A case of hepatic and bone marrow sarcoidosis with progressive renal failure: diagnostic and therapeutic challenges.

Sarcoidosis is a systemic granulomatous disease, sometimes characterized by an extrapulmonary localization in 30 - 50% of cases. We describe a 60-year-old Italian man with an unexplained history of fatigue, ascitis and progressive renal function impairment. Diagnosis of hepatic and bone marrow sarcoidosis was established by histology, and fast improvement of renal function was obtained after starting  corticosteroid therapy. Atypical presentation and simultaneous involvement of liver, bone marrow and kidneys make diagnosis of extrapulmonary sarcoidosis still a diagnostic challenge. Delayed diagnosis could lead to serious organ damage like a progressive severe kidney failure.

The serious threat of late presenters HIV-infected patients in the context of the COVID-19 pandemic.

The impact of current SARS-CoV-2 pandemic on the healthcare services had serious consequences, especially for the most fragile populations such as HIV-positive subjects. In the period April to September 2020 we reported four cases of HIV-infected late presenters with an AIDS-defining life-threatening condition that, due to the difficult access to the hospital during the pandemic, were characterized by a delayed HIV recognition and institution of correct treatment. Even after two decades of highly active antiretroviral therapy late presenters HIV-infected patients still represent a serious clinical challenge.

The first Italian case report of leg ulcer and sepsis caused by Shewanella algae in a immunocompetent patient.

We describe the first Italian case of Shewanella algae septicemia in an immunocompetent patient with chronic leg ulcers. The patient had been exposed to seawater before the onset of symptoms. Despite the absence of severe underlying diseases, the primary soft tissue infection of the leg was complicated by hematogenous dissemination.

Social Media: Changing the Paradigm for Surgical Education.

The role of social media (SoMe) in surgical education is emerging as a tool that augments and complements traditional learning. As SoMe usage has steadily increased in our personal and professional lives, it is no surprise that it has permeated into surgical education. Different SoMe sites offer distinct platforms from which knowledge can be transmitted, while catering to various learning styles. The purpose of this review is to outline the various SoMe platforms and their use in surgical education. Moreover, it will discuss their effectiveness in teaching and learning surgical knowledge and skills as well as other potential roles SoMe has to offer to improve surgical education.

Non-AIDS definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era.

Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has been widely available in industrialized countries since 1996; its widespread use determined a dramatic decline in acquired immunodeficiency syndrome (AIDS)-related mortality, and consequently, a significant decrease of AIDS-defining cancers. However the increased mean age of HIV-infected patients, prolonged exposure to environmental and lifestyle cancer risk factors, and coinfection with oncogenic viruses contributed to the emergence of other malignancies that are considered non-AIDS-defining cancers (NADCs) as a relevant fraction of morbidity and mortality among HIV-infected people twenty years after HAART introduction. The role of immunosuppression in the pathogenesis of NADCs is not well defined, and future researches should investigate the etiology of NADCs. In the last years there is a growing evidence that intensive chemotherapy regimens and radiotherapy could be safely administrated to HIV-positive patients while continuing HAART. This requires a multidisciplinary approach and a close co-operation of oncologists and HIV-physicians in order to best manage compliance of patients to treatment and to face drug-related side effects. Here we review the main epidemiological features, risk factors and clinical behavior of the more common NADCs, such as lung cancer, hepatocellular carcinoma, colorectal cancer and anal cancer, Hodgkin's lymphoma and some cutaneous malignancies, focusing also on the current therapeutic approaches and preventive screening strategies.

You have a message! Social networking as a motivator for FLS training.

OBJECTIVES: Despite evidence supporting the value of the Fundamentals of Laparoscopic Surgery (FLS) curriculum, surgical educators still find it challenging to motivate residents to practice. Wiggio is an online networking and collaboration tool that allows learners to track performance, see what their peers are doing, and send and receive updates. The purpose of this study was to assess whether using Wiggio increases practice and improves performance of the FLS manual skills. DESIGN: After baseline FLS testing, residents were randomized into control (C) and Wiggio (W) groups. The practice events, time spent practicing, and best scores were recorded. Residents in the W group interacted with each other via the Wiggio website. The website moderator sent motivational messages, calendar reminders, and FLS-related articles. The best times and progress graphs for each resident were also posted online. After 4 weeks, all residents underwent final FLS testing and filled out a questionnaire. SETTING: The study was performed in a tertiary care center, at the Steinberg-Bernstein Centre for Minimally Invasive Surgery at the Montreal General Hospital. PARTICIPANTS: Postgraduate year-1 and postgraduate year-2 general surgery residents with no or minimal FLS simulator experience were included. RESULTS: Of the 15 eligible residents, 14 participated, with 7 residents in each group. The FLS scores were similar at baseline (C = 56.9 [±14.2], W = 57. 6 [±14.7]; p = 0.93). During the study period, twice as many residents in the W group practiced compared with those in the C group (4 vs 2); W-group residents reported more practice events than the C-group residents did (14 vs 4) and spent more time practicing in the laboratory (1035 vs 480 minutes). These results did not reach statistical significance. During practice sessions, proficiency scores were achieved for 40% of the tasks in the W group compared with 8.6% in the C group; however, this difference was also not significant. There was no difference in the FLS scores in both groups at the end of the study. The moderator spent an average of 6.5 minutes per day sending messages and managing the Wiggio website. CONCLUSIONS: Participation in Wiggio seems to increase practice events and time spent training on FLS. Social networking may play a role in surgical education and learner motivation; however, the optimal use of Web 2.0 tools in resident education is not yet fully understood.

