Subacute Combined Degeneration of the Spinal Cord: A Consequence of Recreational Nitrous Oxide Use.

A 21-year-old female presented to the hospital with worsening bilateral lower extremity weakness and sensory changes in the distal extremities following chronic nitrous oxide (N2O) abuse. Laboratory and radiographic results were suggestive of subacute combined degeneration of the upper cervical and thoracic spinal cord in the setting of a normal vitamin B12 level of 374 pg/mL with an elevation in methylmalonic acid to 1.14 mcmol/L. She was diagnosed with a relative B12 deficiency and treated with supplemental vitamin B12, resulting in an improvement in symptoms. This case highlights the importance of considering relative vitamin B12 deficiency as a diagnosis in the setting of nitrous oxide use, regardless of measured vitamin B12 level.

Neoadjuvant Immunotherapy in the Treatment of Renal Cell Carcinoma: A Case Series.

Renal cell carcinoma is a type of urologic cancer that has a poor prognosis, with the majority of these being clear cell renal carcinoma. This subset has a tendency to cause disruptions in the cell cycle, making immune checkpoint inhibitors for adjuvant treatment of renal cell carcinoma the predominant pharmacological approach. Despite this, the use of immune checkpoint inhibitors in this setting is still an area of much research. In the following three different cases, we demonstrate the role and benefit of treatment with neoadjuvant immune checkpoint inhibitors in patients that have an extensive tumor burden at diagnosis, making them ineligible for operative treatment. Our hope is that these cases serve as a foreshadowing of the potential neoadjuvant treatments have in this oncological setting.

E-cigarette or Vaping Product Use Associated Lung Injury Among Three Young Adults: A Retrospective Case Series From Delaware.

BACKGROUND: E-cigarette or vaping associated lung injury (EVALI) is a lung disease associated with an inflammatory response to the vaping fluid. Currently, diagnosis remains elusive without definitive biomarkers. CASE PRESENTATION: Herein, we describe three cases of EVALI among 18- to 21-year-old patients ranging from mild to severe. All cases presented with a combination of respiratory, gastrointestinal, and constitutional symptoms. Oxygen support and level of medical care varied based on disease severity. Bilateral pulmonary opacities were observed on chest imaging in each case. Additionally, each case had markedly elevated inflammatory markers, specifically C-reactive protein (CRP). None of these patients improved with intravenous (IV) antibiotics and all required IV corticosteroid therapy to achieve clinical improvement. CONCLUSION: EVALI should be suspected among young, otherwise healthy patients who present with new-onset hypoxia, non-specific gastrointestinal symptoms, and endorse a history of vaping. Though considered a diagnosis of exclusion, diagnosing EVALI requires thorough history taking. Inflammatory studies, CRP, and erythrocyte sedimentation rate (ESR) should be considered adjunctive biomarkers to aid clinicians when the diagnosis remains unclear. Corticosteroids are the mainstay of treatment and patients should have close follow-up whether or not they require hospitalization.

Implementing a medical student interpreter training program as a strategy to developing humanism.

BACKGROUND: Humanistic care in medicine has shown to improve healthcare outcomes. Language barriers are a significant obstacle to humanistic care, and trained medical interpreters have demonstrated to effectively bridge the gap for the vulnerable limited English proficiency (LEP) patient population. One way in which medical schools can train more humanistic physicians and provide language access is through the implementation of programs to train bilingual medical students as medical interpreters. The purpose of this prospective study was to evaluate whether such training had an impact on bilingual medical student's interpretation skills and humanistic traits. METHODS: Between 2015 and 2017, whole-day (~ 8 h) workshops on medical interpretation were offered periodically to 80 bilingual medical students at the Penn State College of Medicine. Students completed a series of questionnaires before and after the training that assessed the program's effectiveness and its overall impact on interpretation skills and humanistic traits. Students also had the opportunity to become certified medical interpreters. RESULTS: The 80 student participants were first- to third- year medical students representing 21 languages. Following training, most students felt more confident interpreting (98%) and more empathetic towards LEP patients (87.5%). Students' scores in the multiple-choice questions about medical interpretation/role of the interpreter were also significantly improved (Chi-Square test, p < 0.05). All students who decided to take the exam were able to successfully become certified interpreters. Ninety-two percent of participants reported they would recommend the program and would be willing to serve as a future "coaches" for interpreter training workshops delivered to peer students. CONCLUSIONS: Our program was successful in increasing self-reported measures of empathy and humanism in medical students. Our data suggests that implementation of medical interpreter training programs can be a successful strategy to develop of humanism in medical students, and aid in the development of sustainable language access for LEP patients.