Present Case Research Articles

Concurrent spinal schwannoma and meningioma without neurofibromatosis: case presentation and review of literature

Abstract Background Concurrent multiple tumors developing in the spinal cord are rare, except for in genetic disorders, such as neurofibromatosis and von Hippel–Lindau disease. The presence of multiple histologically different spinal tumors in the absence of NF-2 is extremely rare. Schwannoma and meningioma can be explained partly by their common origin from the same mesenchymal cell, there is currently no explanation for the simultaneous existence of different spinal tumors other than simple coincidence. Case presentation After review of literature, there are thirteen such cases reported in the literature in addition to the present case. The current patient presents with lower limb weakness, and the patient radiology revealed intradural mass opposite the fourth lumbar vertebra with contrast enhancement and intradural extramedullary mass opposite the tenth dorsal vertebra with contrast enhancement in MRI spine. The coexistence of these tumors may be coincidental or might be due to a common histological origin of the Schwann cells and the meningocytes. Conclusion Schwannoma and meningioma have different radiological characteristics and require different managing procedures such as dural base coagulation in meningiomas and rootlet sacrifice in schwannomas.

Solitary fibrous tumor of the gallbladder: a case report

Abstract Background Primary solitary fibrous tumors (SFTs) of the gallbladder are rare. Here, we report the case of a patient who underwent surgical treatment for a primary SFT originating in the gallbladder. Case presentation A 48-mm gallbladder tumor was detected in a 70-year-old man using abdominal ultrasonography at a primary hospital, and he was subsequently referred to our department. A 50-mm enhanced tumor in the gallbladder was identified using computed tomography. Magnetic resonance imaging revealed a smooth-marginated tumor with hyperintensity on T2-weighted imaging. 18F-Fluorodeoxyglucose positron emission tomography confirmed high-level fluorodeoxyglucose uptake in the gallbladder tumor in the early phase without increasing uptake in the later phase. Surgical resection was planned to evaluate the tumor diagnosis. Initially, we performed open cholecystectomy with wedge resection of the gallbladder bed. Intraoperative pathological examination suggested gallbladder cancer; therefore, we performed radical surgery, including resection of the common bile duct, extended radical lymphadenectomy, and choledochojejunostomy. Ultimately, the final pathological examination revealed an SFT originating from the gallbladder with a negative surgical margin. Postoperatively, the patient developed bile leakage that was treated with tube drainage. The patient recovered satisfactorily and was discharged on postoperative day 20. At 24 months postoperatively, the patient was in good general condition without recurrence. Conclusions We report a rare case of a primary SFT originating in the gallbladder. Clinicians should be aware that SFT can be found in the gallbladder, and when it is difficult to make a preoperative diagnosis, surgical treatment should be considered.

Paracetamol overdose associated with cortical blindness-complicated acute leukoencephalopathy: a case report

Abstract Background Paracetamol is one of the most used antipyretics and analgesics among pediatrics, and its overdose is highly encountered among pediatrics especially in the pre-school age. While it is well-known that paracetamol overdose may lead to toxicities including severe hepatic toxicity, some recent reports have highlighted its “in situ” toxicity on brain tissue at high doses, even in the absence of hepatotoxicity. This can result in acute leukoencephalopathy (AL), coma, or even death. This report describes a case of a child who developed cortical blindness-complicated AL, following a paracetamol overdose. Case presentation An 18-month-old previously healthy girl accidentally ingested 300 mg/kg of paracetamol suspension. After ingestion, the child was in an initial bad condition that has gradually improved. Several days after ingestion, the patient lost her vision, and she remained blind since then despite a newer appreciation to light. The initial brain magnetic resonance imaging (MRI) suggested AL demonstrated as a faint high T2/fluid-attenuated inversion recovery (FLAIR) signal intensity in the cortical and subcortical regions of both parieto-occipital lobes with sulcal effacement and restricted diffusion. After around 3 months, the subsequent brain MRI showed involutional changes that were manifested as a brain volume loss in the same areas with evidence of gyri-form laminar necrosis in both parieto-occipital regions without restricted diffusion. Other brain MRI findings include right cerebral convexity hyperacute subdural hematoma with prominent subarachnoid spaces. Conclusions The child developed cortical blindness-complicated AL following a paracetamol overdose. It is well- known that AL may result from several toxins by their direct and/or indirect effect on the cerebral white matter. However, there is still no enough data in the literature clearly explaining the relation of paracetamol overdose to AL. The generally proposed effect of paracetamol on the brain is mainly justified by the excessive oxidative stress. Further studies at the cellular and genetic levels are still needed to investigate the exact association between paracetamol overdose and AL, as well as the underlying mechanisms involved.

