Coincidence or association: Adult-onset Still's disease following HPV vaccine.

This case details adult-onset Still's disease (AOSD) onset post-human papillomavirus (HPV) vaccination and acute gastroenteritis. The timing of HPV vaccine and vaccine-autoimmune disease literature may potentially confound the well-established link between infections and AOSD onset.

Transplant hepatology and diversity: A decade-long analysis (2013-2022).

Diversity among physicians has been shown to positively impact patient care. Physicians from minority backgrounds are more likely to serve underserved communities and be involved in health disparities research. Efforts to increase the proportion of underrepresented minorities and women in medicine will help prepare a physician workforce that best cares for a diversifying nation. The purpose of this paper was to highlight trends in sex and ethnic representation among incoming U.S. transplant hepatology trainees over a 10-year period.

Orthopaedic Surgery Residency Advice on YouTube: Unveiling Gaps, Emphasizing Inclusivity, and Striving for Comprehensive Guidance.

Background: As orthopaedic surgery remains a highly competitive specialty, YouTube has emerged as a major online resource for medical students seeking guidance for residency applications. The credibility, thoroughness, and representation of the advice provided in these videos warrant a critical analysis. Methods: A YouTube search was conducted, and the top 100 videos were screened. Seventeen of the videos met the evaluation criteria. Three authors independently assessed these videos for 23 significant residency application variables. Content creators' qualifications, viewership, sex, and racial representation were also evaluated. Discrepancies were resolved through joint review and consensus. Results: Of the 17 evaluated YouTube videos on orthopaedic surgery residency, research experience and the United States Medical Licensing Exam Step 1 score were the most discussed variables. Videos hosted by orthopaedic physicians received fewer views on average than those hosted by nonorthopaedics. Minority representation varied, with Asian-identifying creators receiving the highest average views. Male-hosted videos had greater viewership compared with female creators. Conclusion: YouTube videos on orthopaedic surgery residency focused on research experience, reflecting changes in National Resident Matching Program's application evaluation metrics. The ambiguity of advice on research type and underemphasis on other crucial factors, such as letters of recommendation and interview performance, suggest the need for more comprehensive guidance. Moreover, the videos' demographic disparity compared with the actual field indicates the need for more diverse representations among content creators. We recommend that orthopaedic organizations create tailored and comprehensive guidance for prospective applicants.

Pediatric physical medicine and rehabilitation: Fellowship website content comprehensiveness evaluation.

This cross-sectional analysis of Pediatric Rehabilitation Medicine (PRM) fellowship program websites in the United States assesses their comprehensiveness based on 43 variables commonly sought by applicants. The study found that 30% of programs had a direct link to the PRM fellowship page, with limited information on criteria such as education resources, research stipend, mentorship opportunities, and fellow wellness. The results underscore the need for improved accessibility, content expansion, and yearly link maintenance. These improvements could enhance the applicant experience, foster informed decisions, and streamline the application process. The findings offer a roadmap for PRM fellowships to better align their online platforms with applicant needs, reflecting the current shift toward virtual interactions in the post-pandemic era.

Pseudohyperkalemia in chronic lymphocytic leukemia and diabetic ketoacidosis.

Pseudohyperkalemia can lead to inaccurate hyperkalemia diagnosis, inappropriate initiation of potassium-lowering therapies, and overall unnecessary treatment possibly inducing iatrogenic hypokalemia. Patients with leukocytosis and thrombocytosis should raise clinical suspicion that hyperkalemic laboratory results in the absence of other traditional signs of hyperkalemia may be indicative of pseudohyperkalemia. Here we present a case of severe leukocytosis with chronic lymphocytic leukemia (CLL) found to have critically elevated potassium levels on admission to the intensive care unit (ICU). The patient was also diagnosed with diabetic ketoacidosis (DKA) at admission, requiring an increased frequency of electrolyte monitoring. The events leading to the prompt recognition of pseudohyperkalemia in this patient will be delineated alongside our recommendations for revising the institutional protocol to avoid false hyperkalemia diagnoses in patients with CLL.

Analyzing the Content Found on Fellowship Websites for Adult Congenital Heart Disease.

