搜索结果：South Dakota medicine : the journal of the South Dakota State Medical Association

Q fever is a reportable, zoonotic infection caused by Coxiella burnetii. It can present as either an acute or chronic infection. Acute Q fever is frequently asymptomatic or presents with nonspecific symptoms, making the diagnosis challenging. In the chronic state it will manifest as localized infection such as endocarditis, which is the most common. South Dakota has the highest incidence of Q fever in the U.S. with 12.4 cases per million people. We present a case of a patient in their 50s with mild hepatitis and persistent fevers and eventually was diagnosed with Q fever. The patient had no known exposures. The Q fever was diagnosed using Karius testing, liver biopsy, and serology. The patient was treated with doxycycline and improved. This case highlights diagnostic challenges and management considerations for South Dakota clinicians.

A man experiencing homelessness presented to the emergency department with extensive involvement of ulcerative lesions. On examination, the lesions were painful, numerous, crusted, and deeply ulcerated. At first the diagnosis was thought to be cellulitis but was later confirmed after an infectious disease consult to be Group A Streptococcus ecthyma. Ecthyma is a deep-seated skin infection commonly referred to as "deep impetigo". While the diagnosis of ecthyma was straightforward, the encounter prompted reflection of the unique role dermatology plays in revealing the intersection between disease and circumstance. Skin disease is uniquely visible. Unlike many internal illnesses, dermatologic conditions are displayed on the body's surface where biological processes and social realities often converge. In patients experiencing housing instability, crowded living conditions, limited access to hygiene facilities, wound care, and consistent medical follow-up can allow minor trauma or superficial infection to progress into more extensive disease. In this case, the patient's lesions were not simply the result of bacterial invasion but also a reflection of structural vulnerability. Research has shown that patients experiencing homelessness are at a significantly higher risk of ecthyma. For clinicians, dermatologic examination requires more than pattern recognition. It invites attention to the broader narrative on the skin. Lesions become more than diagnostic clues; they are markers of lived experience and structural vulnerability. While antibiotic therapy addressed the immediate infection, the encounter underscored how social context can shape the presentation and severity of dermatologic disease. This experience highlights the importance of approaching dermatologic findings with both clinical precision and humanistic awareness. Recognizing the stories skin can tell may deepen clinicians' understanding of their patients and the social conditions that influence health. Furthermore, it invites clinicians not only to treat dermatologic disease but also to advocate for greater health equity and address the structural conditions that influence skin health.

Medical students nationwide suffer from increasing costs associated with tuition, supplemental learning resources, and costs of living. National reports show an average graduating debt burden of $234,597, excluding undergraduate loans. Fiscal year 2026 interest rates will increase debts of $125,000 or more by at least five figures annually. Legislation and accreditation measures offer little guidance for schools to develop financial wellness curriculum. Interpretive ambiguity exists between the lines, and students absorb the impact from the execution of these guidelines. USD IRB exemption was obtained. Surveys were developed with input from an interdisciplinary team of advisors from Sanford School of Medicine and Beacom School of Business. Likert scale responses and qualitative feedback were analyzed to assess student attitudes stratified by Pillars. Initial data yielded an 18% response rate with respondents representing all years of training, with a majority from the clinical phase. Early analysis revealed that while students expressed general interest in financial literacy, most reported low confidence in managing student loans, budgeting, and long-term financial planning. A recurring theme in open-ended responses was a strong preference for more individualized financial education, with several students comparing their ideal experience to the academic advising model. Many noted that current offerings felt too generic or disconnected from their specific financial situations and career plans. These preliminary findings suggest a need for tailored, relationship-based approaches to financial education within medical curricula. Data will be collected again in May 2026. Preliminary findings highlight a clear demand among medical students for more personalized, longitudinal approaches to financial education that mirror the structure of academic advising. While overall financial literacy and confidence remain limited, students value individualized guidance over generalized sessions. These results underscore the importance of integrating tailored, mentorship-based financial programming into medical education to better support learners' financial well-being and preparedness for residency and beyond.

Chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm with an annual diagnosis rate of 93,000 individuals in the U.S. per year. Advances in therapy have reduced mortality. In this study, we aim to explore trends of CML-related mortality in the U.S. from the years 1999 to 2020 as they pertain to sex, race, year, state and census region. CDC Wonder retrospectively identified patients with an age ≥ 45 with CML-related deaths. Data points analyzed included mortality related to sex, race, year, and census region. Statistical analysis for age adjusted mortality rate (AAMR) per 100,000 persons, annual percentage change (APC), and average annual percentage change (AAPC) were calculated via joinpoint regression. Between 1999 and 2020, there were 32,484 CML-related deaths in the U.S. The AAMR declined across the entire study period. There was a pronounced decrease from 1999 to early 2006 (APC -8.50% for males and -8.30% for females, with the decline plateauing in the following years). Males exhibited higher AAMRs than females throughout the study period. White individuals appeared to have a higher AAMR than black and Hispanic individuals, while Asian individuals (as reported in national datasets) had the lowest rates. The Midwest has a higher AAMR followed by the West, the South, and the Northeast. Notably, from 2018 to 2020, a slight increase in AAMR was observed across all groups. Disparities of CML related mortality were observed as they relate to sex, race, year, state and census region.

Women pursuing careers in medicine are often highly motivated to participate in mentorship opportunities to develop leadership skills and encourage the growth of prospective women in medicine. Longitudinal near-peer mentorship has been shown to support leadership identity development and produce positive mentor outcomes, including increased professional skills and confidence. Acknowledging the logistical barriers to longitudinal mentoring programs, such as scheduling constraints and competing priorities, our project seeks to explore whether short-term mentorship outreach activities may offer a feasible model for female medical students to engage in experiential leadership identity development and attain benefits associated with the mentor role. We will host an outreach event providing female medical students at the University of South Dakota Sanford School of Medicine (SSOM) an opportunity to serve as mentors to South Dakota undergraduate and high school women interested in pursuing careers in medicine. During the event, mentors will lead skills simulations and participate in discussions about medical education and experiences as women in medicine. Post-event surveys will be completed by participating medical students to evaluate the effectiveness of this one-time outreach event, especially as it pertains to the short-term practice of leadership and development of leadership identity. We anticipate that participation in this outreach event, scheduled on April 9 in Sioux Falls, will result in survey data which will demonstrate that this event provides an opportunity for women at SSOM to practice leadership skills, build confidence in leading, and grow in their identity as physician leaders. Findings may help improve future programming offered by SSOM's chapter of Women in Medicine and Science. Short-term mentorship outreach events may provide a practical avenue for female medical students to grow in their leadership identity and attain benefits of the mentor role while supporting the next generation of women in medicine.

Despite the proven efficacy of direct oral anticoagulants (DOACs) in preventing thrombus formation in atrial fibrillation (AF), thrombus formation may rarely occur even with appropriate anticoagulation. We report the case of a 70-year-old woman with a history of AF, initially on warfarin, who underwent percutaneous left atrial appendage closure with a Watchman FLX 27 mm device due to recurrent gastrointestinal bleeding. She subsequently developed multiple unprovoked deep venous thromboses, necessitating the reinitiation of rivaroxaban therapy. She presented to the hospital with complaints of lower abdominal pain. Although the CT abdomen and pelvis was not a dedicated cardiac study, the superior slices incidentally captured the inferior and posterior left atrium, revealing a lobulated soft-tissue density suspicious for thrombus. Labs included INR 1.8, APTT of 40, and D-dimer of 0.62. Transthoracic echocardiography could not visualize thrombus. Transesophageal echocardiography revealed a large mobile thrombus in the superior cavity of LA. The watchman device was well seated with no flow noted across the device. A hypercoagulability workup showed low levels of Protein S antigen at 21. She was placed on warfarin. Follow-up TEE in 3 months showed a decrease in the thrombus size. This case highlights the importance of evaluating an underlying hypercoagulable state when thrombus develops despite DOAC therapy. While DOACs prevent thrombus formation in atrial fibrillation, their failure should not be dismissed as incidental. Clinicians should pursue a hypercoagulability workup, especially when thromboembolic events appear disproportionate to the CHA₂DS₂-VASc score. Early identification of inherited or acquired thrombophilies can guide tailored and effective long-term management.

