Uncovering Barriers to the Diagnosis and Treatment of Metastatic Melanoma: A Case Report.

Melanoma is a malignant disorder of the skin that originates from melanocytes. It is the most aggressive of the skin malignancies. This case study presents a unique case of a 52-year-old male gardener with melanoma on the plantar side of his foot, which progressed to a large ulcer.

Complex Cardiovascular Management in an 80-Year-Old Female With Gastrointestinal Bleeds and Klatskin Tumor: A Case of ST-Elevation Myocardial Infarction (MI) Management Complicated by Severe Anemia and Post-MI Ventricular Septal Defect Development.

Managing acute coronary syndrome (ACS) in patients with a recent history of gastrointestinal bleeding presents a unique and challenging clinical dilemma, necessitating a careful balance between minimizing ischemic risk and avoiding potentially life-threatening rebleeding. Standard treatment for ACS typically involves dual antiplatelet therapy (DAPT) to prevent recurrent thrombotic events. However, in patients with recent gastrointestinal hemorrhage or significant anemia, these therapies may substantially increase the risk of life-threatening bleeding, complicating the decision-making process and often leading to conservative management strategies.

Navigating the Complexities of Anterior Cord Syndrome in a 71-Year-Old: A Case Study of Vertebral Osteomyelitis and Methicillin-Resistant Staphylococcus aureus Bacteremia.

Anterior cord syndrome is a rare yet critical neurological condition that poses significant challenges in clinical management. We present the case of a 71-year-old male with a medical history of hypertension, uncontrolled type II diabetes mellitus, hypothyroidism, and end-stage renal disease requiring dialysis who presented to the emergency department with complaints of chills, back pain, abdominal pain, and vomiting episodes. Based on the severity of the patient's illness, it was decided that inpatient admission would be best.

Prognostic Factors of Hodgkin's Disease Recurrence: An Experience From a Tertiary Academic Center in Iran.

Introduction Despite the favorable prognosis of Hodgkin's disease (HD), some patients experience disease recurrence. Therefore, determining recurrence prognostic factors is very crucial to identify patients at risk of early relapse, maintain remission, and improve outcomes. Materials and methods This retrospective cohort study enrolled HD patients at the National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, between January 1, 2002, and June 30, 2018.

Iodoform in Surgical Practice: A Comprehensive Review of Its Historical Evolution, Clinical Applications, and Safety Profiles.

Iodoform, a halogenated organic compound, has been a cornerstone in surgical practice due to its potent antiseptic and antimicrobial properties. This comprehensive review examines the historical evolution, mechanism of action, clinical applications, and safety profile of iodoform across various surgical disciplines. Historically significant formulations like Whitehead's varnish and bismuth iodoform paraffin paste (BIPP) demonstrated remarkable efficacy in wound healing during the late 19th and early 20th centuries.

Diffuse Large B-Cell Lymphoma Presenting Primarily as a Cutaneous Leg Lesion: A Case Report and Literature Review.

Primary cutaneous B-cell lymphoma (PCBCL) has three subtypes, among those, the leg type variant is the rarest with the highest rates of relapse and recurrence making it an intriguing focus for researchers. Nevertheless, prior to framing a diagnosis solely based on the lesion's location, it is prudent to reconsider whether it is genuinely a primary cutaneous B-cell lymphoma (PCBCL) or if it aligns more closely with the more prevalent lymphoma variants such as diffuse large B-cell lymphoma (DLBCL) with cutaneous involvement. We are reporting a case of an 85-year-old African American lady, who presented with unilateral left leg DLBCL with cutaneous involvement.

Pacemaker-Induced Superior Vena Cava Syndrome.

Superior vena cava (SVC) syndrome is a result of impaired blood flow from the SVC to the right atrium, leading to venous congestion in the head and neck. It can be caused by clotting disorders or compressive tumors of the head and neck but has become more prevalent in the setting of implantable devices such as pacemakers. As such, managing these patients can present challenges for physicians who have to account for SVC syndrome as well as their underlying condition requiring an implantable cardiac device.

Diffuse Pulmonary Ossification (DPO) in the Setting of Firefighter Occupation.