The Adult Congenital Heart Disease (ACHD) fellowship is a two-year fellowship that can be done by physicians who have finished their internal medicine residency and cardiology fellowship. This study evaluated the accessibility and provided information on the websites of the ACHD fellowship programs to identify potential areas of improvement for future fellowship applicants. Analysis of 25 ACHD fellowship program websites was conducted based on 34 criteria under three main categories: recruitment information, education and research information, and incentive information. This study found that many evaluated ACHD program websites lacked information regarding recruitment. Specifically, information regarding mentorship opportunities, hospital statistics/number of beds, selection process, and interview dates, leaving out crucial details on what to expect during the matching process. Additionally, more information on education and research is beneficial for applicants to sufficiently compare ACHD fellowship programs and make more informed decisions about which programs they would like to apply to. Information on academic stipends, evaluation criteria, expected caseload, moonlighting opportunities, elective opportunities, rotation schedules, call requirements, and types of procedures were all limited across multiple websites. Lastly, incentive information was found to be insufficient across most ACHD fellowship websites. Incentive information included fellow wellness, harassment policies, parental leave, salary, benefits, and vacation/sick leave. This study shows that ACHD fellowship programs need to supply more information on their websites to provide applicants with details to help them choose the fellowship program that corresponds best with their career goals. Expanding upon information regarding recruitment, education, research, and incentives will provide applicants with a strong understanding of ACHD fellowship programs and what they can expect throughout their education. In return, this will help ACHD fellowship programs attract stronger applicants, ultimately improving the quality of their respective programs.

Musculoskeletal Oncology Fellowship Websites: A Comprehensive Assessment and Cross-Sectional Content Analysis.

This manuscript evaluates the utility of Musculoskeletal Oncology (MSK Oncology) fellowship program websites and identifies areas for improvement. This study identified 20 MSK Oncology programs using two public databases, allocated 45 criteria domains into 6 categories, and evaluated each program independently. MSK Oncology programs had limited information (34%) on their websites, particularly under the "People" category. It is recommended that programs include more information about current fellows and their training background, faculty publications, and alumni descriptions. MSK Oncology program websites should contain necessary information for prospective applicants, particularly considering the increased virtual world during and after the COVID-19 pandemic. Websites should be more comprehensive for applicants in their process of choosing their preferred programs and submitting their rank order lists.

The elusive cause of syncope: Left atrial myxoma with mitral valve obstruction.

Key Clinical Message: Syncopal patients should be evaluated for cardiac causes, including myxoma, as highlighted in this case. Transthoracic echocardiography and coronary angiography are valuable diagnostic tools. Interventional cardiology plays a crucial role in the successful treatment of myxoma. Abstract: This case video describes the presentation and successful treatment of a 58-year-old woman who experienced recurrent episodes of syncope. After ruling out other health concerns, a pulmonary embolism was suspected and further investigations revealed a mass in the left atrium causing significant obstruction of the mitral valve. The mass, identified as a neovascularized myxoma, was successfully resected, emphasizing the significance of considering myxoma as a potential cause of syncope and highlighting the role of interventional cardiology in its management.

Therapeutic cyproheptadine regimen in serotonin syndrome: Complications after cardiovascular surgery.

Serotonin syndrome can be a life-threatening condition that occurs from the overactivity of serotonin in the central nervous system. This report describes the use of cyproheptadine for the management of serotonin syndrome in a patient taking fluoxetine and bupropion, who received methylene blue for vasoplegia syndrome. A 61-year-old female taking fluoxetine and bupropion preoperatively was given a total of three doses of methylene blue 100 mg IV within a brief time frame during and after a planned coronary artery bypass graft surgery. Postoperatively, the patient was not following commands, was agitated and confused, febrile with diaphoresis, tachycardic, had muscle rigidity, and horizontal ocular clonus. The patient's presentation was most consistent with serotonin syndrome due to a drug-drug interaction. Cyproheptadine and supportive care were used successfully to treat serotonin syndrome, and the patient was discharged home 14 days postoperatively. Based on the literature, there is no standardized method of weaning cyproheptadine when used for serotonin syndrome. The patient in our case received a total of 188 mg of cyproheptadine over the course of 10 days and did not experience any side effects. This case highlights a potential dosing regimen that can be used for other patients.

Becker muscular dystrophy and successful intervention with mechanical thrombectomy of right atrial clot-in-transit with pulmonary embolism.

This case report discusses the effectiveness of the Inari FlowTriever system in treating a right atrial (RA) clot in-transit in a 55-year-old male patient with Becker's muscular dystrophy (BMD). BMD is an X-linked recessive muscle disease caused by mutations in the gene that code for the protein dystrophin, which is associated with partially functional dystrophin in variable amounts. Right heart thrombi (RHT) are thrombi that can be visualized in the right atrium, right ventricle, or proximal surrounding vasculature. The Inari FlowTriever system was used to treat RA clot in-transit and removed acute, subacute, and chronic clot in a single session without the use of thrombolytics and subsequent ICU stay. The estimated blood loss with the FlowSaver system was approximately 150 mL. This report complements the FLARE study by highlighting the effectiveness of the FlowTriever system for mechanical thrombectomy of RA clot-in-transit in a patient with BMD.

Papillary thyroid neoplasm: An incidental malignant nodule.

