A Case of Esophageal Plasmablastic Lymphoma with Literature Review

Background: Plasmablastic lymphoma (PbL) has been recognized by the World Health Organization (WHO) classification as a distinct subtype of diffuse large B-cell lymphoma (DLBCL), which are characterized with a strong expression of plasma cell markers instead of conventional B-cell markers. Although strongly associated with HIV-positive patients, it has also been commonly described in patients with solid organ transplants as well as immunocompetent patients. Plasmablastic lymphoma has shown to have an increase affinity for the oral cavity, followed by digestive tract. Furthermore, tumor involvement of the digestive tract accounts for around 20% of plasmablastic lymphomas. Although mainly found in the oral cavity, a few cases were documented to affect the gastrointestinal tract, and of those, only 3 cases were found to involve the esophagus, and we present the 4th case in a 48-year-old HIV positive male. Case Presentation: A 48-year-old male with past medical history of hypertension, alcohol dependence, chronic macrocytic anemia, with a smoking history presents to the emergency department with multiple complaints including severe weight loss, poor appetite, fatigue, and nonproductive cough with sinus drainage for the past month. According to the patient he has lost around 50 pounds in the span of 4 to 5 months and has been complaining of early satiety for the past 2 months. Patient admits to drinking more than 1 pint of hard liquor a day for the past 4 years and has been smoking half a pack a day for the past 30+ years. Patient is a homosexual, has multiple partners, and does not use protection. During his visit to the emergency department patient had 2 episodes of vomitus with large bright red blood, patient denies any history of varices or variceal bleeding. Computed tomography (CT) scan of the abdomen/pelvis without contrast was initially done and was negative for any acute pathology. Patient was resuscitated with intravenous (IV) fluids and 2 units of packed red blood cells and was started on octreotide drip for possible variceal bleed. Patient subsequently underwent EGD for his hematemesis and a friable ulcerated circumferential mass lesion was seen in the distal esophagus extending from 28 to 40 cm from the incisors with active oozing that was seen from the mass. Multiple biopsies were obtained and sent to pathology. Patient was tested for HIV which was positive with a viral load of 219,000 cpy/mL, with appropriate HIV 1 genotyping. Pathologic analysis of esophageal biopsy showed a diffuse perforation of the large, atypical cells associated with brisk mitotic activity consistent with plasmablastic lymphoma. Patient was started on chemotherapy with dose adjusted V-EPOCH and highly active antiretroviral therapy (HAART) with Truvada and Dolutegravir. Conclusion: Esophageal plasmablastic lymphoma is an extremely rare and aggressive subtype of diffuse large B-cell lymphoma and is most commonly found in HIV-positive patients. Disease awareness and early detection is warranted especially those with risk factors such as smoking, alcohol use, and HIV with concurrent B symptoms, as 55% of extra-oral PbL patients were found to be at stage IV during diagnosis

Efficacy and Safety of Blood Flow Restriction Therapy in Knee Arthroplasty

Blood Flow Restriction (BFR) treatment is gaining attention as a method for improving recovery and muscle strength following total knee replacement surgery (TKA). This analysis combines results from studies to assess how effective and safe BFR therapy is, in postoperative settings and to highlight any possible drawbacks it may have. Studies suggest that when administered correctly BFR therapy can bring advantages to patients in terms of their recovery process, muscle strength improvement and overall health status. Several research investigations indicate that Blood Flow Restriction (BFR) therapy plays a role in enhancing post-surgery results for individuals with severe post operative muscle weakness or those who do not show improvement, with traditional treatment approaches. Despite studies showing the benefits of BFR therapy, many limitations remain, such as the differing BFR protocols used across studies, sample sizes and brief follow up periods that make it challenging to establish consistent clinical recommendations for treatment practices. Additionally, while certain research findings suggest no statistical disparities in muscle strength between BFR therapy and traditional treatments, other studies emphasize noticeable enhancements in functional abilities and patient reported outcomes. Indicating that BFR therapy may offer more than just strength restoration benefits. Considering the results and recognized constraints discussed here, we highlight the need for additional reproducible randomized controlled trials with greater sample sizes and extended follow up durations to be conducted in order to establish stronger evidence that can inform the creation of standardized BFR therapy protocols and ultimately improve patient outcomes following TKA surgery

Investigating the effectiveness of a POE-based teaching activity on students’ understanding of condensation