A 76-year-old man with a past occupational history as a firefighter and construction worker presented at an urgent care center with signs and symptoms of chronic dry cough, exertional dyspnea, and fatigue. His initial chest X-ray showed interstitial thickening in the middle and lower lobes with pulmonary infiltrates bilaterally. The patient was treated with an outpatient course of antibiotics.

Assessment of Reproductive Endocrinology and Infertility Fellowship Programs Website.

The aim of the study was to assess the comprehensiveness of the Reproductive Endocrinology and Infertility (REI) fellowship program websites in North America. All active REI fellowship program websites in the United States of America (USA) and Canada were evaluated and assessed using 72-point scoring criteria. Any fellowship programs without publicly accessible websites were excluded.

Care for end-stage kidney disease in China: progress, challenges, and recommendations.

This review comprehensively evaluates China's progress in care of end-stage kidney disease (ESKD) by identifying achievements and gaps, reviewing ESKD-related policy initiatives, and proposing policy recommendations. In the past decade, China has made laudable progress in access to ESKD care with narrowed difference between the number of patients needing and receiving kidney replacement therapies (KRT). China has also experienced significant improvements in clinical quality and outcomes of ESKD care.

Keratinocyte-derived extracellular vesicles in painful diabetic neuropathy.

Painful diabetic neuropathy (PDN) is a challenging complication of diabetes with patients experiencing a painful and burning sensation in their extremities. Existing treatments provide limited relief without addressing the underlying mechanisms of the disease. PDN involves the gradual degeneration of nerve fibers in the skin.

Adverse childhood experiences, resilience, and syringe services program attendance among persons who inject drugs in Northeast Georgia, USA: A mediation analysis.

Background: Syringe services programs (SSP) are evidence-based venues offering harm reduction services to persons who inject drugs (PWID), such as sterile syringes, STI/HIV testing, and linkage to care to decrease drug use-related morbidities and mortalities. Adverse childhood experiences (ACEs) have been linked with reduced resilience, while increased resilience can help PWID attend SSPs. This study examined the potential mediating role of resilience between ACEs and SSP attendance among PWID.

Cannabis use and alcohol-related outcomes among sober living house residents with alcohol use disorders.

Background: Evidence supporting cannabis substitution along with liberalized cannabis laws have left recovery homes such as sober living houses (SLHs) in a difficult position regarding policies relating to cannabis use among SLH residents. Moreover, there are few studies of cannabis use among SLH residents that can be used to inform cannabis use policies. Here we assess whether cannabis is related to alcohol use among SLH residents.

The Impact of Additional Fractures and Polytrauma on Complications in Patients Undergoing Femoral Neck Fracture Fixation.

Background: While there have been significant advancements in recent years, complications following fixation for femoral neck fractures remain a concern. This retrospective cohort study aimed to investigate the influence of polytrauma and additional fractures on the occurrence of complications in patients who underwent surgical fixation for femoral neck fractures. The study focused on analyzing patient demographics, comorbidities, fracture classifications, fixation methods, and the likelihood of experiencing post-operative complications, with a specific emphasis on the impact of polytrauma and additional fractures.

The Influence of Patient Provider Educational Interactions and Associated Preoperative Variables on Outcomes in the Hip Dysplasia Population.

Background: Patient provider interactions influence patient treatment adherence, clinical outcomes, patient satisfaction, and an overall patient's engagement in healthcare decisions. The purpose of this study was to examine the effectiveness of patient provider educational interactions and associated variables on patient reported outcomes in the hip dysplasia population.

Methods: A secondary data analysis was completed with 6-month postoperative survey data from participants, who had undergone periacetabular osteotomy.

Tourniquet and/or Adductor Canal Block Use Confer No Additional Early Quadriceps Weakness Following Total Knee Arthroplasty: An Analysis of 203 Patients.

Background: Quadriceps weakness following total knee arthroplasty (TKA) delays rehabilitation and increases fall risk. The combined impact of tourniquets and adductor canal blocks (ACBs) on postoperative quadriceps strength has not been defined. This study evaluated the early effects of tourniquet and/or ACB usage on quadriceps strength following TKA.

Searching for a Job: A Survey of Hand Fellowship Applicants and Current Hand Surgeons.