Suturing is a fundamental surgical skill, yet many medical students learn independently on synthetic models with limited guidance. This presentation evaluates the impact of a cadaveric suturing curriculum on the clinical readiness of preclinical medical students. Seventy preclinical medical students at the USD Sanford School of Medicine participated in a mandatory suturing curriculum integrated into the preclinical phase of training. The curriculum consisted of a 90-minute laboratory, where students received instruction and performed suturing on individual cadaveric specimens. The laboratory focused on teaching five suturing techniques with their appropriate ties: simple interrupted, simple running and locking, vertical mattress, horizontal mattress, and subcuticular sutures. After two semesters of clinical experiences, students were surveyed on their clinical readiness, anatomic suturing locations in the clinic, and specialty where suturing occurred. Forty-one students (59%) completed the optional survey one-year postlaboratory. A 5-point Likert scale assessed student confidence in the order of "not at all," "slightly," "moderately," "significantly," and "extremely" confident. Twenty-six respondents (63%) felt moderately to extremely confident if faced with the opportunity to suture on a live patient. Among students who performed clinical suturing (n=11), 100% reported the laboratory provided moderate to extreme preparation for the procedure. Additional survey data revealed that the abdomen and upper extremities are the most common locations to suture during clinical experiences. General surgery was the most common specialty that provided suturing experiences, followed by plastic surgery, orthopedic surgery, and otolaryngology. Consistent with existing literature, these findings demonstrate that suturing on cadaveric models enhances clinical readiness. Novel contributions include assessment of a suturing curriculum formally integrated into the preclinical phase of medical school and categorization of clinical suturing experiences by anatomy and specialty. These results provide a framework for suturing curriculum development.

Diabetic foot infections (DFIs) are a common complication of diabetes mellitus and a leading cause of hospitalization. Due to the polymicrobial nature of these infections and delays in aerobic and anaerobic culture results, patients are often started on broad-spectrum antibiotics, which may lead to unnecessary antimicrobial use. The purpose of this study was to assess the incidence of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and anaerobic organisms in DFIs. Secondary endpoints evaluated the frequency of empiric antibiotic coverage for these organisms in both the emergency department (ED) and on initial hospital admission. This single-center retrospective study reviewed medical records over a five-year period for patients admitted with an initial DFI. The incidence of positive cultures for MRSA, Pseudomonas, and anaerobic organisms was compared with the frequency of empiric antimicrobial coverage for each. The incidence of these organisms was also compared between patients with and without hospitalization within the prior 90 days. Of the 184 patients in the study, 102 patients (55.43%) had cultures positive for one or more of the following: MRSA (17.0%), Pseudomonas (5.40%), and/or anaerobic organisms (45.10%). In the ED, 117 patients (63.59%) were treated empirically for MRSA, 111 patients (60.30%) were treated empirically for Pseudomonas, and 82 patients (44.60%) were treated empirically for anaerobes. On admission, 164 patients (89.10%) were treated empirically for MRSA, 140 patients (76.10%) were treated empirically for Pseudomonas, and 115 patients (62.50%) were treated empirically for anaerobes. The study demonstrated rates of MRSA and Pseudomonas consistent with prior literature. However, rates of anaerobic organisms, which have historically been less studied in DFIs, were prominent. Despite this, empiric antimicrobial coverage for anaerobes was lowest among the organisms studied. This study may help guide clinicians in considering organism incidence and in selecting empiric parenteral antibiotic therapy.

At the University of South Dakota Sanford School of Medicine, medical students are provided with memberships to the South Dakota State Medical Association (SDSMA) and American Medical Association (AMA). In this study, the primary goal is to determine if student membership increases membership in the SDSMA and AMA after graduation. An 18-question survey was emailed by the South Dakota Board of Medical and Osteopathic Examiners (SDBMOE) to every South Dakota licensed physician. The survey included questions about membership in AMA, SDMA, and other medical organizations. In total, 438 individuals consented and participated. Overall, 296 (67.6%) indicated membership in a medical association in medical school; 101 only AMA, 38 only SDSMA, 133 both, and 24 only other. For the 234 with a student AMA membership, 71 (30.3%) continued. Of the 171 with a student SDSMA membership, 88 (51.5%) continued. Comparing those with and without a student AMA membership, 21.0% without joined after graduation and 30.3% with continued (p = 0.07). For SDSMA memberships, 28.5% without joined after graduation, while 51.5% of those with continued (p = <0.01). Common reasons for maintaining included professional advocacy (n = 44) and educational opportunities (n = 32), for AMA and professional advocacy (n = 58) and networking (n = 45), for SDSMA. Those who were members of SDSMA as students were more likely to maintain their membership. This difference was less pronounced for AMA. Networking was a common reason for maintaining SDSMA.

Prostate cancer is the most common malignancy among men in the U.S. Despite therapeutic advances, outcome disparities driven by racial and socioeconomic factors persist. This study uses the National Inpatient Sample (NIS) to evaluate inpatient outcomes by race and socioeconomic status among older adults hospitalized with prostate cancer. We conducted a retrospective analysis using the NIS (2020-2022), identifying men aged &#x2265;65 years with a prostate cancer using ICD-10 codes. Primary outcomes included in-hospital mortality, length of stay (LOS), discharge disposition, and total hospital charges (THC). Race was categorized as White (reference), Black, Hispanic, and Other. Multivariate regression analyses adjusted for demographic, clinical, and hospital-level factors. An estimated 437,810 hospitalizations were identified. White patients comprised 69.2%, followed by Black (16.3%), Hispanic (7.2%), and Other (7.4%). Most had a high comorbidity burden (Charlson index &#x2265;3 in 85.1%). Black patients were younger, with a higher proportion aged 65-74 years (71.0% vs. 59.2%) and were more often from the lowest income quartile (46.3% vs. 28.1%) compared with White. Medicare was the predominant payer (87.9%), and 75.1% of admissions occurred at urban teaching hospitals. Nearly half were discharged home (44.6%), 50.1% to facilities or home health, and 5.3% died in-hospital. After adjustment, Black (OR 1.24), Hispanic (OR 1.19), and Other (OR 1.17) patients had higher odds of inpatient mortality. LOS was longer for Black (+1.17 days) and Other (+0.47 days). Black patients had higher odds of non-home discharge (OR 1.31), and THC were higher for Black (+$3,394), Hispanic (+$15,985), and Other (+$10,934) patients compared with White (all p < 0.05). Racial and socioeconomic disparities persist in prostate cancer hospitalizations. Disparities were seen as they related to number of hospitalizations, inpatient mortality, income, LOS, odds of non-home discharge, and THC. Thoroughly addressing these disparities will promote better outcomes for all patients.

Perilunate dislocations are uncommon and frequently missed wrist injuries that can lead to significant morbidity, such as median nerve injury, carpal instability, and poor functional outcomes, if not promptly identified and treated. Early recognition and coordinated management are especially important in rural trauma settings where subspecialty resources are limited. This case describes a 17-year-old male who presented to a rural emergency department following a motorcycle accident. Initial evaluation showed extensive road rash and a gross deformity of the left elbow. Radiographs of the chest, pelvis, left elbow, and right wrist were obtained. The right wrist demonstrated a scaphoid fracture with a perilunate dislocation. A telemedicine consultation was performed with an emergency medicine physician and the patient was transferred for higher-level care. Upon arrival, orthopedic surgery was consulted. Physical exam showed tenderness to palpation and pain with passive wrist motion. Attempted closed reduction of the perilunate injury was unsuccessful. The wrist was splinted, and the orthopedic hand surgeon was consulted. Open reduction of the perilunate dislocation and carpal tunnel release were performed under general anesthesia. A volar approach was performed, with a longitudinal incision made over the palmar aspect of the hand along the radial border of the ring finger. The median nerve was decompressed, a hematoma was removed, and the capitate was reduced back over the lunate with traction, wrist flexion, and direct pressure on the dorsal aspect of the capitate. Reduction was confirmed on orthogonal fluoroscopic views. The wound was irrigated, closed with nylon suture, and a splint was applied. At 2 month follow-up, the patient was doing well and demonstrated stable wrist alignment with interval healing of all injuries. This case highlights the complexity of managing perilunate dislocations in resource-limited healthcare settings and the importance of prompt diagnosis, appropriate care, and timely surgical referral.