Cataloged from PDF version of article.This article reports on the development of a Predict–Observe–Explain, POEbased teaching strategy to facilitate conceptual change and its effectiveness on student understanding of condensation. The sample consisted of 52 first-year students in primary science education department. Students’ ideas were elicited using a test consisting of five probe questions and semi-structured interviews. A teaching activity composed of three Predict–Discuss–Explain–Observe–Discuss–Explain (PDEODE) tasks was employed, based on students’ preconceptions identified with the test. Conceptual change in students’ understanding of condensation was evaluated via a pre-, post-, and delayed post-test approach and students’ interviews. Test scores were analyzed using both qualitative and quantitative methods. The findings suggested that the strategy helps students to achieve better conceptual understanding for the concept of condensation and enables students to retain these new conceptions in their long-term memory

Orthopedic Surgery Residency Trends 2019-2023: Insights and Dynamics

Background: Historically, the Step 1 exam served as a major factor in the residency selection process. We aim to analyze how the shift of Step 1 to pass/fail impacts residency applications in terms of number of applicants and application criteria, such as research experiences, step 2 CK scores, etc. We also aim to analyze how the shift in criteria will impact the quality of orthopedic surgery residents. Using the Orthopedic in Training Examination (OITE) which provides valuable insights into the performance and preparedness of orthopedic surgery residents. Methods: We began by analyzing the data from the AAMC Report on Residents data from 2019-2023. We then examined the match summary data from the National Resident Matching Program (NRMP) starting from 2019 until 2023. We also reviewed the ERAS data from 2019-2023. Finally, we examined and analyzed the Orthopedics in training examination (OITE) using the data by the OITE technical reports from 2020-2023, we excluded the 2019 results due to a change in the categorizing system of the residents. We categorized them into two groups ACGME and non-ACGME and then performed two sample t-tests with equal variances and Cohen’s d tests comparing every year at every PGY-level. Finally, we performed a Bonferroni correction test to decrease the probability of a type I error. Results: There was a rise in orthopedic surgery applicants as well as in positions, however, at a slower rate indicating an increase in the competitiveness of the field. Of note, is the decline in the number of international applicants (IMGs) which may indicate a potential loss in confidence among this group. As expected, there was an increase in research experiences, abstract presentations, publications, and volunteer experiences, however, one interesting point was that Step 2 CK scores have remained stable despite the shift of Step 1 to pass/fail. Moving on to the OITE scores, for the ACGME programs, the scores have fluctuated over the past 4 years, however with the exception of 2022, which appears to have been an outlier, they have remained relatively stable indicating a stability in orthopedic surgery training, for the non-ACGME programs there were significant fluctuations, indicating less stability in their residency selection and training. Conclusion: This study provided interesting insights into the residency application and its dynamics and impact on orthopedic surgery trends, such the increased emphasis on extracurricular aspects of the application. However, several limitations should be acknowledged. Firstly, the reliance on aggregated data may obscure individual program variations and nuances. Additionally, the analysis spans a relatively short timeframe, limiting the ability to discern long-term trends or assess the full impact of the recent changes in the USMLE Step 1 exam. A repeat study in several years when more data is available would shed a better light on the performance trend of orthopedic surgery residents

International clinical rotations during U.S. residency training: Creating an accreditation council for graduate medical education-approved rotation

Healthcare professionals increasingly report interest in global health and participation in international healthcare delivery. Growth opportunities exist for trainees to improve knowledge, skills and attitudes through international experiences. Professional development via international medicine may have lasting effects on patient care and practice patterns following training. In 2010, the first resident took part in an international, exchange elective between The George Washington University’s Department of Anesthesiology in Washington, DC and La Universidad de San Francisco’s Department of Anesthesiology in Quito, Ecuador. This resident elective rotation resulted from a strategic partnership, initiated in 2008, between two training institutions with an established track record of medical student educational exchange programs. The goal of any resident elective rotation should be to enhance an educational experience, to improve upon a perceived training deficiency, or to create a unique offering that takes advantage of local assets and connections. International electives, if properly conceived, can accomplish all three goals. This guide for program leadership addresses the rationale and challenges, from concept to Accreditation Council for Graduate Medical Education approval, of creating an international clinical rotation for residents