Background: Core curricula do not include courses on how to find employment after hand fellowships. Little data exists in literature regarding job selection in hand surgery. This study's purpose was to provide information to future hand surgeons on ways of finding a job that meets their expectations and to elucidate factors that should be considered before deciding on a hand practice.

Evaluating One-Week Post-Casting Alignment Checks and Surgical Intervention Rates in Pediatric Type IIA Supracondylar Humeral Fractures.

Background: This study aims to determine the rate of surgical intervention in children with type IIA supracondylar humerus fractures (SCHF) following routine post-casting radiographic assessment. We hypothesized that no cases would convert to operative management following one-week post-casting alignment assessments.

Methods: This single-center retrospective study focused on pediatric patients diagnosed with type IIA SCHF from 2019 to 2022.

Identifying Predictors of Extended Intensive Care Unit Stay Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: An Analysis of 101 ACS NSQIP Pediatric Participating Centers.

Background: While prolonged operative time and increased levels fused have been shown to increase the risk of prolonged intensive care unit (ICU) length-of-stay (LOS), studies are limited in guiding decision-making regarding the need for intensive care postoperatively. This is especially the case among the cohort of adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF); associations between comorbidities and ICU LOS are not well-delineated.

Methods: AIS patients who underwent PSF from January 1st, 2016 to December 1st, 2016 at 101 participating centers were identified using the American College of Surgeons (ACS) National Surgical Quality Im-provement Project (NSQIP) Pediatric database.

Efficacy of Intraoperative Intra-Articular Morphine on Post-Operative Pain and Opioid Consumption Following Hip Arthroscopy.

Background: The use of intraoperative intra-articular morphine has been suggested to lower postoperative pain scores and opioid use. We sought to evaluate the effectiveness of intra-articular morphine with 0.75% ropivacaine when compared to the use of ropivacaine alone.

Orthopedic Surgery <50 Days Following Covid-19 Infection Is Not Associated With Increased Postoperative Complications.

Background: Recent literature indicates that COVID-19 infection is a negative predictor of good outcomes following elective orthopedic surgery. However, the ideal timing of surgery after infection is unclear. The purpose of this study was to compare the rates of post-operative complications between those who underwent elective orthopedic surgery <50 days and >50 days after COVID-19 infection.

Hip Dysplasia Diagnosed After Skeletal Maturity: Factors Associated With Progression to Osteoarthritis.

Background: Hip dysplasia diagnosed after skeletal maturity is distinct from developmental dysplasia of the hip (DDH) in infants and young children. While the natural history of DDH in infants and young children is well-established, the association between hip dysplasia diagnosed after skeletal maturity and osteoarthritis is less clear. This narrative review summarizes existing literature assessing characteristics of hip dysplasia diagnosed after skeletal maturity associated with progression to osteoarthritis.

Do Percutaneously Applied Medial Proximal Tibia Plates Need To Go Beneath the Pes Tendons?

Background: Bicondylar tibial plateau fractures are often associated with significant soft tissue compromise making operative treatment challenging. Dual plating through a two-incision approach following temporary external fixation has been shown to improve complication rates although deep infection rates remain high.The objective was to evaluate early outcomes following a novel technique of percutaneous application of the medial plate superficial to the pes anserinus tendons.

Is Femoral Head to Acetabular Cup Ratio Associated With Dislocation After Total Hip Arthroplasty?

Background: Dislocation remains a common complication following total hip arthroplasty (THA). Previous literature has shown that the femoral head-to-neck ratio is essential in hip motion, function, and stability. While large femoral heads and dual mobility bearings have been developed to improve stability, it remains unknown if the ratio between femoral head size to acetabular cup size also plays a role in stability.

Trochleoplasty in Pediatric Patients - A Systematic Review.

Background: Trochleoplasty is a surgical consideration for the treatment of high-grade trochlear dysplasia. The safety profile of this procedure remains particularly unclear in the skeletally immature population where concerns exist regarding physeal arrest and the development of premature patellofemoral arthritis. The purpose of this study was to systematically review the literature to evaluate trochleoplasty use, outcomes and complications observed among pediatric patients.