Jordans’ anomaly in Chanarin-Dorfman syndrome

Abstract Objectives Chanarin-Dorfman syndrome is a rare disease inherited in an autosomal recessive pattern whose prevalence does not exceed 130 cases worldwide. Case presentation A 4-year-old patient with generalized erythematous-desquamative ichthyosiform syndrome since birth. The main laboratory finding was persistent hypertransaminasemia. Supplementary studies included peripheral blood smear (PBS), which revealed the presence of multiple cytoplasmatic vacuoles in polymorphonuclear leukocytes (PMN) and platelets. Ichthyosiform lesions concomitant to the presence of lipid vacuoles in peripheral blood PMNs are signs of Chanarin-Dorfman syndrome. Diagnostic suspicion was confirmed by genetic sequencing. Conclusions Chanarin-Dorfman syndrome is characterized by a mutation in the CGI-58 gene. This gene is involved in the catabolism of long-chain triglycerides stored in cytoplasmic lipid droplets. Jordans’ anomaly is a congenital alteration characterized by the presence of multiple vacuoles in the granulocytic series due to defective lipid metabolism. In this syndrome, long-chain triglycerides build up in tissues, thereby causing dermatological manifestations that are controllable through diet.

Malignant Transformation of Recurrent Benign Phyllodes Tumor: A Case Report and comprehensive review of literature

Introduction: Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, accounting for less than 1% of all breast tumors. The World Health Organization (WHO) classifies PTs into benign, borderline, or malignant categories based on histological features. While benign PTs generally have a favorable prognosis, they carry a risk of transformation into malignant variants, particularly in cases of recurrence. Case Presentation: A 33-year-old female presented with a recurrent benign PT, previously treated with lumpectomy on two occasions. Recent imaging suggested possible malignant transformation, and histopathological examination confirmed a malignant PT. Discussion: This case highlights the crucial role of imaging in the early detection of malignant transformation in PTs. Surgical management strategies are discussed, with an emphasis on the potential for recurrent benign tumors to progress to malignancy. Conclusion: Regular imaging and close follow-up are essential for early detection of malignant transformation in recurrent PTs, guiding timely and appropriate surgical intervention.

The Migration of an Intrauterine Device in the Bladder of an Asymptomatic Woman: A Case Report

Background: The use of intrauterine devices (IUDs) for contraception has increased in many countries. However, their application has some serious complications such as uterine perforation and injury to adjacent organs. The translocated IUD into the bladder is a very rare occurrence. Case Presentation: Our case was a 41-year-old woman whose IUD was accidentally discovered in her bladder during a routine ultrasound. The IUD has migrated from its normal position in the uterus to the bladder. The IUD was successfully removed by cystoscopy without any complications. Conclusion: The mislocation of an IUD in the bladder, while uncommon, is a possibility that should be considered when the IUD string is not visible during examinations.

Placental Histopathological Changes and the Level of Anti-Spike Antibody After Covid-19 Vaccination During Pregnancy: A Case Series

Background: COVID-19 infection during pregnancy could be associated with placental histopathological changes such as vascular diseases and malperfusion. There are studies showing that mRNA vaccines are not associated with significant placental pathological changes. Our objective was to evaluate the placental histopathology in pregnant women who received Sinopharm, an inactivated virus vaccine, during pregnancy. Case Presentation: The study included placental samples collected from mothers who gave birth of living singletons through elective cesarean sections performed between March 2022 and May 2022 at Imam Khomeini Hospital Complex. The study included women who had no history of positive reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 during pregnancy, and had received at least one dose of COVID-19 vaccine during their pregnancy. Humoral levels of anti-SARS-CoV-2 spike IgG were measured in both the mothers and neonates. Results: The study included 20 mother-neonate pairs. The mean maternal age was 34±3.6 years, and all mothers received Sinopharm vaccine as their first and second doses. The last vaccine dose was administered during pregnancy, with 3 mothers receiving it in the first trimester, 9 in the second trimester, and 8 in the third trimester. The histopathological findings in the placental samples included decidual vasculopathy, subchorionic thrombosis, and chronic histiocytic intervillositis. All mothers and neonates, except one pair, were positive for anti-spike antibody. Conclusion: Multiple abnormal histopathological findings were reported in placenta of vaccinated mothers. However, similar to previous studies, these placental findings are considered mild lesions and have been observed in both vaccinated and unvaccinated mothers.

