Frostbite on Denali: a case series and review of treatment options.

Frostbite, defined as tissue freezing due to cold weather exposure, is a major risk associated with mountaineering in cold climates. It represents a significant source of morbidity in the climbing population. In 2021, three individuals were evaluated at a single institution after developing frostbite while climbing Denali, Alaska, US.

Angiosome-Guided Revascularization in Local Flap Reconstruction of the Foot and Ankle: Comparable Outcomes With Both Direct and Indirect Revascularization.

Background: Among patients with critical limb ischemia and tissue loss, revascularization is an essential component for limb salvage. Local flaps of the foot and ankle remain a versatile tool in reconstructive limb salvage but is dependent on adequate arterial flow. In patients with arterial occlusive disease requiring revascularization, there is a lack of evidence in the current literature investigating on the necessity of direct arterial flow to the respective angiosome for local flaps reconstruction.

Shaping the Future of Infectious Diseases: The Journey to Promote Value, Opportunity, and Positive Messaging.

The field of infectious diseases (ID) offers a rewarding career path and is widely viewed as an essential subspecialty in medicine. However, in recent years, these positive aspects have been overshadowed by concerns surrounding low fellowship match rates, undercompensation, and burnout. The Infectious Diseases Society of America Fellowship Training Program Directors Committee met in 2023, discussed the future of ID as a specialty, and sought to develop strategies to highlight the value and opportunities of ID for future generations, as well as underscore the importance of and provide tools for positive messaging to trainees about the subspecialty.

International Consensus Statement on Platelet Function and Genetic Testing in Percutaneous Coronary Intervention: 2024 Update.

Current evidence indicates that dual antiplatelet therapy with aspirin plus a P2Y inhibitor is essential for the prevention of thrombotic events after percutaneous coronary interventions. However, dual antiplatelet therapy is associated with increased bleeding which may outweigh the benefits. This has set the foundations for customizing antiplatelet treatments to the individual patient.

The utility of surgical drains in adult and pediatric posterior spinal fusion: systematic review and meta-analysis.

Surgical drains are utilized in spinal surgery to reduce the incidence of epidural hematomas (EDHs) and to facilitate optimal wound healing. Despite their widespread use, there is a paucity of data to support their utility. The goal of this systematic review and meta-analysis is to compare the effect of using drains versus no drains on postoperative outcomes in adult and pediatric patients undergoing posterior spinal fusions for deformity or degenerative conditions.

Not Just an Oxymoron: The Utilitarian's Guide to Antimicrobial Stewardship in Transplant Infectious Diseases.

Solid organ transplant and hematopoietic cell transplant patients face an increased risk of infectious diseases, greater exposure to antibiotics, and heightened risk of multidrug-resistant organisms (MDROs) due to their immunosuppressed state. Antimicrobial stewardship programs (ASP) are essential in reducing the incidence of MDRO by conserving antimicrobial use, minimizing treatment durations, and improving the appropriate use of diagnostic testing. However, the role of ASP in transplant infectious diseases (TID) is still evolving, necessitating greater collaboration between ASP and transplant programs.

Metabolic Alkalosis.

Metabolic alkalosis is one of the four cardinal acid-base disorders and perhaps the least well understood by students. Taking a mechanistic approach to etiologies and management can be very helpful in such cases. Particularly, one should focus on the factors that generate the alkalosis (source of fluid loss and composition, less commonly alkali administration) and the factors (extracellular fluid volume status, hormonal systems) that maintain the abnormality.

Impact of prior cholecystectomy on diagnosis and outcomes of choledochal cyst resection in adults.

Introduction: The diagnosis of choledochal cysts in the adult population is complicated by the expected physiologic dilation of the common bile duct after cholecystectomy. We aimed to compare patients who underwent choledochal cyst resection based on cholecystectomy status.

Methods: A retrospective analysis was conducted of patients who underwent choledochal cyst resection between 1/1/1998-12/31/2021.

Caregiver Psychopathology, Resilience, and Their Associations with Social-Emotional Challenges of Young Children Affected by Armed Conflict in Colombia.

