A Rare Case of Recurrent Cutaneous Non-Hodgkin's Lymphoma in the Extremity: Long-Term Follow-Up and Review of the Literature Written With the Assistance of ChatGPT.

Cutaneous involvement of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is uncommon. We report on a 71-year-old male with a history of CLL of the skin in the distal extremities. The patient presented with eruptions of new lesions on the toes of his feet bilaterally, causing significant pain that limited his mobility. Cutaneous involvement of CLL is a rare presentation, and management recommendations are largely based on case reports with limited follow-up. Furthermore, assessing the duration of response, response rates, and correct sequencing of treatment is difficult due to variable use and doses of treatment. The case was treated in 2001 when newer systemic treatments were not available. Therefore, the results can also be directly related to local treatments. Based on a literature review and this case, this report provides insight into the benefits and risks of local treatment for cutaneous involvement of CLL in the extremities and how radiation can be sequenced with other options such as surgical excision and chemotherapy.

Acute-on-Chronic Anterolateral Tibiofibular Joint Dislocation in a Child.

Tibiofibular joint injury in children is an uncommon injury. It is usually associated with acute injuries in sports that involve aggressive twisting of the knee, such as soccer and snowboarding. We present a case of a 17-year-old male adolescent who sustained an acute dislocation of the anterolateral tibiofibular joint with routine ambulation, who had a chronic history of subluxation. To our knowledge, this has not been previously reported. The diagnosis requires a high level of awareness and suspicion, and plain radiographs may aid in the diagnosis especially if contralateral comparison views are obtained.

Socialization to professionalism in medical schools: a Canadian experience.

BACKGROUND: Accrediting bodies now recognize the importance of developing the professionalism competency, by setting standards that require medical schools to identify where professionalism is addressed and how it is evaluated within the formal curriculum. The objective of this study was to compare how professionalism competency is formally addressed in the curricula of Canadian medical schools, and to better understand the Canadian approach to reporting and remediation of lapses. METHODS: A literature review was performed and with the input of the AFMC(Association of Faculties of Medicine of Canada) Professionalism group, questionnaires were generated. An electronic survey was circulated to key leaders across the country at all the medical schools. In-depth telephone interviews were used to further explore themes, and a subsequent focus group was held to discuss challenges, particularly related to reporting and remediation. RESULTS: The preponderance of formal professionalism teaching remains in the form of lectures and small group sessions in the preclinical years. Formal teaching declines significantly in the clerkship/clinical years. Evaluation is usually performed by a clinical supervisor, but OSCE, portfolio, and concern notes are increasingly used. Role modeling is heavily relied upon in clinical years, suggesting faculty training can help ensure clinical teachers recognize their influence on trainees. Formal remediation strategies are in place at most schools, and often involve essay writing, reflection exercises, or completion of learning modules about professionalism. Lack of clarity on what defines a lapse and fear of reprisal (for both trainees and faculty) limits reporting. CONCLUSIONS: This study provides an overview of how professional identity formation is supported in the Canadian context, guided by the standards set out by CanMEDS. Despite a rich literature that describes the definition, program design and evaluation methods for professionalism, in some areas of the curriculum there is still an opportunity to ensure programs embrace the suggested framework. Examples of teaching and evaluation methods, deficiencies in the clinical years of study (clerkship) and challenges in addressing lapses and organizational structure are identified. The results help identify the gaps that need to be addressed and some solutions that can be modeled at other academic institutions.

A Severe Case of Recalcitrant Pompholyx.

BACKGROUND: Pompholyx is an inflammatory vesiculobullous skin disease of the hands and feet belonging to the spectrum of eczema. OBJECTIVE: To report a severe case of pompholyx, its clinical presentation, and its management. METHODS: A medical chart review was conducted on a patient with this condition. RESULTS: The patient was patch tested according to the North American Contact Dermatitis Group (NACDG) Standard Screening Series, and results were negative. In the past, she was treated with corticosteroid creams as well as narrow band ultraviolet B (UVB), and Psoralen ultraviolet A (PUVA) therapies, and none were beneficial. When the frequency of the episodes increased, methotrexate was introduced but failed to control the condition. Next, mycophenolate mofetil was started and gradually increased to 3.5 g daily along with a separate trial of radiotherapy with marked success. CONCLUSION: Pompholyx can be challenging to manage, and treatment can involve an assortment of therapies over a prolonged period of time.