Can Talaromyces marneffei Infection Cause Acute Liver Failure? A Case Report

Introduction: Talaromyces marneffei is a pathogen that causes talaromycosis, a systemic fungal infection. Cases in which hepatic failure is the primary clinical presentation are exceedingly rare. Case Presentation: This report details the case of a 49-year-old male with no prior liver disease, presenting to the hospital with persistent symptoms, including a fever lasting over ten days, abdominal distension for five days, and jaundice for three days. The patient’s history included immune thrombocytopenia and prolonged glucocorticoid therapy. Physical examination revealed yellowing of the skin and sclera, abdominal distension, firmness of the abdominal wall, absence of abdominal tenderness, positive shifting dullness, and pitting edema in the lumbosacral region and bilateral lower extremities. An HIV antibody test was negative. The patient developed hepatic failure and received artificial liver support along with routine therapy. Despite these interventions, the patient was automatically discharged without improvement and subsequently passed away. Post-discharge, cultures from pleural and abdominal effusions identified Talaromyces marneffei. Conclusions: Talaromyces marneffei infection should be considered in the differential diagnosis of immunocompromised patients, particularly those with no history of liver disease but with long-term glucocorticoid or immunosuppressant use who present with acute liver failure. Early and aggressive investigation for the causative pathogen is essential to minimize diagnostic and treatment delays. Given the prolonged incubation period of Talaromyces marneffei, metagenomic next-generation sequencing may offer a more rapid approach for etiological diagnosis.

A Case of Acute Necrotizing Encephalitis Misdiagnosed as Opium Poisoning: A Case Report

Introduction: The coronavirus has been associated with significant neurologic complications, including encephalopathy, seizures, ataxia, and motor or sensory deficits. Among these complications, acute necrotizing encephalopathy (ANE) is a rare condition linked to viral infections such as influenza, HHV-6, and COVID-19. This study presents a unique case of ANE in a COVID-19 patient, initially misdiagnosed as opium poisoning. Despite the reduction in pandemic cases, COVID-19 continues to present serious side effects, emphasizing the need to recognize potential neurological manifestations of the virus. Increased awareness and accurate diagnosis are essential for managing these complex cases. Case Presentation: This case study involves a 29-year-old female patient presenting with loss of consciousness and other symptoms that led to a diagnosis of COVID-19-related acute necrotizing encephalitis. Initial suspicions of opium poisoning were ruled out, and imaging tests revealed bilateral ground-glass opacities (GGO) and consolidation in the chest, along with abnormal findings in the brain. The patient was treated with glucocorticoid pulse therapy and IVIG, resulting in symptom improvement, though some neurological deficits persisted at discharge. This case underscores the importance of considering COVID-19 in cases of acute encephalitis and highlights the neurological complications associated with the virus. Conclusions: This study explores ANE as a severe manifestation of COVID-19 infection, focusing on the diverse neurological presentations associated with ANE in COVID-19 patients and a case initially misdiagnosed as opium poisoning. Through a case study of a patient with ANE, characterized by loss of consciousness and meiotic pupils, the research emphasizes the need for early detection and appropriate treatment. Findings suggest that ANE in COVID-19 patients can present with varied symptoms, posing diagnostic challenges. The study underscores the value of timely intervention with glucocorticoid pulse therapy and gamma globulin injection to improve patient outcomes. These findings highlight the necessity for increased awareness among healthcare providers to promptly recognize ANE in COVID-19 patients, aiding in timely and effective intervention.