We examined the social and emotional challenges (SEC) of young children and the mental health of their caregivers in areas affected by armed conflict and displacement in Colombia. Anxiety, depression, and PTSD symptoms were assessed in 1,133 caregivers. Caregivers also reported on the SEC of their children aged 21-53 months.

Safety and tolerability of ubrogepant for the acute treatment of migraine in participants taking atogepant for the preventive treatment of episodic migraine: Results from the TANDEM study.

Objective: To evaluate the safety and tolerability of ubrogepant for the acute treatment of migraine in participants taking atogepant for the preventive treatment of episodic migraine (EM).

Background: Atogepant is an oral calcitonin gene-related peptide (CGRP) receptor antagonist approved for the preventive treatment of migraine in adults and ubrogepant is an oral CGRP receptor antagonist approved for the acute treatment of migraine in adults, with or without aura. The safety and tolerability of the concomitant use of ubrogepant and atogepant have not been previously evaluated in a clinical setting.

Outcomes of medial collateral ligament reconstruction with suture-augmented semitendinosus autograft.

Purpose: This study evaluates patient-reported outcomes among patients who underwent medial collateral ligament (MCL) reconstruction with suture-augmented semitendinosus autograft (SASA).

Methods: Patients who underwent SASA MCL reconstruction between 2017 and 2022 participated in preoperative and postoperative surveys for patient-reported outcomes: Visual Analog Pain Scale (VAS), Knee Injury and Osteoarthritis Outcomes Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Single Assessment Numeric Evaluation (SANE), Marx Activity Rating Scale (MARS), and Veterans Rand 12 (VR-12). Paired t-tests were performed to compare preoperative and postoperative scores.

Vascular Point-of-Care Ultrasound.

The use of point-of-care ultrasound (POCUS) of the vasculature has expanded beyond procedural guidance and is utilized by multiple specialties in varied clinical settings. Evidence supports the use of POCUS for diagnosing deep venous thrombosis in the lower extremities, while for thrombosis in the upper extremities or abdominal aortic aneurysm screening, the evidence is still nascent. Here, we review POCUS of the extremity veins and abdominal aorta with a summary of the pertinent literature, review of the relevant anatomy, description of the appropriate acquisition technique, introduction to associated pathology, and discussion of pitfalls one could encounter.

Benefit-risk assessment based on number needed to treat and number needed to harm: Atogepant vs. calcitonin gene-related peptide monoclonal antibodies.

Background: To evaluate the benefit-risk assessment of atogepant and calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) vs. placebo based on the number needed to treat (NNT) and the number needed to harm (NNH) in a blended episodic migraine and chronic migraine (EM + CM) population.

Methods: The NNT was calculated based on achievement of a ≥ 50% reduction in mean monthly migraine days (MMDs) from baseline across 12 weeks.

Horseshoe Retinal Tear Minutes After Use of a New Pilocarpine Formulation in a Presbyopic, Emmetropic Man.

To examine the risks associated with the use of pilocarpine hydrochloride 1.25% ophthalmic solution prescribed for presbyopia. The adverse ocular events reported after the use of pilocarpine were compared with the symptoms experienced by a 62-year-old presbyopic man shortly after taking pilocarpine.

Endovascular Repair of Zone 0 Ascending Aortic Aneurysm: A Review of Current Knowledge and Developing Technology.

Aortic aneurysms represent the 15 leading cause of death in men and women over 55 years of age. Where historically these lesions were all addressed via an open approach, endovascular aortic repair has entirely altered the way that surgeons approach aortic lesions. Although it was initially employed for patients who were poor surgical candidates, endovascular repair is now standard for abdominal aortic aneurysms and aneurysms in the descending thoracic aorta.

Feasibility of Obtaining Patient-Reported Outcome Measures in a High-Volume Multidisciplinary Surgical Limb Salvage Center.

Background: Completion of patient-reported outcome measures (PROMs) is labor-intensive but paramount in improving patient-centered care, allowing for advancement of techniques and scrutinization of outcomes. We report the feasibility of PROM collection and reporting for patients seen in a high-volume, multidisciplinary, tertiary limb salvage center to determine pain and functionality outcomes.

Methods: The center received grant funding resources for large-scale PROM collection.