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Dendritic Cell Neurofibroma With Pseudorosettes: A Case Report
No full textDendritic cell neurofibroma with pseudorosettes (DCNP) is an exceedingly rare neurofibroma variant presenting as scattered, isolated, skin-colored papules or nodules primarily on the trunk. It consists of clusters of smaller type I cells with dark nuclei and inconspicuous cytoplasm, surrounded by much larger type II cells with abundant cytoplasm and vesicular nuclei containing pseudoinclusions, resulting in the formation of distinctive pseudorosettes. While unique, it can be misdiagnosed as other neural tumors due to its histologic and clinical similarities. This report presents a unique case of DCNP in a 34-year-old male with a longstanding, asymptomatic 1.3 cm pink nodule on his mid-chest, initially suspected to be a neurofibroma. This case, along with surgical excision and histopathologic evaluation, provides valuable insight into the diagnosis of DCNP, highlighting the need for increased recognition of this rare entity and encouraging further research to refine diagnostic criteria and management strategies
Trauma Whipple at a Community Level 1 Trauma Center: A Case Report
No full textThe Whipple operation is oftentimes considered one of the most challenging and complex abdominal operations, usually reserved for duodenal and hepatopancreatobiliary malignancies. In cases of duodenal and/or pancreatic trauma with disruption of the biliary systems, a Whipple reconstruction can be performed. Such operative traumas are rare and carry with them a high level of morbidity and mortality. This case report presents a challenging 46-day clinical course of a 22-year-old African American female, who suffered multiple gunshot wounds, resulting in severe abdominal injuries. These injuries included a grade 3 duodenal injury, grade 4 pancreatic injury, and a grade 4 renal injury. The patient underwent a staged Whipple operation. Postoperative complications included pancreaticojejunostomy leak, feeding tube leak, and mesenteric bleeding, all of which required surgical and interventional radiology management. After a 46-day hospitalization, the patient was discharged to a rehab facility, achieving an impressive recovery 2 years post-surgery
A Proven Template for Providing Streamlined, Scalable, Cost-effective Clinical Research Opportunities in Osteopathic Medical Schools
No full textContext: In an era in which clinical research plays a crucial role in advancing medical knowledge and contributing to the resume of medical students attempting to match into a residency, the creation of sustainable and effective research opportunities within medical education is paramount. Colleges of Osteopathic Medicine (COMs) face unique challenges in creating these opportunities in a scalable and cost-efficient manner. Without these opportunities, osteopathic medical students may find themselves at a disadvantage compared to their allopathic counterparts in residency placements and academic career paths.
Objectives: We have created a template for providing perpetual, streamlined, scalable, cost-effective clinical research at our institution, and we believe that it can be implemented at other COMs. This abstract describes our research template and its outcomes.
Methods: Our template for creating clinical research opportunities has been in operation for the past 3 years. All of our studies are structured as retrospective analyses of data obtained from the electronic medical records of patients admitted to the hospital over a specific time frame. Initially, a broad-based research proposal is submitted to the hospital Institutional Review Board (IRB) on a particular topic. From this, multiple initial IRB research projects are generated. First- and second-year medical students go through a standardized application and onboarding process prior to participation in research. Students are then subdivided into research groups of four students each. Each research group is assigned a research topic and a faculty mentor who will help them navigate through the research project.
Results: Since 2022, a total of 295 medical students have participated in clinical research through this model, supported by 11 faculty research mentors. Across four completed research cycles, 64 projects have been conducted, resulting in 62 poster presentations (97 %), 15 peer-reviewed publications (23 %), and 6 additional manuscripts (9 %) currently under review.
Conclusions: Clinical research opportunities at COMs are needed now more than ever before. Over the past 3 years, our clinical research template has been proven to provide perpetual, streamlined, scalable, cost-effective clinical research. We believe that our template can be utilized to provide increased clinical research opportunities at other COMs
Incidence of C5 Palsy and Recovery Rate After Cervical Spine Surgery: A Systematic Review and Meta-Analysis
No full textBackground and objectives: C5 nerve palsy is a debilitating complication of cervical spine surgery that can occur after certain approaches. To our knowledge, no previous systematic reviews have compared the rates of C5 nerve palsy after different cervical approaches, identifying the rate at which this complication becomes permanent. We aimed to compare the rates of C5 palsy after different cervical spine surgery approaches and the rates of recovery when C5 palsy was present.
Methods: A literature search of the PubMed and Embase databases from their inception to July 1, 2023, was completed to identify studies that focused on cervical spine surgery. Studies were excluded if they did not provide the rate of C5 palsy occurrence or define which surgical approaches were used. A pooled, weighted prevalence rate of C5 palsy was calculated for each approach, including the rate of permanent C5 palsy.
Results: A total of 155 studies met the inclusion criteria. Of these studies, 22 (14.2%) reported on laminectomies, 77 (49.7%) on laminoplasties, 38 (24.5%) on posterior cervical decompression and fusion, 39 (25.2%) on anterior cervical diskectomy and fusion, and 4 (2.6%) on corpectomies. Patients who had laminectomies had the highest incidence of C5 palsy at a pooled rate of 8%, of which 1.44% of cases were permanent. This was followed by posterior cervical decompression and fusion with a rate of 7.03% and a permanence rate of 1.02%. Patients receiving laminoplasties had a C5 palsy incidence of 5.11%; of these, 0.28% of cases were permanent. Patients who had corpectomies had an incidence of 4.16%; those who had anterior cervical diskectomy and fusions had the lowest incidence of 2.61%, of which 1.06% of cases were permanent.
Conclusion: C5 nerve palsy is a known complication after cervical spine surgeries, with increased rates in posterior approaches, although the rate of these complications becoming permanent is minimal
Nontyphoidal Salmonella as a Rare Cause of UTI: A Case Report, Systematic Review, and Analysis of Surveillance Data
No full textIntroduction and hypothesis: Urinary tract infections (UTIs) associated with nontyphoidal Salmonella (NTS; NTS-UTI) are uncommon. Although NTS infections typically result in gastroenteritis, cases of isolated UTIs have been documented. This report examines over 300 NTS-UTI cases described since 1980, highlighting trends in patient demographics, clinical presentation, and environmental exposure.
Methods: A search of the PubMed database was conducted for NTS-UTI reports published between 1980 and 2025. Urine isolate data reported by the Centers for Disease Control and Prevention (CDC) across the USA between 2020 and 2024 were analyzed to estimate the incidence of Salmonella Bareilly (S. Bareilly) UTI. Correlation between S. Bareilly incidence and both chicken and egg production was assessed to explore potential associations.
Results: A total of 321 patients with NTS-UTI were identified in our systematic review. The cohort had an average age of 54.5 ± 24.0 years and an approximate male-to-female ratio of 8:10. Contributing factors for NTS-UTI included comorbidities, such as diabetes and hypertension, and underlying urological conditions, including urolithiasis and recurrent UTI. Analysis of CDC surveillance data revealed a higher incidence of S. Bareilly UTI in the Four-State Area (Arkansas, Kansas, Missouri, Oklahoma) compared with the national average.
Conclusions: Our findings highlight the importance of considering nontyphoidal Salmonella (NTS) in the differential diagnosis of UTI. Environmental exposure, comorbid conditions, and genitourinary abnormalities appear to play a role in the pathogenesis of NTS-UTI. A better understanding of these contributing factors may help to identify at-risk populations in regions where enhanced surveillance may be warranted
Endoscopic Ultrasound-guided Esophagojejunal Anastomosis for Delayed Reconstruction: A Case Series on the Novel Technique and our Experience
No full textEsophagojejunal (EJ) anastomoses are integral to gastrointestinal reconstructive surgeries following procedures such as gastrectomy, particularly in cases of cancer or Roux-en-Y reconstruction. However, the traditional surgical EJ anastomosis approach can pose challenges with notable risks such as anastomotic leakage, stricture, or fistula formation. Endoscopic interventions have been employed for managing these adverse outcomes through stent placement, but a primarily endoscopic EJ anastomosis technique has not yet been described. This retrospective case series details five patients who underwent delayed endoscopic EJ anastomosis, with each patient under differing circumstances of instability necessitating this emergent alternative to standard surgical reconstruction. This approach involved the placement of a lumen-apposing metal stent between the esophagus and jejunum. Successful endoscopic EJ anastomosis was achieved in all cases, with hospital stays ranging from 6-13 days. Adverse events included stent migration, dysphagia, and stricture. Subsequent management strategies for these adverse events included stent removal and exchange, balloon dilation, triamcinolone injection, and appropriate follow-up. Follow-up evaluations revealed successful outcomes with no mortalities or anastomotic leaks.Primarily endoscopic EJ anastomosis for delayed reconstruction emerges as an advanced, minimally invasive alternative in complex patients deemed unsuitable for conventional surgical reconstruction secondary to instability or critical conditions. Within the literature, this is the first human case series description of an endoscopic EJ anastomosis with stent placement between the esophagus and jejunum. This novel technique offers the potential in improving patient outcomes which warrants further investigation to optimize these endoscopic techniques and assess its long-term efficacy across a larger patient cohort
Effective Trauma Training for Foster Parents: A Systematic Narrative Literature Review