Grating coupler integrated photodiodes for plasmon resonance based sensing

Cataloged from PDF version of article.In this work, we demonstrate an integrated sensor combining a grating-coupled plasmon resonance surface with a planar photodiode. Plasmon enhanced transmission is employed as a sensitive refractive index (RI) sensing mechanism. Enhanced transmission of light is monitored via the integrated photodiode by tuning the angle of incidence of a collimated beam near the sharp plasmon resonance condition. Slight changes of the effective refractive index (RI) shift the resonance angle, resulting in a change in the photocurrent. Owing to the planar sensing mechanism, the design permits a high areal density of sensing spots. In the design, absence of holes that facilitate resonant transmission of light, allows an easy-to-implement fabrication procedure and relative insensitivity to fabrication errors. Theoretical and experimental results agree well. An equivalent long-term RI noise of 6.3 x 10(-6) RIU/root Hz is obtained by using an 8 mW He-Ne laser, compared to a shot-noise limited theoretical sensitivity of 5.61 x 10(-9) RIU/root Hz. The device features full benefits of grating-coupled plasmon resonance, such as enhancement of sensitivity for non-zero azimuthal angle of incidence. Further sensitivity enhancement using balanced detection and optimal plasmon coupling conditions are discussed

Perfectly absorbing ultra thin interference coatings for hydrogen sensing

Here we numerically demonstrate a straightforward method for optical detection of hydrogen gas by means of absorption reduction and colorimetric indication. A perfectly absorbing metal-insulator-metal (MIM) thin film interference structure is constructed using a silver metal back reflector, silicon dioxide insulator, and palladium as the upper metal layer and hydrogen catalyst. The thickness of silicon dioxide allows the maximizing of the electric field intensity at the Air/SiO2 interface at the quarter wavelengths and enabling perfect absorption with the help of highly absorptive palladium thin film (∼7 nm). While the exposure of the MIM structure to H2 moderately increases reflection, the relative intensity contrast due to formation of metal hydride is extensive. By modifying the insulator film thickness and hence the spectral absorption, the color is tuned and eye-visible results are obtained. © 2016 Optical Society of America

Extended Work Duration and the Risk of Self-Reported Percutaneous Injuries in Interns

Context: In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries. Objective: To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States. Design, Setting, and Participants: National prospective cohort study of 2737 of the estimated 18 447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed. Main Outcome Measures: Comparisons of rates of percutaneous injuries during day work (6:30 am to 5:30 pm) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 pm to 7:30 am) vs the daytime (7:30 am to 3:30 pm). Results: From a total of 17 003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11). Conclusion: Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training

Knowing the ABCs: Teaching the principles of radiology to medical students in Turkey

Background: Radiology education in Turkey is mainly taught during clinical years of medical school and often lacks main principles. Exposure to the fundamentals of radiology at an early stage of medical education may drastically help students generate a better understanding of radiology and expand their interest in the specialty. With the Principles of Radiology Course that we provided, pre- and post-session tests, and assessment survey at the end of the course, we aimed to evaluate the effectiveness of such an online course among Turkish medical students. Methods: A total of nine online sessions on imaging modalities principles was developed by radiology professors. Each session was given through Zoom by radiologists from different U.S.-institutions to Turkish medical students from state (n = 33) and private (n = 8) universities. Pretests and post-tests were given to participants via Qualtrics before and after each session, respectively. Paired two-sample t-tests were conducted to detect the variance and p=-.05 was used as the significance level. An evaluation survey was distributed at the end of the course to collect their feedback through SurveyMonkey. Results: A total of 1,438 predominantly Turkish (99.32%) medical students engaged with this course. An average of 506 students completed both pre-test and post-test. There was a statistically significant (p <.001) increase in the scores in post-test (mean[range]:7.58[5.21–8.53]) relative to pre-test (mean[range]:5.10[3.52–8.53]). Four hundred and thirty-nine participants (F/M:63.33%/35.54%) completed the end-of-course survey. A total of 71% and 69.70% of the participants strongly agreed that the course would be useful in their clinical practice and had increased their understanding of radiology. They also reported that their level of confidence in the subjects had increased 68% and reached a weighted average of 3.09/4. The survey revealed that 396 (90.21%) of the participants strongly or somewhat agree that introductory principles and concepts should be presented in earlier years of medical education. Compared to in-person education, 358 (81.55%) found the course extremely or very convenient. Conclusion: Online lecture series consisting of the principles of the radiological imaging modalities can be offered to Turkish medical students to enhance their grasp of the various imaging modalities and their correct clinical application

Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison

Background: There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors’ subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy. Aim: We therefore studied the effects on patient's safety and doctors’ work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota. Methods: Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors. Results: Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0–60.0) vs. 52.4 (11.2) (30.0–77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota. Conclusions: Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety