Archives & Special Collections

Many diseases lead to overlapping symptoms, but only one is often referred to as “the great masquerader” and that is syphilis. It is a sexually transmitted disease (STD) that is caused by Treponema pallidum, a gram-negative spirochete1. Syphilis is known to clinically progress in four stages: primary, secondary, latent, and tertiary1. The focus of this case study is secondary syphilis. This stage usually arises two months following a primary infection and presents with systemic symptoms and a disseminated mucocutaneous macular rash which involves the palms and soles1. An uncommon presentation of secondary syphilis is alopecia and is only seen in approximately 4-11% of cases. Syphilitic alopecia is described as “discrete patches of non-scarring alopecia”1. This case will address the need to be vigilant for medical “zebras” in seemingly mundane clinical settings1.

Most literature states that the amount of air needed to achieve an adequate seal in an endotracheal tube cuff during intubation has a range of 5-10 mL. The wide range poses a risk to patients because endotracheal vasculature is only able to withstand a pressure of about 30 cmH2O which should not be exceeded.1 A smaller range and lower upper limit value could help with patient safety and decrease loss of vascularity to the tracheal tissue.

Emergency medicine (EM) residency program directors (PD) play an invaluable role in the supervision, development, education, resident selection, and accreditation of their program. This cross-sectional study aims to evaluate demographic features, academic backgrounds, scholarly achievements, and practice setting, to highlight trends among EM allopathic and osteopathic leadership in the United States, and find potential areas of improvement in PD diversity. This research may also serve as a framework for those aspiring to become EM PDs.

Klebsiella pneumonia, of the Enterobacteriaceae family, is a gram-negative rod bacteria. Often, it is known to inhabit water, sewage, soil and plants. The species is the third leading cause of nosocomial infections and is known to cause opportunistic infections such as pneumonia, bacteremia, and most commonly urinary tract infections. Very rarely, K. pneumonia can cause metastatic infection to the liver known as invasive liver abscess syndrome (ILAS) that can occur with meningitis in Asian populations, which was the case of our patient3. Most K. pneumoniae primary liver abscesses (KLA), especially those associated with metastatic infection, have been reported in Taiwan and are community acquired.³ We present this atypical case of meningitis due to ILAS to enlighten fellow physicians and to raise awareness of this rare condition not typically seen in the US.

Patellofemoral complications have been reported to occur in up to 2% of total knee arthroplasties (TKA)1. Avascular necrosis (AVN) of the patella is a rare complication following a TKA, with a prevalence of just 0.05% to 2%2. Ritter et al found that the risk of AVN following TKA is greatly increased when performed in conjunction with lateral retinacular release, due to interruption of the peripatellar vasculature3. A prospective study looking at the effects of lateral retinacular release on patellar vascularity showed that 56% of postoperative bone scans demonstrated a “cold patella”4. Additional research has underscored the importance of sparing the superolateral geniculate artery during a lateral retinacular release, given that the medial genicular vessels are sacrificed during a TKA5.

Here we discuss acne fulminans and other cutaneous manifestations precipitated by anabolic-androgenic steroids (AAS). We hope that this study can bring light to this issue in the bodybuilding community, while encouraging dermatologists to play a more active role in recognizing and warning of its increased risk amongst bodybuilders.

Hip arthroscopy (HA) with concomitant periacetabular osteotomy (PAO), HA+PAO, has been shown to have favorable outcomes for treatment of hip pathology in the setting of acetabular dysplasia. Mid to long-term studies have shown statistically significant improvement in pain and function following HA+PAO. Clinically important outcome values (CIOVs) have been extensively described for HA alone for the treatment of femoroacetabular impingement syndrome (FAIS), but there is a dearth of literature on HA+PAO1,8.

CIOVs allow for “Interpretability”, or, in other words, a qualitative value associated with a quantitative score. In a clinical practice, this is useful as it gives predictors on postoperative outcomes both preoperatively and at specific timepoints throughout the postoperative course1. Metrics to assess clinical significance including minimally clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) remain sparsely defined for HA+PAO.

Gender identity and biological sex are important and distinct variables in dermatology research. However, these are often conflated or poorly demarcated, which threatens the validity of study results. Our analysis aims to illuminate the need for a robust consensus regarding assessments of gender identity and biological sex in dermatology research that does justice to the complexity and significance of this distinction.

