Medical student program to learn from families experiencing developmental disabilities.

Patients and families experiencing developmental disabilities (DDs) may lack trust in physicians due to negative experiences in healthcare. DDs include conditions impairing physical, learning, language, or behavior areas, beginning during the developmental period and impacting daily functioning ('Developmental Disabilities'). Medical students generally do not receive standard training to effectively communicate with and diagnose patients with DDs. ARIE is a program for medical students to meet and learn from these patients and their families. Students learn about these families' experiences during home visits, guided by standardized interview questions and surveys about families' trust in physicians. Families did not appear to strongly trust physicians, with no significant changes after the program. Families shared they experienced physicians' lack of empathy and knowledge when caring for patients with DDs. Families wanted future physicians to be empathetic and informed when treating children with disabilities. Students reported increased comfort and confidence in interacting with patients with DDs as well as their families after completing the training program. Implementing a service-learning model focused on DDs at other medical schools, incorporating training with communication techniques and home visits, can increase students' confidence and experiences when engaging with patients with DDs and their families.

Woringer-Kolopp disease (localized pagetoid reticulosis): a systematic review.

OBJECTIVE: Woringer-Kolopp disease (WKD), also known as localized pagetoid reticulosis, is a rare variant of mycosis fungoides as described by the World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) classification system for cutaneous lymphomas. Our objective was to conduct a comprehensive review that describes and evaluates patient demographics, clinical presentation, immunohistochemical findings, management, and outcomes of WKD. METHODS: The databases PubMed, Embase, and Cochrane Library were searched for relevant literature. Patient demographics, imaging, treatments, and other clinical characteristics were obtained. The literature search was conducted on December 7, 2020. Studies were included if they contained primary data related to WKD. Non-pertinent studies, non-English studies, non-human studies, review articles, or studies with insufficient case information were excluded. The quality of the included studies and the risk of bias were evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation Group (GRADE) criteria (2016), Oxford Centre for Evidence-Based Medicine: Levels of Evidence (OCEBM) (March 2009), and the Methodological Index for Non-Randomized Studies (MINORS) criteria (2003). RESULTS: A total of 84 studies with 143 patients met the inclusion criteria for this study. The most common chief complaint was an asymptomatic, slow-growing, and erythematous plaque. The average time from initial skin eruption to presentation was 97.6 months. Histologically, 128 cases of WKD displayed epidermotropism (97.7%). Various therapies, including radiotherapy, surgery, and local chemotherapy, were used. In total, 92 (78.6%) cases had complete remission and 11 (9.4%) cases recurred. CONCLUSIONS: WKD is a rare cutaneous T-cell lymphoma that often presents as a single plaque on the extremities with an indolent course and a favorable prognosis. However, it is often misdiagnosed, leading to delays in treatment. The diagnosis of WKD involves clinical appraisal, a biopsy of suspicious lesions, and immunohistochemistry. Monotherapy appears to be preferred compared to combination therapy for WKD with radiotherapy demonstrating among the highest cure rates and lowest recurrence. Future retrospective and prospective studies are needed to accurately determine the epidemiology, prognosis, and effective treatments for WKD. Limitations include a possibility of missed studies, heterogeneity in reporting methods, publication, and selection bias.

Views of Diagnostic Radiology Residency Program Directors Regarding Methods to Increase Female and Under-Represented in Medicine Residents: A Cross-sectional Study.

RATIONALE AND OBJECTIVES: Diagnostic radiology remains one of the least diverse medical specialties. Recent reports have found that the number of female and under-represented in medicine (URiM) residents have not increased despite efforts to increase representation over the last decade. Given the critical role of residency program directors in selecting diverse applicants, this study was performed to identify which strategies were most preferred to increase the number of female and/or URiM residents by directors of diagnostic radiology residency training programs. MATERIALS AND METHODS: This was an anonymous, cross-sectional study of diagnostic radiology residency program directors that included a survey about program characteristics, demographics, and strategies to increase the number of female and/or URiM residents. RESULTS: The questionnaire was submitted to 181 potential participants with a 19.9% response rate. The most preferred strategies to increase diversity involved directly recruiting medical students, promoting mentorship, increasing the number of diverse teaching faculty, and unconscious bias training. The least supported strategies included deemphasizing exam scores, accepting more international graduates, accepting a minimum number of female and/or URiM applicants, and de-identifying applications. Female and/or URiM program directors indicated a statistically significant preference for medical student recruitment and providing an opportunity to discuss workplace issues for female and/or URiM trainees (p < 0.05). CONCLUSION: Diagnostic radiology residency program directors endorsed a wide variety of strategies to increase diversity. Recruitment of female and/or URiM medical students and promoting the number of diverse faculty members and mentorship of trainees by these faculty appear to be the most preferred strategies to increase female and/or URiM residents. Female and/or URiM program directors placed a greater importance on recruiting diverse applicants and supporting safe discussion of workplace issues faced by female and/or URiM radiology residents.

Failure factors in pediatric deep neck space abscess surgical management.