The effects of acute aerobic exercise on the acquisition and retention of laparoscopic skills.

INTRODUCTION: Exercise is beneficial to learning. The purpose of this research was to determine whether an episode of aerobic exercise prior to practice improves the acquisition and retention of laparoscopic skills in the fundamentals of laparoscopic surgery (FLS) simulator. METHODS: Baseline maximal physical fitness (VO2 max), performance on peg transfer (PT), pattern cut (PC), and intracorporeal suture (ICS) were measured for FLS naïve undergraduates. 2 Weeks later, participants were randomized into exercise (E) and control (C) groups. C did unrelated work for 40 min and then practiced PT and PC for 10 min, and ICS for 15 min. Final scores were recorded. In E, participants ran on a treadmill for 20 min at 60 % of their VO2 max. After a 15 min cool down, they engaged in identical FLS simulator training as group C. Both groups completed the NASA task load index (TLX) to assess workload. Retention was recorded 2 months after the training session. Groups were compared using t tests, χ(2) and Wilcoxon rank tests. p < 0.05 was considered significant. RESULTS: There were 52 participants (22 in C; 30 in E) with high physical fitness at baseline. Demographics between the groups were similar at baseline. There were no differences in VO2 max and scores on the three tasks at baseline (all p values NS). There was no statistical significance between the scores of the C and E groups at the training session and retention, except for higher PT scores in the E group after the training session. CONCLUSION: In physically fit, surgically naïve students, one bout of aerobic exercise enhanced immediate learning of simple FLS skills but did not have an impact on more complex skills or on retention. The use of exercise in the surgical curriculum, or as a learning tool, warrants further investigation regarding how best to apply it.

Small bowel adenocarcinoma and Crohn's disease: any further ahead than 50 years ago?

This review of the literature on small bowel carcinoma associated with Crohn's disease specifically addresses the incidence, risk factors, and protective factors which have been identified. It also reviews the clinical presentation, the current modalities of diagnosis, the pathology, treatment, and surveillance. Finally, the prognosis and future direction are addressed. Our experience with small bowel adenocarcinoma in Crohn's disease is reported. Readers will be provided with a better understanding of this rare and often poorly recognized complication of Crohn's disease.

Yoga therapy for breast cancer patients: a prospective cohort study.

We sought to study the impact of yoga therapy on anxiety, depression and physical health in breast cancer patients. Stage I-III post-operative breast cancer patients were recruited with twelve 1-h weekly yoga sessions completed with an experienced yoga instructor. Before and after each module completion, assessments were obtained with the Hospital Anxiety and Depression scale (HADS), the Dallas pain scale and shoulder flexibility measurements. Fourteen patients completed the entire yoga session with 42.8% having a total mastectomy and 15.4% having breast reconstruction. Both right and left shoulder abduction flexibility significantly improved (p = 0.004; p = 0.015 respectively) as well as left shoulder flexion (p = 0.046). An improvement trend in scores for the HADS and Dallas questionnaires pre- and post-intervention was found, although it was not statistically significant. Our data indicates an improvement in physical function in addition to a consistent amelioration in anxiety, depression and pain symptoms after a yoga intervention.

Assessing clinical judgment using the Script Concordance test: the importance of using specialty-specific experts to develop the scoring key.

BACKGROUND: The Script Concordance test (SCT) assesses clinical judgment. The purpose of this study was to determine whether a specialty-specific scoring key improves the validity of the SCT. METHODS: Thirty experts from 6 general surgery disciplines answered questions pertaining to their area of expertise. We created a scoring key of 5 amalgamated expert panel members. The answers of 227 general surgery residents were analyzed. RESULTS: The optimized test had a reliability level (Cronbach α) of .81. Scores increased progressively throughout all levels of training, with R5s scoring higher than R4s (R1, 42.7 ± 7.1; R2, 47.6 ± 7.5; R3, 48.7 ± 6.7; R4, 49.8 ± 7.7; R5, 52.9 ± 9.3). The average score of juniors (R1s + R2s, 45.1 ± 7.6) was significantly lower (P < .001) than seniors (R3s + R4s + R5s, 50.4 ± 8.0). CONCLUSIONS: We showed that specialty-specific experts must be used to develop the scoring key. This has important implications in the application of the SCT on a wider level.