediatric (<18 years) encounters from the ESO Data Collaborative, which includes approximately 2000 Emergency Medical Services agencies in the United States. We developed age-based centile curves for DBP using generalized additive models for location, scale, and shape.

Predictive value of pituitary tumor morphology on outcomes and complications in endoscopic transsphenoidal surgery.

Purpose: Endoscopic transsphenoidal surgery (ETSS) is an increasingly utilized approach for resection of pituitary tumors. Prior studies have evaluated preoperative tumor size, location, and extent as prognostic factors for surgical resection. There is little data on the relationship between preoperative pituitary tumor radiographic morphology and surgical outcomes.

Hook effect in gestational trophoblastic disease: An emergency department case presentation.

Gestational trophoblastic disease is a process that affects ≈1 of 1000 pregnancies. If left untreated, this can progress to potentially life-threatening complications with malignancy such as choriocarcinoma.  The emergency physician must be aware of the presentation and complications of this disease process, including the difficulties in diagnosis.

An emergency medicine based model for community-engaged learning.

Community-engaged learning (CEL) integrates community service with structured learning to strengthen the knowledge and skills of future physicians while still in medical school. A national model forCEL during medical school does not currently exist. Emergency physicians have the opportunity to play a vital role in medical student education using CEL as a platform.

Overcoming barriers to promotion for women and underrepresented in medicine faculty in academic emergency medicine.

Equity in the promotion of women and underrepresented minorities (URiM) is essential for the advancement of academic emergency medicine and the specialty as a whole. Forward-thinking healthcare organizations can best position themselves to optimally care for an increasingly diverse patient population and mentor trainees by championing increased diversity in senior faculty ranks, leadership, and governance roles. This article explores several potential solutions to addressing inequities that hinder the advancement of women and URiM faculty.

Utility of laboratory markers in evaluating for acute compartment syndrome in the emergency department.

Background: Acute compartment syndrome is diagnosed by clinical examination with the aid of direct compartmental measurement. Previous work suggested using several laboratory markers that may suggest ongoing acute compartment syndrome in hospitalized patients. Serum creatinine kinase (CK) levels >4000 U/L, chloride (Cl) levels >104 mg/dL, and blood urea nitrogen (BUN) levels <10 mg/dL were found to have 100% association with the diagnosis of acute compartment syndrome.