Retrospective review of the development and implementation of a bedside tunneled dialysis catheter program.

Background: The decision to place a subcutaneously tunneled catheter is an infection prevention strategy for long term venous access allowing the proceduralist to access a vein and relocate the catheter exit site to a region on the body where care and maintenance can be safely performed. Subcutaneously tunneled centrally inserted dialysis catheter (ST-CIDC) placement is commonly performed in patients with renal disease and is traditionally performed with fluoroscopy in the interventional radiology suite or the operating theater. However, today's interventional radiologists and surgeons perform advanced invasive procedures that can be time-consuming resulting in delays in the scheduling of elective tunneled catheter placements.

Secondary Myiasis in an Immunocompetent Patient With Severe Chromoblastomycosis.

This is the case of chronic chromoblastomycosis (CBM) in a 61-year-old male from the Dominican Republic (DR) with extensive cutaneous eruptions over multiple areas of the body including bilateral lower extremities and the flank extending to the back. A 61-year-old male with a history of morbid obesity, chronic kidney disease stage III, and well-controlled hypertension presented to the family medicine clinic for the evaluation of chronic painful skin lesions on his legs and torso. The lesions began 19 years prior, following a flood in the Dominican Republic (DR) where he was living at the time.

AI-based Cleft Lip and Palate Surgical Information is Preferred by Both Plastic Surgeons and Patients in a Blind Comparison.

Introduction: The application of artificial intelligence (AI) in healthcare has expanded in recent years, and these tools such as ChatGPT to generate patient-facing information have garnered particular interest. Online cleft lip and palate (CL/P) surgical information supplied by academic/professional (A/P) sources was therefore evaluated against ChatGPT regarding accuracy, comprehensiveness, and clarity.

Methods: 11 plastic and reconstructive surgeons and 29 non-medical individuals blindly compared responses written by ChatGPT or A/P sources to 30 frequently asked CL/P surgery questions.

Carbohydrate Antigen (CA 19-9) Surge: Unraveling the Enigma of Elevated Levels in the Setting of Benign Etiologies.

Carbohydrate antigen 19-9 (CA 19-9) is widely recognized as a tumor marker primarily associated with pancreatic cancer. However, its elevation in benign pancreaticobiliary conditions complicates its diagnostic utility. We present the case of a 39-year-old male with no significant medical history who presented with symptoms of abdominal pain, nausea, vomiting, and diarrhea.

From Unassuming to Unbelievable: A Case Report of Pyoderma Gangrenosum.

Pyoderma gangrenosum (PG) is an autoinflammatory skin disease, and there is no definitive test or established criterion for its diagnosis yet. This report discusses a case of a 34-year-old male patient who presented with an unassuming lesion that quickly worsened with physical manipulation. He was eventually diagnosed with PG.

An Interesting Case of Asymptomatic Cholera in the Setting of Large Bowel Obstruction.

Vibrio cholerae is the culprit behind many endemics globally. Classically characterized by profuse diarrhea with a "rice water" description, cholera can be fatal if not treated promptly. However, infected individuals can present with little to no symptoms.

A Case Report and Literature Review of Gastric Stump Carcinoma: An Uncommon Entity Following the Billroth II Procedure.

Gastric stump carcinoma is a rare phenomenon and could occur in individuals after a distal gastric resection. Regardless of the surgical approach, it can lead to certain complications. However, the Billroth II gastrojejunostomy procedure has been noted to have some specifically interesting complications due to the anatomical changes it triggers.

An Interesting Presentation of Pneumomediastinum Secondary to Hyperemesis Gravidarum in the Second Trimester.

We present a rare case of pneumomediastinum in the setting of hyperemesis gravidarum. Pneumomediastinum is a condition characterized by the presence of air leaking into the mediastinum. Often secondary to trauma, there remains the potential for it to develop spontaneously.

Incidence of Pneumoperitoneum After Gastrostomy Tube Removal.

We present the case of an 88-year-old man with a previous medical history of severe colitis and colonic strictures who presented with hematemesis. The patient was found to have a lower esophageal ulcer without any signs of perforation. Esophagogastroduodenoscopy (EGD) revealed a scar in the greater curvature of the stomach from a previously removed gastrostomy tube two months prior.

Rare Direct Locoregional Brain Metastasis and Recurrence in Laryngeal Squamous Cell Carcinoma.

Laryngeal cancer is predominantly a squamous cell in origin that can present with voice changes and difficulty or pain with swallowing. It is more likely to cause local spread than distant ones. The prognosis depends on multiple factors, including the stage, tumor differentiation, extranodal extension, and adjuvant therapy.

Non-ST Segment Elevation Myocardial Infarction (NSTEMI) in the Setting of Severe Rhabdomyolysis and COVID-19 Infection: A Case Report.

We present a case report of a non-ST segment elevation myocardial infarction (NSTEMI) occurring in an 89-year-old male with severe rhabdomyolysis and COVID-19 infection. The patient had a complex medical history, including non-ischemic cardiomyopathy, sinus bradycardia status post permanent pacemaker placement, and multiple comorbidities. He presented to the emergency department after a mechanical fall and was found to be COVID-19 positive.

Intracranial Hemorrhage Secondary to Vaping: A Case Report and Literature Review.

Vaping and marijuana use are becoming more common and accessible in young adults. However, questions remain regarding their long-term health implications. Current literature does not suggest that vaping causes intracranial hemorrhages.

Managing Patent Foramen Ovale (PFO) in Adults With Cryptogenic Stroke and Lymphoma: A Multidisciplinary Perspective.

​​Cryptogenic strokes are strokes with no clear underlying cause. Patent foramen ovale (PFO) is believed to be one of the causes of cryptogenic strokes. To manage such cases, closing the PFO is usually considered an option.

A Case of Immune Checkpoint Inhibitor-Induced Probable Myocarditis and Treatment Response.

Immune checkpoint inhibitors (ICI) are a new class of pharmaceuticals that facilitate the immune system in identifying and targeting cancerous cells. However, suppressing immune regulation can often cause immune-mediated adverse events. One such downstream effect recently recognized is ICI-associated myocarditis.

Chemotherapy-Induced Atrial Fibrillation With Rapid Ventricular Response in a Patient With Pleomorphic Rhabdomyosarcoma: A Case Report and Approach to Management.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Its prevalence in cancer patients undergoing treatment with radiation or chemotherapeutic agents has been on the rise. The most common offending agents are alkylating agents and anthracyclines causing various types of arrhythmias, including AF.

Gastric Adenocarcinoma of the Remnant Stomach After Roux-en-Y Diagnosed by Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE).

It can be difficult to evaluate for pathology with traditional endoscopic modalities following a Roux-en-Y gastric bypass. This is due to the truncated gastrointestinal tract and excluded distal stomach formed during a Roux-en-Y procedure. In these circumstances, a modified endoscopic procedure, known as endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) is used.

"Bariatric Beriberi": A Rare Case of Wernicke Encephalopathy Two Weeks After Laparoscopic Sleeve Gastrectomy.

Wernicke encephalopathy (WE) is an acute neurological syndrome caused by thiamine (vitamin B1) deficiency. This disorder manifests as a triad of gait ataxia, confusion, and vision abnormalities. The absence of a full triad does not rule out WE.