Introduction: Yaws is an endemic non-venereal treponematoses, which is caused by Treponema pallidum, subspecies pertenue and is spread from person-to-person through direct skin contact with an infected lesion. Yaws causes a chronic skin infection that is characterized by papillomas and ulcers and if left untreated can be disfiguring and debilitating. Cases typically occur in warm, humid, tropical climates and cases are commonly seen in children under 15 years old. However, due to migration, cases can be seen outside of its endemic region.
 Case Description: We present a case of a 39-year-old African American male who presented with painless bilateral ulcers on his dorsal feet that began as blisters approximately 1-2 weeks prior to presentation at our clinic. Our patient had recent travel history to Jamaica and reported potential sources of trauma to his feet by walking barefoot on the beach and roofing in sandals prior to onset. These findings led to the clinical diagnosis of Yaws. A regimen of azithromycin and basic wound care led to significant improvement.
 Discussion: Non-venereal endemic treponematoses, such as Yaws, are typically not seen outside of their endemic region. However, due to migration and the ease of travel non-venereal endemic treponematoses can be found elsewhere and it is important for healthcare workers to keep these diseases on their differential, especially in a patient with travel history. After making the diagnosis of Yaws, proper treatment and basic wound care can result in rapid significant improvement and prevent the progression of Yaws lesions to the subsequent stage.

Here we report a case of dermatofibrosarcoma protuberans (DFSP) that presented originally to the emergency department with chief complaint of ‘chest pain arising from a chest wall mass’. This case is unique for multiple reasons including the fact that the DFSP caused this patient severe pain that radiated from the site of the mass to the patient’s back. The lesion originated from a traumatic scar that the patient had obtained following a car accident two years prior to presentation. In addition, the DFSP was significantly larger in size than what has typically been reported in the literature. This case illustrates that DFSP has the potential to present with multiple atypical features.

BackgroundApproximately 20% of patients with chronic limb-threatening ischemia have no revascularization options, leading to above-ankle amputation. Transcatheter arterialization of the deep veins is a percutaneous approach that creates an artery-to-vein connection for delivery of oxygenated blood by means of the venous system to the ischemic foot to prevent amputation.MethodsWe conducted a prospective, single-group, multicenter study to evaluate the effect of transcatheter arterialization of the deep veins in patients with nonhealing ulcers and no surgical or endovascular revascularization treatment options. The composite primary end point was amputation-free survival (defined as freedom from above-ankle amputation or death from any cause) at 6 months, as compared with a performance goal of 54%. Secondary end points included limb salvage, wound healing, and technical success of the procedure.ResultsWe enrolled 105 patients who had chronic limb-threatening ischemia and were of a median age of 70 years (interquartile range, 38 to 89). Of the patients enrolled, 33 (31.4%) were women and 45 (42.8%) were Black, Hispanic, or Latino. Transcatheter arterialization of the deep veins was performed successfully in 104 patients (99.0%). At 6 months, 66.1% of the patients had amputation-free survival. According to Bayesian analysis, the posterior probability that amputation-free survival at 6 months exceeded a performance goal of 54% was 0.993, which exceeded the prespecified threshold of 0.977. Limb salvage (avoidance of above-ankle amputation) was attained in 67 patients (76.0% by Kaplan–Meier analysis). Wounds were completely healed in 16 of 63 patients (25%) and were in the process of healing in 32 of 63 patients (51%). No unanticipated device-related adverse events were reported.ConclusionsWe found that transcatheter arterialization of the deep veins was safe and could be performed successfully in patients with chronic limb-threatening ischemia and no conventional surgical or endovascular revascularization treatment options. (Funded by LimFlow; PROMISE II study ClinicalTrials.gov number, NCT03970538.)

Our study compares perioperative outcomes between two-dimensional (2D) laparoscopic radical prostatectomy (LRP) and the 4th generation three-dimensional/high definition (3DHD) LRP. Retrospectively acquired data from patients that underwent 2D LRP (n = 75) and 3DHD LRP (n = 75) from March 2013 to October 2015 were evaluated. Procedures were performed by a single surgeon. The extra-peritoneal approach with 5 trocars was utilized. Perioperative outcomes, potency, and continence were compared between groups. Patient characteristics were similar between the two groups in terms of age (p = 0.44), prostate-specific antigen (PSA) levels (p = 0.34), and Gleason scores (p = 0.14). Body mass index (BMI) was significantly higher in the 3DHD group (p = 0.0036). Postoperatively, no significant differences were observed in Hgb loss (p = 0.50), positive surgical margins (p = 1.00), and post-op Gleason scores (p = 0.30). Significant differences were observed for length of hospital stay (p < 0.001) and Jackson-Pratt (JP) drainage (p < 0.001). Regarding potency, 73.7% and 51.6% of the patients in the 3DHD and 2D groups regained potency at 6months, respectively (p = 0.0025). Almost 43% of the patients in the 3DHD group regained continence at 1month while for the 2D groups it was only 17.3% (p = 0.0008). 3DHD and 2D LRP have resulted in good outcomes in the perioperative periods. Our results show decreased JP drainage, shorter length of hospital stay, earlier return of urinary control, and earlier return of sexual function in the 3DHD LRP group. In lower volume centers where robotics equipment is not feasible due to economic barriers 3DHD can be safely performed as a minimally invasive alternative.