Sunscreen is a simple, well-known medium for reducing photoaging, preventing sunburn, and reducing the risk of skin cancer.1 Portable sunscreen dispensers, which are similar to soap and hand sanitizer dispensers, have the potential to greatly benefit the public health and to augment skin cancer efforts by increasing the accessibility of sunscreen prevention. The COVID-19 pandemic triggered a significant decrease in the use of free sunscreen dispensers, in both public and private sector enterprises, including healthcare, recreation, and parks.2,3 In the 2018- 19 academic year, the University of Colorado Anschutz Medical Campus partnered with DEFEATMelanoma (defeatmelanoma.org) and the Richard David Kann (RDK) Melanoma Foundation to provide six free sunscreen dispensers around the Medical Campus.4 During the pandemic, there was a considerable decrease in use of these dispensers at the Anschutz Medical Campus – notably, this represents a similar plummet to that described by Eason, et al.2 and Szeto, et al.3 Supply chain disruptions secondary to the pandemic greatly affected the availability of numerous commodities across the country,5 one of these being sunscreen dispensers. Therefore, we undertook an investigation to ascertain the range of sunscreen dispensers currently available on the market.

At Rocky Vista University College of Osteopathic Medicine (RVUCOM), there is no traditional course in the didactic curriculum that teaches gowning and gloving. The Association of Women Surgeons Club conducted a hands-on event for pre-clinical, RVUCOM students including training in gowning and gloving, followed by a surgical simulation. Research has shown individual gown and gloving courses (i.e. gowning, gloving, water based scrubbing, waterless scrubbing, scrubbing out) has been beneficial for improving first and second year medical student’s confidence prior to entering a surgical rotation during clinical years.1 Training for these procedures has been demonstrated to improve student's self-efficacy and reduce their anxiety about entering an OR setting.2 There is limited research investigating how effective a glove and gowning training is in conjunction with a surgical simulation. This research consisted of a pre- and post-training survey, used to evaluate student's confidence in gowning and gloving procedures, hand washing protocols, and understanding of operating room (OR) etiquette/regulations. These results will provide beneficial insight into determining whether this combined training would be valuable to students early on during didactics prior to surgical rotations in making them more confident in their surgical preparatory skills.

The United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Exam (COMLEX) Level 1 transitioned from numeric scoring to Pass/Fail (P/F) designation in January 2022. This transition intended to decrease stress and improve medical student wellbeing, as well as encourage residency programs to emphasize other aspects of residents' applications.

Correlating prehospital measurements of ketones, glucose, hemoglobin, creatinine and lactate to the severity of head injury to initiate additional testing and needed interventions by medical teams sooner, thereby increasing survivability of TBI patients.

Coronavirus disease (COVID-19) is a highly infectious virus that typically causes mild to moderate respiratory symptoms. Most patients do not require medical treatment and make a full recovery within 1-2 weeks. Some patients do become seriously ill and require hospitalization, patients with underlying medical conditions such as cardiovascular disease, diabetes, and chronic respiratory disease are more susceptible to severe COVID-19 infections. Eureka is a small, remote city of Northern California surrounded by sparsely populated, broad expanses of forest.1 It lies within Humboldt County and is relatively isolated from major population centers by the Pacific coast to the west, and by rugged mountains to the north, south, and east.

Eureka is one of Humboldt’s handful of small population centers, which are mainly located along the U.S. Highway 101 that generally runs north-south along the Pacific coastline.1 Apart from Redding, CA about 150 miles to the east and across the mountains, the nearest major metropolitan areas are at least 4-5 hours and 275 miles away, including San Francisco and Sacramento, CA to the south, and Eugene and Portland, OR to the north. According to the US Census Bureau the average yearly household income in Eureka is $64,207 vs. San Francisco which is $181,909.2

We hypothesize that due to its geographic and economic isolation, Eureka presents a unique opportunity to study the impact of the COVID-19 pandemic on rural communities in comparison to major metropolitan areas in the United States.

Medication adherence among Hispanic patients in the United States is poor compared to non Hispanic whites¹
• Nonadherence is detrimental to healthcare outcomes and expensive, costing $100B --$289B annually²

• The World Health Organization (WHO) has
grouped medication adherence into five categories³ (Figure 2)

•Socioeconomic, Patient --*, Condition --, Therapy - and Health System Specific Risk Factors

• *Medication concordance (perceived vs. actual
understanding) not extensively explored in low income,
Hispanic patients

Concussion research has recently become a popular topic regarding sports teams and chronic head impact. Many studies have been done regarding neck muscles and their effect on head trauma. Hides3 found in their study that there is a link between motor control of trunk muscles and head/neck injury. Their focus was specifically on the multifidus whereas we want to investigate the muscles anterior to the spine. We know that isolated and integrated ‘Core Stability” has an effect on athletic performance measures6. They found that targeted core stability training provides benefits to athletic performance but there is a lack of standardization for measurement and outcomes to determine the relationship. They recommend further research targeted to determine the relationship. The
abdominal muscles have been studied during core physical fitness exercises5. They found that the rectus abdominis and external oblique had the greatest activity with free weights and bridge exercises when looked at through an EMG. The Sarhmann test involves the athlete holding a bridge. Through this systematic review along with the standardization of the Sahrmann test, we know that we will be directly targeting the core muscles. We believe that the current literature has given us reason to believe that a stronger set of core muscles will not only help the athlete compete at a higher level biomechanically but also protect them from head trauma from contact. In addition, throughout our osteopathic education, we have learned about fascial
planes, and the body biomechanics of tensegrity.

