Black Salve: A Dangerous Corrosive Disguised as an Alternative Medicine.

Black salve is a dangerous compound that has long been used as an alternative and complementary medicine despite clear warnings of its hazards from the medical community and governmental agencies. A paucity of information exists for clinicians seeking guidance regarding the management of black salve-related adverse outcomes. Secondary infection is a common sequela of black salve application to skin lesions. This case report presents a summary of the management of a secondary infection in a patient who applied black salve to an open skin wound. The resolution of this patient's symptoms was a function of the interdisciplinary care provided by infectious disease specialists, an acute surgical care team, and dermatologists. The patience, clinical expertise, and judgment provided by these healthcare teams resulted in an appropriate diagnosis while also avoiding unnecessary medical procedures. This case sheds light on one of the varied consequences of black salve use and advocates for the incorporation of multiple medical teams in the management of black salve-related events.

Expanding Medical Student Knowledge and Impacting Patient Outcomes Through a Student-Run Clinic: A Case-Based Reflection.

Cryptogenic stroke is a debilitating condition that requires follow-up care and treatment that is appropriate for the underlying etiology. Here, we present the case of a 46-year-old uninsured patient with an undocumented immigration status who presented to our student-run clinic (SRC) for the management of her post-stroke care. She initially presented to an outside hospital with focal neurological deficits, was diagnosed with an acute stroke, and was told to follow up with a primary care provider. The patient established care at the Cooper Medical School of Rowan University's SRC one week following her stroke event. The SRC served as a conduit for access to healthcare services necessary for her recovery and secondary prevention of future strokes which otherwise would have been unattainable due to the patient's socioeconomic constraints. These services and treatments included specialist appointments, anticoagulation medications, physical and speech therapy, labs, placement of an internal heart rhythm monitor, and surgical closure of a patent foramen ovale. All services, medications, and procedures were provided free of charge. One year following her stroke, the patient is living without disability and has had no recurrence of a cerebrovascular ischemic event. This case highlights the dual-purposed value of SRCs in providing both meaningful clinical educational experiences to students and necessary health care to disadvantaged patients.

Intensity-specific considerations for exercise for patients with inflammatory bowel disease.

The rising prevalence of inflammatory bowel disease (IBD) necessitates that patients be given increased access to cost-effective interventions to manage the disease. Exercise is a non-pharmacologic intervention that advantageously affects clinical aspects of IBD, including disease activity, immune competency, inflammation, quality of life, fatigue, and psychological factors. It is well established that exercise performed at low-to-moderate intensity across different modalities manifests many of these diseased-related benefits while also ensuring patient safety. Much less is known about higher-intensity exercise. The aim of this review is to summarize findings on the relationship between strenuous exercise and IBD-related outcomes. In healthy adults, prolonged strenuous exercise may unfavorably alter a variety of gastrointestinal (GI) parameters including permeability, blood flow, motility, and neuro-endocrine changes. These intensity- and gut-specific changes are hypothesized to worsen IBD-related clinical presentations such as diarrhea, GI bleeding, and colonic inflammation. Despite this, there also exists the evidence that higher-intensity exercise may positively influence microbiome as well as alter the inflammatory and immunomodulatory changes seen with IBD. Our findings recognize that safety for IBD patients doing prolonged strenuous exercise is no more compromised than those doing lower-intensity work. Safety with prolonged, strenuous exercise may be achieved with adjustments including adequate hydration, nutrition, drug avoidance, and careful attention to patient history and symptomatology. Future work is needed to better understand this intensity-dependent relationship so that guidelines can be created for IBD patients wishing to participate in high-intensity exercise or sport.