Case Report with Systematic Literature Review on Vascular Complications of BCG Intravesical Therapy for Bladder Cancer.

(1) Background: Intravesical instillation of therapeutic Bacillus Calmette-Guerin (BCG) is the standard of treatment for non-muscular invasive bladder cancer. Although the exact immunomodulatory effects of BCG therapy in non-muscular invasive bladder cancer (NMIBC) are still unclear, it has been considered a safe and effective treatment with the largest to-date report of complications citing minimal side effects, none of which included arterial involvement; (2) Methods: A systematic literature review was performed using PubMed, Cochrane, Medline, and Google Scholar from database inception to March 2021. Only eligible studies reporting aneurysm formation in adult patients with a history of BCG immunotherapy and no previous vascular pathology were included; (3) Results: A systematic literature review was conducted, highlighting 17 reports suggestive of BCG-induced mycotic aneurysm development. We added a case of a 78-year-old male, 30 months after last BCG-instillation, with a mycotic abdominal aneurysm yielding Mycobacterium tuberculosis with pyrazinamide resistance culture.; (4) Conclusions: Concluding results suggest a higher incidence of vascular complications from BCG intravesical therapy in the treatment of non-muscular invasive bladder cancer than previously reported. Recommendations are made to emphasize further research of this immunotherapy complication to facilitate the creation of guidelines for diagnosis and management of these patients.

An emergency medicine based model for community-engaged learning.

Community-engaged learning (CEL) integrates community service with structured learning to strengthen the knowledge and skills of future physicians while still in medical school. A national model forCEL during medical school does not currently exist. Emergency physicians have the opportunity to play a vital role in medical student education using CEL as a platform. This article elucidates the structure of a bystander cardiopulmonary resuscitation (B-CPR) CEL program developed by emergency physicians that could serve as a national model for community engagement. As B-CPR is a well-known evidence-based community intervention that can be taught by students and implemented by the community, it represents an ideal CEL that can also have a measurable impact on local B-CPR rates. The development and structure of a B-CPR CEL program, lessons learned, and impact on B-CPR in a local area are reported.

Current Insights in Whipple's Disease.

Therapy for Whipple's disease should be continued for a minimum of 1 year, and the regimen should include an agent or agents that achieve acceptable concentrations in the central nervous system, given the likelihood of recurrence at this site. Clinical follow-up of proven cases of Whipple's disease should be conducted for a minimum of 10 years after discontinuation of therapy, given the potential for late relapses. Polymerase chain reaction analysis is preferred rather than endoscopy when evaluating for disease recurrence.