Unexpected Anti-tumor Effect of Selective Internal Radiation Therapy and Radiofrequency Ablation Followed by Immune Checkpoint Inhibitors for Hepatocellular Carcinoma

Introduction: Hepatocellular carcinoma (HCC) has become an increasingly serious health problem worldwide. Combining immune checkpoint inhibitors (ICIs) for HCC with local treatments can produce synergistic effects. Although the abscopal effect was noted in 1953, most studies on this phenomenon have been conducted in the context of external beam radiotherapy (EBRT). The incidence of the abscopal effect induced by selective internal radiation therapy (SIRT) alone is lower. This research reports a case of a patient with multifocal HCC who received SIRT plus radiofrequency ablation (RFA) followed by ICI therapy. During the subsequent course of ICI therapy, an anti-tumor effect was detected in the left hepatic lobe, far from the site targeted by the local treatments. Case Presentation: The abscopal effect has recently attracted widespread attention because ICIs can enhance this phenomenon. However, little is known about the relationship between inducing the abscopal effect and local treatment against HCC. A 76-year-old male patient presented with multifocal HCC. During hepatic angiography, MRI showed multiple HCCs in both lobes of the liver. Selective internal radiation therapy was performed on a tumor with a diameter of approximately 80 millimeters in the right lobe. A month later, RFA was conducted on another tumor in the right lobe, approximately 30 mm in diameter, and ICI therapy was administered on the second day post-RFA. Hepatic arterial phase imaging of contrast-enhanced magnetic resonance performed 10 months after SIRT showed the disappearance of the tumor in the left liver lobe. Conclusions: This case highlights that the combination of multiple local treatment methods with ICI therapy can enhance the anti-tumor immune response and benefit patients with multifocal

Multipotent mesenchymal stromal cell therapy for a neonate with congenital diaphragmatic hernia and adhesive small bowel obstruction

Background. In the last decade, therapy using multipotent mesenchymal stromal cells (MSCs) has offered hope for regenerating the lungs of preterm babies with chronic lung disease. Due to similar disease mechanisms, it is logical to explore the potential impact of MSC therapy on pulmonary hypoplasia in congenital diaphragmatic hernia. Furthermore, MSCs may also contribute to the regeneration of the intestines affected by adhesive small bowel obstruction in patients with congenital diaphragmatic hernia. Case presentation. A female newborn, delivered at 32 weeks and six days gestational age, was diagnosed with a left congenital diaphragmatic hernia. After surgical repair and respiratory/nutritional support for 39 days, she was still dependent on a ventilator and total parenteral nutrition. Two MSC treatments were given a week apart: 10 million cells/kg intratracheally and 5 million cells/kg intravenously. She was extubated, and her enteral nutrition improved after the treatment. No side effects were detected. We present the first documented case using MSCs derived from the umbilical cord to simultaneously treat pulmonary hypoplasia and adhesive small bowel obstruction of congenital diaphragmatic hernia. Conclusion. Although MSC treatment is very promising for pulmonary hypoplasia and adhesive small bowel disease of congenital diaphragmatic hernia, much more needs to be learned about potential side effects, appropriate dosage, and the optimal method of administration.

A Case of the Initial Presentation of Hemophagocytic Lymphohistiocytosis as Acute Unilateral Vision Loss

A Case of the Initial Presentation of Hemophagocytic Lymphohistiocytosis as Acute Unilateral Vision Loss

Balancing Tradition and Modernity: The Brand Personality of Santiniketan as a Tourist Destination

The present case study rigorously investigates the brand personality of Santiniketan, a prominent tourism destination in West Bengal, India. This research aims to explore the dominant personality dimensions that define Santiniketan’s identity and to examine potential differences in perceptions between tourists who have visited the town and those who have not. Santiniketan’s unique identity, rooted in its cultural heritage, customs and the legacy of Rabindranath Tagore, is communicated through diverse marketing campaigns and promotions. A strong and positive brand personality can set a destination apart, providing a significant competitive advantage and facilitating increased visitation rates. To evaluate Santiniketan’s brand personality, traditionally associated with peace, tranquillity and spirituality, while exploring additional dimensions such as sustainability and environmental consciousness, this study used the rigorous Destination Personality Scale by Kumar and Nayak (2018, Journal of Hospitality and Tourism Research, 42, 1, 3–25). The study employed a mixed-method approach, combining qualitative and quantitative tools, to gather data from 97 respondents through focus group interviews and surveys. Participants aged 18–70 were divided into those who had visited Santiniketan and those who had not but were knowledgeable about the destination. The findings indicate that courteousness, conformity, creativity and tranquillity significantly influence tourists’ perceptions of Santiniketan, with notable differences between visitors and non-visitors. This research contributes to the literature on destination branding by comprehensively understanding Santiniketan’s brand personality, emphasizing its cultural attributes and rich heritage as critical factors in its success as a popular tourist destination. The insights gained can assist destination marketers in aligning their strategies to enhance tourists’ perceptions and increase visitation rates. This study addresses the gap in academic inquiry into Santiniketan’s brand personality, offering valuable implications for developing and promoting similar cultural heritage destinations.

