Lack of alternatives to colonoscopy limits care of patients unable to complete bowel preparation

A clinical decision report using: Benech N, Vinet O, Gaudin JL, et al.: The ONECC Study Group. Colon capsule endoscopy in clinical practice: lessons from a national 5-year observational prospective cohort. Endosc Int Open. 2021;9(10):E1542-E1548. https://doi.org/10.1055/a-1526-09231 for a patient with incomplete bowel preparation and colonoscopy

Effects of Marijuana Use in Patients Undergoing Abdominal Free Flap Breast Reconstruction

PURPOSE: Marijuana use is associated with incidence of vascular inflammation and clotting, resulting in endothelial damage and arteritis. As marijuana use rises, few studies have evaluated its impact on surgical outcomes, wound healing, and vascular anastomoses in free flap breast reconstruction. METHODS: A retrospective cohort study of patients undergoing abdominal free flap breast reconstruction between 2016 and 2022 at a large metropolitan healthcare system was performed. Patient demographics, comorbidities, procedural details, and complications were analyzed. Minor complications were defined as skin necrosis, any wound requiring management in the clinic, hematoma, seroma, or fat necrosis that did not require intervention. Major complications were defined as re-operation, flap loss, thromboembolic events, or hospital readmission. Active marijuana users were those with marijuana use within 12 weeks of surgery. Those who utilized nicotine within 12 weeks of surgery were excluded from analysis. RESULTS: 149 patients underwent 241 deep inferior epigastric artery-based flaps for breast reconstruction. There were 17 active marijuana users. There were no significant differences in patient age, race, BMI, cancer treatment, cancer stage, or operative details. However, there were significantly higher rates of anxiety/depression, tobacco and narcotic use, and hypertension in the marijuana use group (P CONCLUSION: Marijuana use appears to not impact surgical outcomes in breast free flap reconstruction. Advising marijuana abstinence pre-operatively may not alter patient outcomes. This study may be limited by power and further evaluation will be needed

A Case of Immune-Mediated Pneumonitis Associated With Dual Nivolumab and Ipilimumab Immunotherapy Treatment

Nivolumab and ipilimumab are immunotherapy agents used in combination to treat metastatic melanoma and have proven to be efficacious. However, they have been linked to the development of immune-mediated inflammatory processes in various organ systems and tissues, including immune-mediated pneumonitis (IMP). This case report describes a 50-year-old female patient with metastatic melanoma who was treated with nivolumab and ipilimumab therapy and developed IMP as a complication. Despite treatment with steroids and infliximab, the patient\u27s condition worsened, and she passed away due to respiratory compromise. This report emphasizes the potential for serious complications in patients receiving combination immunotherapy and highlights the importance of close monitoring and risk stratification, particularly in patients with underlying lung conditions

Immunosuppressant Responsive Neuropsychiatric Systemic Lupus Erythematosus Manifestations Initially Diagnosed As Schizophrenia and Bipolar Disorder

Systemic lupus erythematosus (SLE) is a well-documented multi-system autoimmune disease with increased frequency noted in younger females and among minority populations. Disease-defining signs and symptoms can vary widely and involve multiple organ systems including the nervous system. Involvement of the nervous system, known as neuropsychiatric SLE (NPSLE) can present as manifestations consistent with central nervous system or peripheral nervous system pathologies, with the former including presentations of psychiatric illnesses. This case report reviews a 21-year-old Black female\u27s presentation that was most notable for psychosis with other findings on examination and laboratory investigation resulting in a diagnosis of NPSLE. Our patient had a positive initial response to high-dose steroids with improvement of her psychosis and was planned for further treatment with the well-known chemotherapy and immunomodulatory agent, cyclophosphamide

Longitudinal Professional Identity Development Amongst Medical Students

Abstract Title: Longitudinal Professional Identity Development Amongst Medical Students Background: Professional development is a core competency for medical student education. A standardized model for assessment of student longitudinal professional identity development will allow medical schools to better implement interventions. Methods: To assess professional development at a large, Midwest, allopathic medical school, a survey with seven statements regarding professional development was created. The statements encompassed domains of mentorship, communication skills, professionalism, and innovation and asked students to rank each statement from 1-5 (1 - highly deficient, 5 - highly proficient). The online, anonymous survey was emailed to all students (n = 1154) over a 2 month time period. Results: 319 (27.6%) surveys were completed. Responses between year 1-2 and year 3-4 showed a unanimous increase in average proficiency across all 7 statements. Year 3-4 had a significant increase in overall proficiency (p Conclusion: Although professional identity development follows an overall upward trend, year 3 is a vulnerable period for professional identity development. While increased accessibility to advising is needed in all four years, it is even more necessary in year 3. The power of the study is limited by the number of responses

Radiated Immediate Prepectoral Direct to Implant Reconstruction: A Retrospective Cohort Study

Purpose: Increasing use of prepectoral plane in post mastectomy implant-based reconstruction has made immediate direct to implant (DTI) reconstruction more achievable. There has been increased incidence of post mastectomy radiation therapy (PMRT) making it important to understand the complication profile of immediate DTI reconstruction in patients who may require adjuvant radiation therapy. Methods: A retrospective cohort study of consecutive patients undergoing prepectoral DTI reconstruction with and without PMRT was performed. Patient and treatment level factors, operative, and post-operative outcomes were extracted on both the patient and breast level for the prepectoral radiated and nonradiated patients. The presence of at least one minor complication (superficial or full-thickness necrosis, cellulitis requiring oral antibiotics, hematoma, or seroma) or major complication (cellulitis requiring intravenous antibiotics, hospital readmission, explanation, or unplanned return to the operating room) was compared. We also evaluated how radiation affects outcomes of prepectoral DTI vs subpectoral DTI. Univariate analysis was performed to evaluate differences in outcomes between groups. Results: 242 patients underwent DTI reconstruction.148 patients underwent prepectoral DTI reconstruction. 54 patients underwent subpectoral DTI reconstruction. Patients who underwent PMRT had higher rates of neoadjuvant chemotherapy and axillary lymph node dissection. Univariate analysis did not demonstrate any significant differences in minor or major complications between the radiated and non-radiated prepectoral DTI breasts. Radiated prepectoral patients had a higher rate of capsular contracture and explant for capsular contracture. Conclusion: Immediate prepectoral DTI reconstruction in patients who will have PMRT has an improved complication profile compared to subpectoral placement