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare condition characterized by a severe sudden onset headache coupled with a narrowing of cerebral vasculature. Due to its infrequency, diagnosis and treatment of RCVS can be challenging. It is often confused with other conditions such as subarachnoid hemorrhage, cerebral aneurysm, or primary thunderclap headaches.

In the primary care setting, one of the most common questions and issues patients present with is how to lose weight and optimize their nutrition and lifestyle strategies. While lifestyle modifications are always the first recommendation to address weight loss and metabolic health, there is little guidance provided as to which specific modifications will have the most powerful effect. Unfortunately, there are limited studies on the various diets/interventions that are marketed today and their effects on metabolic disease. The Sapien diet consists of high protein intake, low carbohydrate consumption, and a focus on healthy fat consumption. While this concept is debatable, our hypothesis is that a whole food-based low carbohydrate diet that integrates intermittent fasting strategies will produce an improvement in patients’ metabolic markers, weight, and ultimately chronic disease management. A retrospective observational study was conducted using outpatient data from 2017 to 2022 at Evolve Healthcare. The data analysis revealed a significant decrease in BMI, triglycerides (TGL), and TGL/HDL ratio from baseline to 18 months. Through our work, we learned that nutritional research is difficult to conduct due to the overwhelming number of confounding variables and the difficulty in assuring compliance. As a result, most nutrition research is observational
in nature and there is much disagreement in the scientific community about the most optimal approach to nutrition and lifestyle.

Social media is now a popular method of delivering healthcare information to the masses; dermatology has successfully invaded social media, with countless Instagram pages, TikTok videos, “med-fluencers,” and YouTube channels dedicated to improving skin health. Dermatologic surgery has been integrated into social media from popular accounts like Dr. Pimple Popper to smaller accounts reflecting academic institutions. Of such, the American College of Mohs Surgery (ACMS), an organization that includes more than 1,700 fellowship-trained surgeons, has an Instagram page with over two thousand followers. Mohs Micrographic Surgery (MMS) is an innovation in the field and transformed the treatment of basal cell (BCC) and squamous cell (SCC) carcinoma over the last century. While accounts like these are useful for students and clinicians in the field, it is important that we remain critical of the content they post, specifically regarding the representation of skin of color (SoC) on these platforms, or lack thereof.

Underrepresentation of Skin of Color (SoC) in academic resources, such as case reports, may curtail diagnostic training and exacerbate health disparities given an increasingly diverse United States population.1 Additionally, race/ethnicity reporting can be detrimental via the implicit promotion of a social construct unrelated to actual biological differences or genetic ancestry.2 Since case reports are important resources for research and clinical practice, we therefore sought to examine SoC representation and race/ethnicity reporting in all case photos published by the highly read and influential Journal of the American Academy of Dermatology (JAAD) Case Reports journal from 2015 through 2021.

Plasma cell neoplasms are characterized by the neo-proliferation of a single clone of plasma cells. They can present as a single lesion (solitary plasmacytoma) or as multiple lesions (multiple myeloma). Solitary plasmacytomas fall into two categories depending on their location. They are most frequently found in the bone marrow (medullary plasmacytoma), but can also be found in soft tissue (extramedullary plasmacytoma).1

•Solitary extramedullary plasmacytoma (SEP) accounts for
approximately 3% of all plasma cell malignancies. Of these, 45-80% occur in the upper respiratory tract, as in this case.2 Diagnostic criteria for SEP include: a biopsy-proven extramedullary tumor with evidence of clonal plasma cells, a 18F-FDG PET/CT with no visible lytic lesions, a bone marrow aspirate and biopsy with no evidence of clonal plasma cells, and no evidence of anemia, hypercalcemia, or renal insufficiency that could be attributed to a clonal plasma cell proliferative disorder.3

Aspirin (ASA), which is used primarily for its anti inflammatory and anti thrombotic properties, has been found in numerous in vitro and in vivo studies to stimulate bone growth. These observations provide a solid scientific premise for our hypothesis that extended release of ASA from a synthetic bone graft void filling putty (BVFP) can prevent coagulation while simultaneously stimulating skeletal progenitor cells and mesenchymal endothelial cells to promote regeneration of bony defects. To investigate this hypothesis, an FDA approved, coralline, hybrid bone graft material ( ProOsteon 500R from Biomet) was combined with a cocktail of medically relevant polymers ( polycaptrolactone (PCL), polyethylene glycol (PEG), and polylactic glycolic acid (PLGA)) to fabricate a bone void filling putty capable of releasing ASA over several weeks. This approach will provide the groundwork for future studies applying this model for bone regeneration and could have a significant clinical impact in orthopedic surgery.