Variability in procedure volume of physical medicine and rehabilitation residents graduating from 2014 to 2021.

BACKGROUND: Adequate exposure to commonly performed procedures during physical medicine and rehabilitation (PM&R) residency is an important issue. OBJECTIVE: To assess temporal trends and variabilities in reported procedural volumes, including the number of residents achieving procedure minimum requirements as established by the Accredited Council for Graduate Medical Education (ACGME) PM&R Residency Review Committee. DESIGN: This was a retrospective cohort study of PM&R residents graduating from 2013-2014 to 2020-2021. Descriptive statistics were calculated for tracked procedures and compared over time with analysis of variance (ANOVA) tests. Variability was calculated as the procedure volume difference between the 90th and 10th percentile groups. SETTING: ACGME-accredited PM&R residency training programs. PARTICIPANTS: A total of 3231 PM&R residents graduating from 2014 to 2021. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reported procedure volume and number of residents achieving minimum requirements. RESULTS: Total procedure volume increased over the study period (436 ± 225 to 523 ± 238, p = .013). The percentage of all procedures that were performed versus observed was stable over the study period (81%-77%, p = .234). Variability in total reported procedure volume remained stable over the study period. The percentage of PM&R residents not achieving minimum requirements ranged from 2% for peripheral joint injections to 22% for ultrasound in the contemporary training period. CONCLUSIONS: The volume of reported procedures has increased along with the number of PM&R residency programs and residents. Variabilities in total reported procedure volume were stable over time, but PM&R residents struggle to obtain minimum requirements for ultrasound procedures.

Myasthenia gravis presenting like guillain-barré syndrome.

Myasthenia gravis (MG) is an autoimmune disorder characterized by weakness in specific muscle groups, especially the ocular and bulbar muscles. Guillain-Barré syndrome (GBS) presents with ascending paralysis and areflexia, often secondary to an infection. Several theories have been proposed regarding the etiology behind GBS, with many studies pointing to a possible autoimmune cause. If this is in fact true, it is also possible that the two diseases may develop concurrently. While this is unusual, several recently published studies highlight such cases of concurrent MG and GBS. This co-occurrence could involve certain common proteins, as the two diseases can present somewhat similarly. This is an unusual case of a patient with no significant past medical history, presenting with generalized weakness and symptoms of new-onset diabetes, who developed bilateral ptosis, distal weakness, and areflexia while in the hospital, raising the possibility of concurrent MG and GBS. Although the diagnosis of MG was confirmed by the positive anticholinesterase antibodies and tensilon test, several features, including sudden onset of ascending paralysis and areflexia, were more common in GBS than MG. It is possible, albeit rare, that these two syndromes could have developed concurrently and that the untreated diabetes mellitus could have contributed to the neurological symptoms. This case is reported because of the rarity of its features, diagnostic and management challenges.

Myasthenia gravis: a review.

Acquired myasthenia gravis is a relatively uncommon disorder, with prevalence rates that have increased to about 20 per 100,000 in the US population. This autoimmune disease is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. In about two-thirds of the patients, the involvement of extrinsic ocular muscle presents as the initial symptom, usually progressing to involve other bulbar muscles and limb musculature, resulting in generalized myasthenia gravis. Although the cause of the disorder is unknown, the role of circulating antibodies directed against the nicotinic acetylcholine receptor in its pathogenesis is well established. As this disorder is highly treatable, prompt recognition is crucial. During the past decade, significant progress has been made in our understanding of the disease, leading to new treatment modalities and a significant reduction in morbidity and mortality.

Rare association of thymoma, myasthenia gravis and sarcoidosis : a case report.

INTRODUCTION: The association of thymoma with myasthenia gravis (MG) is well known. Thymoma with sarcoidosis however, is very rare. We presented an interesting case with coexisting thymoma, MG and sarcoidosis. CASE PRESENTATION: A 59-year-old female patient with a history of sarcoidosis was admitted to the hospital with a one-day history of sudden onset of right-sided partial ptosis and diplopia. Neurosarcoidosis with cranial nerve involvement was considered, but was ruled out by the clinical findings, and MG was confirmed by the positive tensilon test, electrophysiological findings and positive acetylcholine receptor binding antibodies. On further evaluation, a CT chest scan showed a left anterior mediastinal mass and bilateral lymphadenopathy. Post surgical diagnosis confirmed the thymoma and sarcoidosis in the lymph nodes. CONCLUSION: When two or more diseases of undetermined origin are found together, several interesting questions are raised. It is important to first confirm the diagnoses individually. Immunologic mechanisms triggering the occurrence of these diagnoses together, are difficult to address. Although the coexistence of thymoma, MG and sarcoidosis may be coincidental, it is noteworthy to report this case because of the multiple interesting features observed as well as the rarity of occurrence.