Case Report: Idiopathic Subcutaneous Thrombotic Vasculopathy.

Lower extremity ulcers have significant morbidity, with treatment determined by the underlying disorder. Reported is a 32-year-old female presenting with small skin nodules and bruises across her legs 4 weeks following her second COVID vaccination. These lesions progressed into large, necrotic ulcers over several months. Initial work-up showed widespread pannicular thrombotic vasculopathy with ischemic skin necrosis. The tissue was negative for calcification on Von Kossa histochemistry, and a working diagnosis of subcutaneous thrombotic vasculopathy was suggested. The ulcers progressed despite treatments with corticosteroids, therapeutic anticoagulation, intravenous immunoglobulin, plasmapheresis, sodium thiosulfate, wound care, and repeat debridement. Later debridement specimens demonstrated rare vascular and pannicular calcifications. This finding supports the hypothesis that subcutaneous thrombotic vasculopathy is a precursor to calciphylaxis, the patient's current working diagnosis. However, based on the patient's entire clinical picture, a definitive diagnosis has yet to be found. This report highlights the challenges of working with rare diseases and the importance of multidisciplinary cooperation.

Is a Video Worth a Thousand Words? Educating Preclinical Medical Students on Sterile Scrubbing, Gowning, and Gloving Virtually and In-Person.

INTRODUCTION: Programs that offer early exposure to surgery for medical students foster interest in and positive perceptions of surgery. The COVID-19 pandemic led to suspension of these activities at our institution, the University of Kansas School of Medicine. In response to the lack of virtual alternatives, a pilot virtual surgery enrichment program was implemented for first-year students in place of in-person surgical exposure. The aim of this study was to compare the efficacy of in-person and virtual-based surgical education programs to expose preclinical medical students about the surgical realm of medicine. METHODS: First-year medical students participated in either a virtual (Group A) or in-person (Group B) week-long surgical enrichment program. Group assignments were dictated by COVID restrictions on each of our three medical school campuses: Salina, Wichita, and Kansas City. Pre- and post-surveys with a 14-question multiple-choice assessment of surgical knowledge were distributed to participants. Paired Wilcoxon Signed Rank tests and Mann-Whitney-U tests were used for statistical analysis. RESULTS: There were 14 participants in Group A and 7 participants in Group B. Both groups improved significantly from pre- to post-assessment score. (Group A, p = 0.01; Group B, p = 0.04). There was no difference between groups in the magnitude of score improvement from pre- to post-assessment (p = 0.59). CONCLUSIONS: This pilot program demonstrated that virtual platforms can be a method to provide meaningful clinical experiences in surgery to preclinical medical students restricted from clinical activities. Further development of mentorship in virtual surgical programs and assessment of subjective experience is needed.