Rare Finding of Rectal Squamous Metaplasia in Inflammatory Bowel Disease.

Rectal squamous metaplasia in inflammatory bowel disease is rare. We present 2 cases of rectal squamous metaplasia, one in a patient with Crohn's disease and another with ulcerative colitis. Given the risk of malignant transformation, dysplasia surveillance is important particularly in areas of chronic inflammation.

Mismatch repair deficiency confers worse survival in stage IV colon cancer.

Background: Metastatic colon cancer (MCC) is a debilitating condition with a poor prognosis. Currently, there is limited data that investigates MCC in relation to mismatch repair (MMR) status. The aims of this study are to compare sociodemographic and clinicopathologic features and mortality between patients with MMR-proficient (MMR-P) and MMR-deficient (MMR-D) MCC.

Lightning Can Strike Twice: Management of an Infant With Anomalous Left Coronary Artery from the Pulmonary Artery Complicated by Coccidioidomycosis Infection.

Cardiac disease in young children can be unrecognized until symptoms are unmasked by a precipitating event, such as an infection. We present a case of anomalous left coronary artery from the pulmonary artery causing clinically significant disease in a four-month-old male with concomitant mitral regurgitation and pulmonary coccidioidomycosis who required modification of his surgical management due to the infection. This case highlights how timely diagnosis and perioperative management and recovery can be affected by concurrent infections in patients with congenital heart disease.

Accuracy of Survey-Based Assessment of Eligibility for Medication Abortion Compared to Clinician Assessment.

Background: With increasingly restricted access to facility-based abortion in the United States, pregnant people are increasingly relying on models of care that utilize history-based or no-test approaches to eligibility assessment. Minimal research has examined the accuracy of abortion patients' self-assessment of eligibility for medication abortion using their health history, a necessary step towards ensuring optimal access to history-based or no-test models, as well as potential over-the-counter access.

Objective: To examine the accuracy of pregnant people's eligibility for medication abortion determined using their self-reported health history as compared to clinician assessment with ultrasound and other tests.

Carcinogenetic mechanisms employed by the oral microbiome: a narrative review.

Cancers of the oral cavity, lip, salivary gland, and oropharynx cause substantial global disease burden. While tobacco-use and alcohol use are highly associated with oral cancers, the rising incidence of disease in patients who do not use tobacco or alcohol points to additional carcinogenic risk factors. Chronic inflammation, disruption of the oral microbiome, and dysbiosis are becoming more widely implicated in the pathogenesis of oral cancer.

The Circadian Response to Evening Light Spectra in Early Childhood: Preliminary Insights.

Although the sensitivity of the circadian system to the characteristics of light (e.g., biological timing, intensity, duration, spectrum) has been well studied in adults, data in early childhood remain limited.

How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide.

Neurologic adverse events associated with BRAF and MEK inhibitor therapy in patients with malignant melanoma: a disproportionality analysis using the Food and Drug Administration Adverse Event Reporting System.

BRAF and MEK inhibitor (BRAFi + MEKi) therapy has improved the treatment of solid tumors with BRAF mutation. However, their neurologic adverse events (nAEs) have been largely unexplored. This study aimed to provide clinicians with more updated knowledge on nAEs associated with BRAFi + MEKi therapy in patients with malignant melanoma compared with nonmelanoma cancers.

Images: Combined positive air way pressure and atomoxetine-oxybutynin for the treatment of severe obstructive sleep apnea.

Obstructive sleep apnea (OSA) is one of the most common sleep disorders. Positive airway pressure therapy (PAP) is considered the gold standard for treating OSA. Yet, optimal therapy might not be achieved in some cases of severe OSA, despite using maximum settings.

Burden of Hospitalization for Coccidioidal Meningitis: An Analysis of the National Inpatient Sample, 2019-2021.

Coccidioidal meningitis (CM) requires lifelong aggressive management, often necessitating hospitalization. In the National Inpatient Sample (2019-2021), CM hospitalizations (N = 2305) were associated with frequent CM-related procedures (63.6% [95% confidence interval {CI}, 59.

Classification of intrahepatic cholangiocarcinoma.

Cholangiocarcinoma is a heterogenous malignancy with various classifications based on location, morphological features, histological features, and actionable genetic mutations. Intrahepatic cholangiocarcinoma (ICC), which arises in and proximal to second order bile ducts, is the second most common primary liver malignancy after hepatocellular carcinoma. In this review, we will discuss ICC risk factors, precursor lesions, various growth, anatomic, morphologic, and histologic classifications, rare variants, and differential diagnoses.

microRNA and Hypertension.