No full textTrauma can significantly influence children’s emotional development and behavior, understanding its impact is essential for effective caregiving. This systematic narrative literature review addressed these questions: What validated trauma-informed parenting trainings reflected the best practices for foster parents and what components of those training programs proved to be the most effective? What validated trauma-informed parenting trainings did foster parents deem to be the most effective? The a priori hypotheses for this study were: (1) trauma-informed training programs for foster parents would include components aimed at reducing foster parent stress; (2) trauma-informed training programs for foster parents were expected to focus on educating parents about the effects of trauma on children’s behavior and emotional well-being; (3) the most effective trauma-informed training programs would introduce foster parents to resources, such as mental health services, therapy, and community-based support systems; (4) training programs focusing on improved parenting skills would correlate with higher retention rates among foster parents; (5) trauma-informed training programs would reduce placement disruptions. Findings from the ten studies provided potential support for hypotheses 1-3, trainings consistently incorporated stress-reduction strategies, trauma psychoeducation, and resource support, whereas evidence for hypotheses 4 and 5 (higher foster parent retention and fewer placement disruptions) remains limited. Overall, trauma-informed parent trainings showed preliminary evidence of improved parenting competencies, foster parent confidence, and behavioral outcomes for children by emphasizing psychoeducation, stress management, and access to resources and community support. A post-hoc hypothesis emerged suggesting additional training components, such as psychoeducation and kinship resources, might enhance trauma-informed training programs. Seven of the ten studies lacked control groups, limiting the ability to establish causal relationships between training and outcomes. The limitations prevented definitive conclusions about effectiveness. Psychology has an ethical obligation to pursue rigorous research definitively identifying which training approaches best support both healing and placement stability
Comparative Analysis of Postoperative Visual Outcomes of Light-Adjustable Lens, Toric Monofocal, and Spherical Monofocal Intraocular Lenses
No full textThis retrospective study compares postoperative visual outcomes among 150 eyes treated with Light-Adjustable Lenses (LAL), toric monofocal lenses, and spherical monofocal lenses at Discover Vision Centers in Missouri and Kansas. The study included individuals with an average age of 68.9 years (25-82 years) who had cataract extraction (CE) within the past five years. Patients with prior corneal refractive procedures, including Radial Keratotomy (RK), Photorefractive Keratectomy (PRK), Laser-Assisted In Situ Keratomileusis (LASIK) or Small Incision Lenticule Extraction (SMILE) were excluded. Sixty-four percent of eyes with LALs achieved uncorrected distance visual acuity (UCDVA) better than 20/20 after the final lock-in, 46.0% with toric monofocal lenses, and 32.0% with spherical monofocal lenses. LAL-treated eyes also showed lowest residual refractive error, with a final mean spherical equivalent of 0.0 ± 0.353D, outperforming toric (0.08 ± 0.386D) and spherical monofocal lenses (0.20 ± 0.631D). These results suggest that LALs offer superior outcomes, though further research is warranted
Diagnostic Accuracy and Bias in Open Access and Subscription-based Large Language Models for Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder
No full textOverlapping clinical symptoms between people with multiple sclerosis (PwMS) and those with neuromyelitis optica spectrum disorder (PwNMOSD) can result in misdiagnosis. Large language models, such as ChatGPT, offer accessible tools for preliminary health guidance. We assessed the accuracy of open-access (GPT-3.5) and subscription-based (GPT-4) models in diagnosing MS and NMOSD, and the influences of key diagnostic inflection points (initial MRI findings and aquaporin-4 (AQP4) antibody testing) and subject demographics on model performance. PwMS and PwNMOSD were retrospectively identified within a single academic center, and structured clinical timelines were processed through GPT-3.5 and GPT-4. Seven digital derivatives per subject, varying race, ethnicity, and sex, were also created to assess demographic influences. ChatGPT provided one diagnosis after each timepoint, and diagnostic accuracy was determined using mixed-effects logistic regression. A total of 98 PwMS and 157 PwNMOSD were included, generating 4080 ChatGPT conversations across models and digital derivatives. GPT-4 demonstrated higher diagnostic accuracy for MS (OR=2.67) and NMOSD (OR=1.31), relative to GPT-3.5. Accuracy improved as the clinical time line progressed, although GPT-4 paradoxically performed worse after the initial MRI report for MS cases (OR=0.56). For PwMS, diagnostic accuracy was lower in males (OR=0.81) and older individuals (OR=0.56 per 10-year age increase). Conversely, accuracy was higher for African Americans (OR=1.30) and Asians (OR=1.38) for PwNMOSD. GPT-4 demonstrated higher diagnostic accuracy for both diseases, but superior performance was not uniform across demographic groups. Further, the paradoxical decline in accuracy after MRI interpretation in MS cases suggests context-dependent performance, and responsible interpretation remains necessary
Enhancing Hip and Knee Arthroplasty Outcomes with Immunonutrition: A Review of the Evidence
No full textTotal hip and knee arthroplasty are common surgical procedures aimed at improving mobility and quality of life. Despite surgical advances, postoperative complications remain a concern, particularly for patients with comorbidities and poor nutritional status. Immunonutrition, the targeted administration of nutrients that modulate inflammation, such as arginine, omega-3 fatty acids, and antioxidants, has been shown to reduce infections, complications in wound healing, and shorten hospital length of stay. This review examines current evidence on the role of immunonutrition in hip and knee arthroplasty, focusing on the mechanisms of key nutrients, clinical application of supplementation, and areas for future investigation. Despite promising outcomes, further research is needed within orthopedics to establish guidelines for patient screening, nutrient dosage, and timing of administration