IgM Multiple Myeloma: A Rare Clinical Entity and Diagnostic Dilemma

IgM multiple myeloma is a rare disease that shares many common features with Waldenström macroglobulinemia and lymphoplasmacytic lymphoma. It has been described in the literature as having unique diagnostic findings that separate it from the more common IgG and IgA myelomas. It is important for physicians to be able to differentiate between IgM multiple myeloma, Waldenström macroglobulinemia and lymphoplasmacytic lymphoma as their treatments vastly differ. This case report describes the clinical presentation of a patient with IgM lambda multiple myeloma and highlights the pathologic and clinical findings that are specific to this rare entity. We aim to provide further evidence for the previously reported diagnostic criteria for IgM multiple myeloma

Investigating Gender Disparities in Internal Medicine Residency Awards

Background: Significant gender disparities persist in career advancement for physicians. Studies have highlighted the lack of female representation in awards from both academic institutions and professional societies; these awards play a role in promotions, making them a fundamental building block of success. Objectives: We aim to explore the gender breakdown among resident awards presented by several Internal Medicine residency programs across the United States in this pilot study. Our ultimate goals are to define disparities in award selection, determine what variables contribute to these disparities, and work to mitigate these variables. Methods/Research: We generated a survey in REDCap to collect retrospective data about resident award selection from academic Internal Medicine residency programs across the country. This survey gathered awards data from 2009-2019 and included variables such as gender breakdown of the program, gender of resident award recipients, and details about how awards are selected. Eight programs completed the survey; these programs were from six different states in various geographic regions. Overall 43.1 percent of residents were female. Across all residency programs and years, there were 51 distinct resident awards with 290 (39.7%) female winners. Of the 51 distinct awards, there were 10 which were awarded to female residents with the same or higher frequency as males; 6 of these mentioned words that have been differentially associated with women in medicine such as “ambulatory,” “community,” “compassion,” and “humanism.” In the 41 awards favoring males, there was only a single mention of the word “compassion,” and no mention of the others. Conclusions/Impact: This data shows a concerning disparity in gender of award winners. In the future we will collect data from more residency programs and perform a thorough investigation of selection mechanisms that may help mitigate bias in order to ultimately propose strategies to reduce these gender disparities.https://jdc.jefferson.edu/sexandgenderhealth/1007/thumbnail.jp

Lack of autoantibody production associated with cytomegalovirus infection

To confirm an association between cytomegalovirus (CMV) infection and the presence of antibodies to Smith (Sm), to ribonucleoprotein (RNP), and to a component of the U1 ribonucleoproteins (U1-70 kD), we measured antibodies to these protein antigens using an enzyme immunoassay and an immunoblot. The antibodies were measured in the sera of 80 healthy subjects, one-half of whom were naturally CMV seropositive and one-half were CMV seronegative, and in eight subjects immunized with a live attenuated strain of CMV. None of the vaccinees developed antibodies to Sm, to RNP, or to U1-70 kD at either 4 or 12 months after immunization. Additionally, there was no statistically significant association between levels of antibodies to Sm or to RNP and between sera obtained from vaccinees, natural CMV seropositive individuals, and CMV seronegative individuals. One CMV seropositive serum and one CMV seronegative serum tested positive for antibodies to U1-70 kD. These data indicate that neither wild-type infection nor the live-attenuated Towne vaccine frequently induce autoantibody production

IM with Her: Fostering Career Advancement of Female Internal Medicine Residents

Background: Despite the rising number of matriculating female medical students, a gender gap favoring men exists in multiple arenas within academic medicine. Prior studies suggest that gender-specifc professional networking groups increase the likelihood of women attaining leadership positions. Objectives: Our goal was to create a multidisciplinary group with a flat hierarchy within the Internal Medicine Department in order to foster mentorship, sponsorship, allyship, and scholarship to ultimately improve professional advancement opportunities for female internal medicine residents. Methods/Research: A group named “IM with Her” was created at Thomas Jefferson University Hospital in July 2018. IM with Her is composed of internal medicine residents and faculty of all genders. The group has hosted monthly onehour conferences called “Monday Mentors” that pair a resident with a faculty member to host a discussion surrounding a topic of their choosing related to adversity and disparity faced by female physicians. Additionally, the group has held periodic evening sessions discussing topics such as salary and contract negotiation. Conclusions/Impact: The IM with Her group has made significant progress toward its goals. The pairing of a resident and faculty member for Monday Mentors discussions allows for one-on-one mentorship regarding both personal and professional topics. These sessions also provide dedicated time for networking amongst residents and faculty, facilitating sponsorship and allyship. Additionally, the sessions often lead to further initiatives spearheaded by IM with Her members including scholarly projects and examinations of institutional policies (for example those surrounding sexual harassment and lactation room accessibility). In the future, IM with Her will focus on continuing to foster mentorship, sponsorship, and allyship, on advancing research related to gender disparities in medicine, and on developing institutional changes.https://jdc.jefferson.edu/sexandgenderhealth/1008/thumbnail.jp

Antidepressant- and anxiogenic-like effects of acute 5-HT2C receptor activation in rats exposed to the forced swim test and elevated plus maze

This study investigated the behavioral effects in the forced swim test (FST) and the elevated plus-maze (EPM) of acute administration of WAY 161503 ([4aR]-8,9-dichloro-2,3,4,4a-tetrahydro-1H-pyrazino[1,2-a]quinoxalin-5[6 H]-one), a selective 5-HT2C receptor agonist with putative antidepressant-like properties. Fifteen minutes after intraperitoneal (i.p.) injections of either WAY 161503 (1, 3 and 10 mg/kg) or saline, naive male Wistar rats were exposed to the EPM for 5 min to assess classical and ethological anxiety-like measures. Immediately after EPM exposure, each animal was exposed to the FST, and the latency to the first episode of immobility was recorded (trial session). Twenty-four hours later, the rats were reexposed to a second EPM-FST exposure sequence (test session for FST) under the effect of the same pharmacological treatment. The two lowest WAY 161503 doses selectively reduced open-arm exploration and increased risk-assessment without affecting locomotor activity. This selective anxiogenic-like effect was observed in both the first and second EPM exposures. The highest WAY 161503 dose produced robust locomotor impairment. In the FST, the same WAY 161503 doses significantly increased the latency to the first immobility in the test session, a behavioral profile that suggests an antidepressant-like action. These results further support the involvement of 5-HT2C receptors in the mediation of anxiety and suggest an intricate relationship between anxiogenic- and antidepressant-like actions