A novel USP51 variant in a patient with autism spectrum disorder and epilepsy

Abstract Background Autism spectrum disorder (ASD) is a highly heritable neurodevelopmental disorder characterized by impaired social communication and repetitive behaviours. The genetic basis of ASD is complex and involves both rare variants with large effect sizes and common variants with small effect sizes. Case presentation This case report describes a 19-year-old male with ASD, intellectual disability, absent speech, and epilepsy. Molecular testing revealed a novel maternally inherited variant in the USP51 gene, which encodes Ubiquitin Specific Peptidase 51, a deubiquitinating enzyme involved in the DNA damage response. Conclusions Based on current knowledge, the variant is predicted to result in a truncated protein and is considered a variant of uncertain significance (VUS). The USP51 gene has been implicated in neurodevelopment, and its role in the developing brain suggests its potential relevance to ASD. Further studies are needed to establish the association of USP51 variants with ASD and elucidate the full phenotypic spectrum associated with these variants.

Aeromedical Fitness Considerations in Myocardial Bridging: A Case Study and Literature Review

Aims: Management of cardiac disease in aeromedical expertise can be challenging for asymptomatic crew members, especially during the first aeromedical examination, myocardial bridging is a good example. Presentation of Case: A 24-year-old student pilot candidate shows repolarization disorders at the ECG in the aeromedical examination, the exploration allowed the discovery of a myocardial bridge on The Coronary computed tomographic angiography (CCTA) of the left anterior descending (LAD) coronary artery responsible for tight stenosis. Discussion: The prevalence of MB varies according to the method of investigation, ranging from 2% in coronary angiography and 19% in coronary computed tomography to 42% in autopsy.The prevalence among active civilian aircrew (pilots and cabin crew) monitored at CEMPN is 0.4%, all revealed by electrocardiogram abnormalities. MB are usually small and of no clinical significance, the myocardial bridge proximal segment has been associated with atherosclerosis. Symptomatic patients with myocardial bridges as their only cardiac abnormality may present with myocardial ischemia, acute coronary syndromes, coronary spasm, syncope or even sudden death. The initial therapeutic strategy in the treatment of MB is medical management. Revascularization is indicated by PCI or surgery, including coronary artery bypass grafting (CABG) or myotomy in the case of symptoms recalcitrant to maximal medical treatment. The aviation environment may expose aircrew to additional physiological stressors, including hypobaria, hypoxia and sustained acceleration (+Gz). Such exposure may present a risk if associated with cardiovascular abnormalities, potentially leading to incapacity to fly due to symptoms or complications of the myocardial bridge. Conclusion: The myocardial bridge is an anatomical variant rather than a congenital anomaly with varied symptomatology (ECG abnormality, stable or unstable angina or sudden death), the aeromedical decision is made on a case-by-case basis, and makes a challenge diagnostic, particularly for asymptomatic crews.

Eventration of Right Hemidiaphrgm – A Post Covid -19 Infection Complication

Introduction and Significance: Diaphragmatic eventration is an uncommon disorder marked by partial or complete thinning of the diaphragm's muscle tissue. In this condition, the diaphragm, which is normally flexible and moves downward during inhalation, instead moves upward in a paradoxical manner. This abnormal movement leads to restricted lung function. The condition can be congenital or acquired, with acquired cases often resulting from trauma to the phrenic nerve, either from mechanical or surgical causes, compression by thoracic space-occupying lesions, or various infectious or inflammatory conditions impacting the phrenic nerve. Many individuals with this condition may remain asymptomatic for long periods, leading to frequent underdiagnosis. Clinical suspicion should prompt chest X-rays, and the diagnosis can be confirmed with chest computed tomography (CT).  Case Presentation: We report the case of a 65-year-old male who exhibited right-sided hemi-diaphragmatic eventration and experienced dyspnea over the past two years. The patient underwent a multilayer surgical plication of the right hemidiaphragm, which resulted in a successful outcome.  Clinical Discussion: The choice to proceed with surgical intervention for diaphragmatic eventration is influenced by the severity of associated complications. Patients who are symptomatic and exhibit compromised respiratory, cardiovascular, or gastrointestinal function generally require diaphragmatic plication.  Conclusion: Despite its rarity, diaphragmatic eventration is a condition that warrants careful evaluation by clinicians. Early detection and surgical intervention are key to managing and repairing this condition effectively.