Papillary thyroid cancer (PTC), a common neoplasm originating from thyroid follicular cells, represents 85% of thyroid malignancy. PTC is known to metastasize to adjacent structures. Studies report that 5-15% of detected thyroid nodules represent malignancy; here, we report a 51-year-old woman with incidental thyroid nodules identified on the cervical spine.

Cross-Sectional Content Evaluation of Spinal Cord Injury Medicine Fellowship Websites.

This study evaluated the quality and accessibility of the websites of the Spinal Cord Injury Medicine (SCIM) fellowship programs to identify potential areas for improvement for future applicants. Twenty-four SCIM fellowship program websites were analyzed based on 44 predetermined criteria: website accessibility, education, research, recruitment, and incentives. This study found that many evaluated websites needed more information on didactics, educational resources, evaluation criteria, call requirements, schedules, and expected caseloads, which could lead to an incomplete understanding of the fellowship program. Additionally, more information on education and research can be needed for applicants to adequately compare programs and make informed decisions about which programs to apply to. Information about the selection process, current board pass rates, mentorship opportunities, technology/simulation, and alumni was limited across several evaluated websites. Incentives, fellow wellness, and harassment policies were also found to be insufficient or absent. The study emphasizes that SCIM fellowship programs should provide comprehensive and accurate information on their websites to facilitate applicants in choosing the program that aligns best with their professional goals. Including detailed and accurate information regarding general program qualities, educational and research opportunities, recruitment, and incentive data will provide prospective applicants with a holistic understanding of the program. By providing detailed and transparent information on their websites, SCIM fellowships can attract more qualified applicants and enhance the applicant pool, ultimately improving the quality of their program.

Peripheral Arterial Diseases and Diabetes Mellitus: Associations With Quality of Health Measures in Patients Undergoing Percutaneous Vascular Interventions.

BACKGROUND: Peripheral arterial disease (PAD) is more prevalent and severe in patients with diabetes mellitus (DM) compared with those without DM. Peripheral vascular intervention (PVI) is often used in patients failing conservative management. The association of PVI with health status in diabetic patients has yet to be determined. METHODS: We analyzed the clinical response to PVI in DM (n = 203, 52 %) compared with non-DM patients (n = 183, 48 %), using the Peripheral Arterial Questionnaire (PAQ) for patients during baseline and a maximum 6 months after PVI. We used the PAQ summary score, which summarized the patients' level of physical and social function, patient symptoms, and overall quality of life. This represented the PAD-related Quality of Health (QOH). Our score range is between 0 (lowest health quality) and 100 (highest health quality). RESULTS: Compared with non-DM patients, those with DM were more likely to have a history of prior PVI, an increased prevalence of PAD risk factors, and significantly lower QOH scores at baseline (32.7 ± 20 vs 37.5 ± 20.6, p = 0.02). After adjustment for baseline confounding, neither the baseline, the change, nor the final summary scores were significantly different between groups, suggesting similar symptomatic and functional improvement in non-DM and DM patients post-PVI. CONCLUSIONS: Following PVI, PAD-specific health status showed a similar improvement in patients with and without DM, illustrating that use of this strategy among patients with multiple comorbidities or diffuse PAD as useful.

Social media and the practice of pediatric physical medicine and rehabilitation in the COVID-19 pandemic: A new era in patient-care.

Social media represents a significant source of health information for the public, especially during the COVID-19 pandemic where gatherings are limited. It is important for pediatric physical medicine and rehabilitation physicians to understand how their patients use these platforms in order to educate the public and provide sound medical advice on social media. Given the lack of current guidelines on medical education through social media, the purpose of this paper is to provide an overview of various online social media platforms and describe how they can be utilized to enhance pediatric patient education. It is necessary to understand the different educational functions and limitations of the various social media platforms. This text provides a comprehensive overview of different social media platforms, their educational uses, limitations, and sample accounts. Relevant to the COVID-19 pandemic, social media can improve the efficiency of educational delivery and clinic workflow. Although social media is not meant to replace physician-patient relationships, it can be used as a surrogate for health information and improve- even start- physician-patient relationships. Despite the benefits of social media, pediatric physiatrists may be hesitant to utilize these platforms for several reasons. This text provides an overview of common barriers to social media usage by physicians and recommendations to overcome them. Given that the pandemic has led to increased social media usage, physicians should be aware of its implications on patient care and how they can be used to enhance the practice of pediatric physical medicine and rehabilitation. As social media usage by both patients and physicians grows, more research is needed to create recommendations on how pediatric physiatrists can best utilize social media to educate the public in an enjoyable manner while maintaining a professional image.

Dermatological considerations and culturally sensitive recommendations for women who wear the hijab.

Currently, there is little guidance in the literature on how to advise patients who wear the hijab on hijab-related dermatoses. This manuscript describes hijab-related dermatoses and provides culturally sensitive recommendations that can be used in conjunction with standard treatments to provide more holistic care for these patients.