BACKGROUND: The widespread use of social media has led to exploration of its use as an educational tool to engage learners and enhance interactive learning with its use in the healthcare literature dating back to 2008. If an intervention can impact clerkship Shelf Exam scores as a measurable short-term goal, it may have a downstream impact on USMLE or COMLEX-USA examination scores. The purpose of the investigation was to evaluate if Twitter could be used in undergraduate allopathic and osteopathic medical students to enhance learning outcomes defined as scores and passage on NBME Shelf examinations taken directly after the intervention period. METHODS: This investigation used a quasi-experimental study design. Ninety questions covering 30 different Family Medicine topics were developed through a psychometrically sound process. Following sample size calculations 32 3rd-year allopathic and osteopathic participants were recruited from a Family Medicine clerkship at a community-based hospital in the Northeast. Participants were sent tweets during two weeks of their Family Medicine clerkships. Upon completion of their clerkship, surveys were emailed to participants containing questions from ane an engagement survey. A historical comparison group of individuals completing their rotations immediately prior to the intervention was used to assess a difference in Shelf examination scores. A two-group Wilcoxon-Mann-Whitney test was used to examine differences. RESULTS: There was no statistical evidence of a difference between percentile scores (_P_-value=.157). The CLES for COMAT/NCME Shelf Exam percentile was 62% - a meaningful effect size. DISCUSSION: This study adds support for the use of Twitter to improve learning outcomes during medical student clerkships. Our study built upon this finding by adding the bidirectional aspect of Twitter communication. The change in scores change may have been due to student engagement. Twitter demonstrated a social media approach to providing students with anytime-anyplace and just-in-time experience consistent with Bauman’s Layered-Learning Model. The chief limitation of this study was medical student in-person clerkships were paused during the COVID pandemic and therefore our study enrollment was also paused and posed many more logistical challenges. The results of this investigation further the potential for Twitter to be used as an inexpensive educational intervention to modestly improve standardized exam scores with the potential to be used in a broader fashion (e.g., COMLEX and USMLE Step Scores). Future research can build upon this study by applying this intervention to other locations with larger samples. This study should be replicated for each core clerkship rotation for COMLEX and USMLE Step preparation.

In the LIBERTY 1 and LIBERTY 2 placebo-controlled trials, once-daily relugolix combination therapy reduced menstrual blood loss volume and pain in women with heavy menstrual bleeding associated with uterine leiomyomas and was well tolerated, with preservation of bone mineral density (BMD) through 24 weeks. Here we report the long-term efficacy and safety of relugolix combination therapy treatment for up to 52 weeks. Women with uterine leiomyoma-associated heavy menstrual bleeding who completed any treatment arm in either the LIBERTY 1 or LIBERTY 2 trial were eligible to enroll in a 28-week long-term extension study. All participants received once-daily relugolix combination therapy (40 mg relugolix, estradiol 1 mg, norethindrone acetate 0.5 mg) in the extension study. The primary efficacy endpoint was the proportion of women who achieved or maintained a menstrual blood loss volume of less than 80 mL and a 50% or greater reduction in menstrual blood loss volume from LIBERTY study baseline to the last 35 days of treatment (defined as responders ). Analyses were conducted for all three randomized treatment groups from pivotal studies. Overall, 477 women enrolled, 476 were treated, and 363 (76.1%) completed 52 weeks. Among patients treated with relugolix combination therapy through 52 weeks (n=163), sustained improvement in heavy menstrual bleeding was observed in 87.7% (responders). The least squares mean menstrual blood loss volume reduction was 89.9%, with 70.6% of patients achieving amenorrhea. At week 52, 59.0% of patients with anemia at baseline had improvements in hemoglobin concentration of greater than 2 g/dL. Distress due to uterine leiomyoma-associated symptoms measured by the BPD (Bleeding and Pelvic Discomfort) scale score was reduced by 51.3 points. Sustained reductions in uterine and uterine leiomyoma volume were observed. Bone mineral density was preserved through week 52. Improvements in heavy menstrual bleeding and anemia and reduction of uterine leiomyoma-associated symptom burden were sustained through up to 52 weeks of treatment with relugolix combination therapy in women with uterine leiomyomas. No new safety concerns were identified, and BMD was maintained. ClinicalTrials.gov , NCT03049735; NCT03103087; NCT03412890. Myovant Sciences GmbH.

Serratia marcescens is a gram-negative bacillus belonging to the Enterobacteriaceae family and is commonly associated with respiratory tract infections, urinary tract infections, and endocarditis.1 On extremely rare occasions, this facultative anaerobe has been associated with primary cutaneous infections.2 These infections tend to manifest in immunocompromised individuals or those with an underlying medical condition, such as alcoholic cirrhosis, venous insufficiency, or chronic granulomatous disease (CGD).

Erythema elevatum diutinum (EED) is a rare small vessel vasculitis with cutaneous manifestations most commonly presenting as red or brown papules, plaques, and nodules on extensor surfaces. It is a chronic, relapsing disease that is often associated with states of immunocompromise, e.g., HIV, gammaglobulinemias, and, more rarely, tuberculosis. Currently oral dapsone is the current treatment of choice, and while most patients respond well, it is imperative that the diagnosis be made early. We report a rare case of EED associated with underlying tuberculosis infection. Recognizing the distinct manifestations of EED and understanding its immunologic and infectious disease associations may enable clinicians to properly recognize, manage, and treat patients with EED.