INTRODUCTION: Deep neck space infections (DNSI) in pediatric otolaryngology are a common occurrence in the inpatient setting. A subset of DNSI patients will fail medical and surgical management. It is difficult to predict which patients will fail. There are no studies that effectively evaluate variables associated with readmission and reoperation for DNSI abscesses. The purpose of this study was to evaluate the specific perioperative decisions that may lead to combined therapy failure and necessitate reoperation. METHODS: A case-control study was performed at a single center academic tertiary care hospital. Patients <18 years old treated from January 2015 to April 2020 with a surgically treated DNSI were reviewed. The single incision and drainage group (SOp) and reoperation group (ReOp) were evaluated with reoperation performed within a 30-day period. Intravenous antibiotic administration timing, drain management and type (gauze or latex), diagnostic, and postoperative factors were evaluated. RESULTS: The SOp group consisted of 275 patients and the ReOp group of 21 patients. The average preoperative intravenous antibiotic time showed no statistical difference (p = 0.884) and no increased risk for reoperation (p = 0.470; OR = 0.993). Timing of drain removal showed a significant difference (p < 0.005; 41.1 SOp vs 46.5 h ReOp). Abscess location (p = 0.855) and complications rate did not vary (p = 0.450). Gauze drains were used in 131 (44.3%), latex in 80 (27%), and no drain in 84 (28.4%) with no difference regarding reoperation (p = 0.124). Length of stay was longer in the ReOp group (8 vs 4 days; p < 0.001). The average measured dimension for each group did not significantly vary (p = 0.633). CONCLUSIONS: The duration of antibiotics in the preoperative period showed no statistical role in the need for reoperation in DNSI abscess patients. Drain type and duration also had a potentially clinically relevant association with the need for reoperation. Extensive unknown abscess pockets or inadequate technique may be the main contributors to the need for reoperation.

Improving Symptoms of Peripheral Artery Disease With Hirudotherapy.

Peripheral artery disease (PAD) is a significant cause of morbidity and mortality in the world. Critical limb ischemia is a complication of PAD that leads to severe pain at rest, numbness, and absent or diminished pulses in the legs or feet. Revascularization with surgery or endovascular intervention is required to re-establish blood flow to the affected areas. Failure to respond to medical and/or surgical treatment can lead to amputations. The decision to amputate one's limb can be very challenging. Here, we report a patient with critical limb ischemia who refused a below-the-knee amputation and self-treated with medicinal leech therapy, or hirudotherapy. His symptoms including his pain, burning, and numbness improved significantly following six months of therapy.

Merkel Cell Carcinoma in the Setting of Chronic Lymphocytic Leukemia and Diffuse Large B-Cell Lymphoma.

Merkel cell carcinoma (MCC) is a rare, rapidly growing, and highly malignant cutaneous tumor that typically presents in elderly males as an erythematous or violaceous plaque or nodule in sun-exposed areas. Risk factors include long-term ultraviolet (UV) exposure, Merkel cell polyomavirus (MCV) infection, immunosuppression, and lymphoproliferative disorders such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Given the aggressive nature of this tumor, patients may present with nodal and distal metastasis. Locoregional disease can be managed with definitive radiotherapy or surgery with or without adjuvant radiotherapy, depending on the case. Disseminated disease, on the other hand, often requires a multidisciplinary tumor board consultation to individually tailor the treatment. Possible treatments include systemic therapy with chemotherapy or immunotherapy, radiotherapy, and surgery. Here we report a case of a patient with a medical history significant for chronic lymphocytic leukemia and diffuse large B-cell lymphoma who presented with a rapidly growing lesion that contained neighboring MCC and CLL/SLL on biopsy. Management included immunotherapy with pembrolizumab and radiotherapy to limit the tumor's growth and spread. To the best of our knowledge, the coexistence of all three malignancies in a person is rare and has not been reported previously.

The Effect of Stress, Acculturation, and Heritage Identity on Depression in Arab Americans.

Introduction: Arab Americans are significantly affected by depression with prevalence as high as 50%. Our study assesses whether unique causes of depression such as stress, acculturation, and heritage identity play a role in the high prevalence of depression in Arab Americans. Methods: We surveyed 142 self-identified Arab Americans using a convenience model. Participants answered questions about their level of perceived stress, everyday discrimination, and acculturative stress. They also answered questions regarding their level of acculturation and heritage identity. Finally, participants answered questions regarding their depressive symptoms. A score of 16+ on the depression scale was used as the cut-off for depression. Results: The prevalence of depression in our sample was 60%. In our logistic regression model adjusted for age, sex, BMI and education, we found that perceived stress (OR = 1.21, 95% CI 1.10, 1.33, p < 0.01) and acculturative stress (OR = 1.02, 95% CI 1.00, 1.05, p < 0.05) were associated with greater odds of having depression in Arab Americans. We did not find that everyday discrimination, acculturation, or heritage identity were associated with depression in Arab Americans (p > 0.05). Conclusions: Our study shows that perceived stress and acculturative stress increase the odds of depression in Arab Americans and therefore may play a role in the high prevalence of depression in this population. We hope our findings inform clinicians on the important underlying causes that may be causing depression in their Arab American patients.

Complete atrioventricular block due to ingestion of Visine eye drops.

Visine eye drops are a commonly used topical drug for irritation of the eye. The active component in Visine eye drops is tetrahydrozoline. Tetrahydrozoline is an imidazoline derivative found in several ophthalmic and nasal decongestants. Exposure is common in young children, who unintentionally ingest it, but cases have been rising in the adult population. The main systemic effects are bradycardia and hypotension due to activation of the central alpha-adrenergic receptors. In this case report, a 76-year-old man presents with bradycardia after 24 hours following ingestion of 120 mL of 0.05% tetrahydrozoline (eight bottles of Visine eye drops) in a suicide attempt. His initial ECG demonstrated complete heart block and QT prolongation. Subsequent ECGs showed unremitting first-degree atrioventricular block and QT prolongation. Here, we are presenting the first case of complete heart block following tetrahydrozoline consumption.