Forming the Hematology-Oncology Collaborative Videoconferencing (CO-VID) Learning Initiative: Experiential Lessons Learned From a Novel Trainee-Led Multidisciplinary Virtual Learning Platform.

PURPOSE: COVID-19 challenged medical practice and graduate medical education. Building on previous initiatives, we describe and reflect on the formative process and goals of the Hematology-Oncology Collaborative Videoconferencing Learning Initiative, a trainee-led multi-institutional virtual COVID-19 learning model. METHODS: Clinical fellows and faculty from 13 US training institutions developed consensus needs, goals, and objectives, recruited presenters, and generated a multidisciplinary COVID-19 curriculum. Weekly Zoom conferences consisted of two trainee-led instructional segments and a trainee-moderated faculty Q&A panel. Hematology-oncology training program faculty and trainees were the targeted audience. Leadership evaluations consisted of anonymized baseline and concluding mixed methods surveys. Presenter evaluations consisted of session debriefs and two structured focus groups. Conference evaluations consisted of attendance, demographics, and pre- or postmultiple-choice questions on topic learning objectives. RESULTS: In 6 weeks, the initiative produced five conferences: antivirals, anticoagulation, pulmonology, provider resilience, and resource scarcity ethics. The average attendance was 100 (range 57-185). Among attendees providing both pre- and postconference data, group-level knowledge appeared to increase: antiviral (n = 46) pre-/postcorrect 82.6%/97.8% and incorrect 10.9%/2.2%, anticoagulation (n = 60) pre-/postcorrect 75%/93.3% and incorrect 15%/6.7%, and pulmonary (n = 21) pre-/postcorrect 66.7%/95.2% and incorrect 33.3%/4.8%. Although pulmonary management comfort appeared to increase, comfort managing of antivirals and anticoagulation was unchanged. At the conclusion of the pilot, leadership trainees reported improved self-confidence organizing multi-institutional collaborations, median (interquartile range) 58.5 (50-64) compared with baseline 34 (26-39), but did not report improved confidence in other educational or leadership skills. CONCLUSION: During crisis, trainees built a multi-institutional virtual education platform for the purposes of sharing pandemic experiences and knowledge. Accomplishment of initiative goals was mixed. Lessons learned from the process and goals may improve future disaster educational initiatives.

Focal blast crisis in concomitant myelodysplastic syndrome and chronic myelogenous leukemia.

Leukemic transformation of myelodysplastic syndrome (MDS) or chronic myelogenous leukemia (CML) is a well-established phenomenon. However, co-occurrence of MDS and CML is a rare phenomenon, with few reports to date. Though blast crisis typically occurs systemically with MDS or CML, rare reports of focal transformation with myeloid sarcoma (MS) have been described. We present the first known case of concomitant MDS and CML on imatinib that developed focal blastic transformation, where the leukemic clone was BCR-ABL1 positive. Local irradiation and second-generation TKI was enough to attain long-term remission. Herein, we discuss MS and its implications in both CML and MDS.

Kasabach-Merritt-like phenomenon in a massive uterine leiomyoma presenting with chronic disseminated intravascular coagulation: A case report.

Kasabach-Merritt phenomenon is a process where the presence of vascular irregularity within a Kaposiform hemangioendothelioma or tufted angioma leads to constitutive coagulation factor activation and the development of chronic disseminated intravascular coagulation (DIC). A similar phenomenon has been seen in other tumors but has rarely been described. A 42-year-old woman presented to the hospital following the development of worsening easy bruising and bleeding. She was ultimately found to have a massive uterine fibroid that led to constitutive coagulation cascade activation and subsequent chronic DIC. Following resection, she had complete resolution of DIC and made a full recovery. Although rare, the development of unexplained chronic DIC in a woman should prompt evaluation for the presence of massive uterine fibroids.

Successful Coronary Artery Bypass Grafting in a Patient With Uncontrolled Scleromyxedema.

Scleromyxedema is a rare disorder characterized by diffuse cutaneous and systemic mucinosis with paraproteinemia. Affected patients usually develop numerous waxy, firm papules and plaques as a result of subcutaneous mucin deposition and fibrosis. Systemic manifestations may involve the cardiovascular, gastrointestinal, pulmonary, musculoskeletal, renal, or nervous systems and are known to lead to significant morbidity and mortality if left untreated. As the skin of these patients can be heavily infiltrated with mucin and fibrosis, it is unknown if scleromyxedema affects wound healing. Additionally, owing to the rarity of the disorder, there is very little data regarding surgical outcomes in these patients and their optimal management in the pre- and post-surgical setting. Herein, we report a case of a patient who underwent elective coronary artery bypass grafting (CABG) while in active relapse of his scleromyxedema; he suffered no pre- or post-operative complications and his surgical incision site healed well without any intervention.

Hydrochlorothizide-induced acute generalised exanthematous pustulosis presenting with bilateral periorbital impetigo.

Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterised by the appearance of erythematous plaques and papules with overlying non-follicular pinpoint pustules. Drugs are the cause of AGEP in approximately 90% of cases. The most common causes include anti-infective agents (aminopenicillins, quinolones, antibacterial sulfonamides and terbinafine), antimalarials and diltiazem. To the best of our knowledge, to date there has only been one report of hydrochlorothiazide-induced AGEP. There has never been a case report of losartan-induced AGEP. Here, we present a case of AGEP that is the second case purportedly caused by hydrochlorothiazide.