Several microRNAs (miRNAs) strongly influence blood pressure and the development of hypertension by modulating vascular, renal, and other physiological mechanisms. In addition, miRNAs may contribute to the genetic regulation of blood pressure. Future research should focus on investigating select miRNAs with potent physiological effects, understanding cellular context-dependent mechanisms conferring specificity to miRNA action, and integrating miRNAs as powerful modulators into the molecular system that underlies the regulation of blood pressure and the development of hypertension.

Perceptions of Automatic External Defibrillator Use and Accessibility in the Deaf and Hard-of-Hearing Populations of the United States.

Background The use of automatic external defibrillators (AEDs) by lay rescuers can reduce the time to defibrillation and improve survival in out-of-hospital cardiac arrest (OHCA). AEDs use voice prompts to guide users through the defibrillation process, creating a potential barrier for deaf and hard-of-hearing (HoH) individuals. The objective of this study is to assess familiarity with and concerns regarding AED use among members of these communities.

Methadone clinic staff perceptions of trauma-informed and patient-centered care: the role of individual staff characteristics.

Background: U.S. policy intervention to increase methadone treatment accommodations during COVID did not result in national adoption of the new patient-centered treatment practices.

Prognostic factors associated with worse outcomes following chemoradiation therapy in patients with anal carcinoma.

Aim: Chemoradiation therapy (CRT) is considered as the first line of treatment for patients with squamous cell carcinoma of the anal canal. Following initial CRT, patients who present with either persistent or locally recurrent disease are treated by surgical intervention. The aim of our study is to determine the prognostic factors associated with failure of CRT and overall mortality in patients with anal squamous cell carcinoma (SCC).

Volumetric CT Assessment of In Situ Induced Hepatic Lesions in a Transgenic Swine Model.

The growth rate of in situ-induced hepatic lesions in an Oncopig large animal model is quantitatively assessed. Oncopigs (n = 9) received baseline triple-phase CT scans prior to lesion induction. Lesions were subsequently induced by delivering the Ad-Cre vector to four locations in the liver.

Identifying Demographic Trends in the Use of Audio-Video and Audio-Only Telehealth by Arizona Medicaid Beneficiaries Before and During the COVID-19 Pandemic.

Introduction: For the first time, our study tracked disparities in the utilization of audio-video and audio-only telehealth for outpatient visits before and during the COVID-19 pandemic.

Methods: Using a dataset of de-identified claims corresponding to telehealth and in-person visits, a retrospective cohort study was conducted for all beneficiaries continuously enrolled in Arizona Medicaid between October 2019 and November 2020. Our definition of telehealth only covered outpatient services delivered remotely via the audio-video or audio-only modality.

GI Surgery Summit white paper: recruiting and training the next generation of surgeons.

Background: There is an ongoing debate on surgical training and its evolution to meet the demands of a complex and changing healthcare environment.

Methods: A GI Surgery Summit was held in January 2024 that included prominent leaders and rising talents from the Society for Surgery of the Alimentary Tract, Society of Surgical Oncology, Association for Academic Surgery, and Society of University Surgeons. This meeting was held to address the multifaceted current and future challenges of surgery.

Retrograde Thoracic Duct Access for Embolization of Lymphatic Malformations in a Child with Congenital Heart Disease and a Plexiform Thoracic Duct Variant.

The physiologic sequelae of the atypical vasculature in patients with congenital heart disease can result in potentially fatal lymphatic complications, especially after corrective cardiac surgery. Transcatheter embolization of the thoracic duct or lymphatic collaterals can reduce morbidity and mortality in these patients. While typically performed transabdominally via an antegrade approach, retrograde embolization may be preferable in cases where this is not feasible, including in rare variants of thoracic duct anatomy.

Coronary Sinus Reducer Improves Angina, Quality of Life, and Coronary Flow Reserve in Microvascular Dysfunction.

Background: Coronary microvascular dysfunction (CMD) is a common cause of angina with no obstructive coronary artery disease (ANOCA), and effective treatment options are limited.

Objectives: This study aims to assess the safety and efficacy of the coronary sinus (CS) Reducer (Neovasc, Inc/Shockwave Medical) for treatment of angina in patients with CMD.

Methods: This Phase II trial enrolled 30 patients with ANOCA, invasively diagnosed CMD, and Canadian Cardiovascular Society (CCS) class 3 to 4 angina despite medical therapy.

Temporal Bone Gunshot Wounds: A Multi-institutional Retrospective Study.

Objective: To investigate management practices and outcomes in a retrospective cohort of patients who have sustained temporal bone gunshot wounds (TBGSW).

Study Design: Retrospective chart review.

Setting: Five participating hospitals.