Understanding oral malignancies: 2 case reports

The clinical presentation, diagnosis, and management of several squamous cell carcinoma cases are covered thoroughly. Roughly 94% of all mouth malignancies are squamous cell carcinomas. Race, gender, and age group differences exist in annual incidence and mortality rates. This percentage is 7.7 per 100,000 in the US. Like other carcinomas, intraoral carcinoma is more common in older adults, especially in men. Individuals with oral SCC have often known about an abnormality in that area for four to eight months prior to seeking professional medical attention. Early growth is characterized by little discomfort, which may account for the delay in seeking professional assistance. The clinical manifestations of oral SCC include exophytic, endophytic, leukoplakic, and erythroplakic, all of which exhibit apparent surface alterations.Tobacco usage, excessive alcohol consumption, HPV infection, eating little fruits and vegetables, prolonged sun exposure, and having a compromised immune system are risk factors. Improving outcomes requires early discovery and treatment, which may include chemotherapy, radiation therapy, surgery, or a combination of these. In order to improve the prognosis for oral cancer, early identification and intervention are crucial. Survival risk from squamous cell carcinoma is often low. This article emphasis on the clinical presentation of oral malignancies.

Connective Tissue Graft May Compensate for Residual Bone Defect of the Implant in the Esthetic Zone: A Case Report with 7-year Follow-up

The present case report aimed to demonstrate the case using a connective tissue graft (CTG) to compensate for a residual defect after guided bone regeneration (GBR) in the anterior maxillary area. An extensive number of studies have reported successful outcomes of horizontal bone augmentation, but it was also demonstrated that a complete resolution of the defect may not be achieved in all cases. In the present case report, the patient underwent implant placement simultaneously with GBR at the anterior maxillary area. After 4 months, partial regeneration of the initial defect was observed. To compensate for such residual defect, a CTG was applied. Other expectations by the CTG were to enhance tissue volume and phenotype. The final prosthesis was delivered after 3 months. Up to 7 years, favorable radiographic and clinical situations were observed. In conclusion, a CTG may compensate for residual bone defect of the implant in the esthetic zone.

Endodontic management of distinctive anatomic aberration with maxillary 1 molar -a case report of three mesiobuccal canal on one side and taurodontism on contralateral arch

The present case describes root canal treatment in a maxillary first molar with unusual anatomy of MB3 canal in one arch and Taurodontism on the contralateral arch. Understanding the differences in root canal morphology is crucial to the success of endodontic treatment. Taurodontism in the contralateral maxillary molar is an uncommon condition. A male patient was referred for the treatment of maxillary right and left first molar tooth. Clinical examination of the pulpal floor revealed 3 orifices in the mesio-buccal root in #16 while Taurodontism in #26. The tooth was treated successfully. Anatomic variations must be taken into consideration in clinical and radiographic evaluation during endodontic treatment.

Active Versus Passive Learning in Large-Group Sessions in Medical School: A Randomized Cross-Over Trial Investigating Effects on Learning and the Feeling of Learning

Abstract Purpose The evidence base for active learning in medical education is based largely on trials with suspect internal validity. We empirically compared the learning and feeling of learning of participants when in large-group interactive sessions and passive lectures using a rigorous trial capable of providing an unambiguous assessment of effect. Further, we evaluated if there was a differential effect based on prior achievement. Materials and Method We conducted a two-day randomized cross-over trial with 146 s-year medical students. Passive learning involved lecture-based case presentation with minimal interaction; in the large-group interactive session, students worked in teams on the same cases. Participants completed a test of learning and a feeling of learning survey. Effects were estimated using linear mixed-effects models. Results Participants in the large-group interactive session scored 0.27 standard deviations higher on the test of learning (p = 0.010) than when in the passive lecture. Learners in the lower 50% of prior achievement benefited most from active learning. The feeling of learning was 0.56 standard deviations higher in the large-group interactive session (p < 0.001). Conclusions Transformation of passive lectures to interactive learning sessions is feasible, has the potential to close achievement gaps by benefiting the lowest achieving learners the most, and provides students a greater sense of learning than passive lectures.