Traditional Objective Structured Clinical Examinations (OSCEs) primarily assess students in the physician role. The OSCE 360 model expands this framework by incorporating student-authored cases and role rotation (student-doctor, student-patient, and evaluator), promoting experimental learning and exposure to multiple perspectives in patient care. Case writing may enhance clinical reasoning and diagnosis generation, while participation as standardized patients and peer evaluators reinforces understanding of clinical encounters. This study evaluates student perceptions of the educational impact of OSCE 360. A cross-sectional anonymous Qualtrics survey was administered to pre-clerkship medical students (Class of 2028) following participation in the OSCE 360 sessions. The survey assessed perceived case complexity, number of differential diagnoses considered, learning across roles, and confidence in case-writing. Descriptive statistics were used to summarize responses. Twenty-seven students responded, with 16 completing all items. Most respondents, 87.5%, rated their cases as average to somewhat complex. When writing cases, 81.3% considered three or more differential diagnoses, compared to 56.3% when acting as student-doctor. Most agreed or strongly agreed that writing cases improved medical knowledge and patient management skills by 75.0%. Similarly, 68.8% agreed or strongly agreed that portraying the patient enhanced understanding of symptom presentation and clinical reasoning. Self-assessed case-writing proficiency was most commonly rated as average (75.0%). OSCE 360 is perceived as a valuable educational approach for enhancing clinical reasoning, diagnostic thinking, and understanding of patient presentations through experiential learning. Role rotation and case construction provide meaningful learning beyond traditional OSCE formats. These findings support continued implementation of OSCE 360 and further investigation into its impact on objective performance and longitudinal clinical skill development.

Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly prescribed for diabetes and obesity and associated with delayed gastric emptying, raising concern for perioperative aspiration and anesthetic complications. However, observational studies have not consistently demonstrated increased anesthetic risk. In 2023, the American Society of Anesthesiologists recommended perioperative discontinuation of GLP-1 agonists despite limited supporting evidence. We conducted a retrospective cohort study to describe perioperative anesthetic outcomes among patients with and without GLP-1 agonist exposure to assess complication rates by perioperative holding status. We performed a retrospective cohort study using electronic medical records from the Sanford Health system. Adult patients undergoing procedures requiring general anesthesia with an active outpatient GLP-1 agonist prescription at the time of surgery were included. All other surgical patients served as controls. Records were identified using SlicerDicer and manually reviewed for demographics, comorbidities, procedure type, ASA classification, GLP-1 agonist discontinuation status, and perioperative anesthetic outcomes. Primary outcomes included aspiration, aspiration pneumonia, difficult intubation, postoperative nausea and vomiting (PONV), anesthesia-related complications, and 30-day mortality. A total of 234 patients were included (mean age 56.4 &#xb1; 13.0 years); 61.5% were female and 73.0% were ASA class 3. GPL-1 agonists were used by 80.5% of patients and 90.2% had diabetes. Perioperative anesthetic complications were minimal. No cases of aspiration, aspiration pneumonia, or anesthesia-related complications occurred. Anticipated difficult airway was noted in 4.3%, PONV in 0.9%, and 30-day mortality in 0.8%. GLP-1 agonists were held preoperatively 57.7% (mean 5.1 &#xb1; 4.3 days), with similarly low complication rates regardless of holding status. Major perioperative anesthetic complications were uncommon, regardless of GLP-1 use or perioperative holding. These findings suggest no observable increase in anesthetic risk associated with GLP-1 agonists, though conclusions are limited by low event rates. Larger prospective studies are needed to guide evidence-based perioperative management.

Chronic pain affects nearly one quarter of U.S. adults and remains difficult to treat with existing pharmacologic therapies. High-definition transcranial direct current stimulation (HD-tDCS) has emerged as a potential non-invasive neuromodulation approach. The insular cortex plays a central role in pain perception and represents a promising stimulation target. Capsaicin-induced hyperalgesia provides a validated experimental pain model for studying analgesic interventions. To determine whether HD-tDCS targeting the insular cortex modulates thermal sensitivity and subjective pain perception in a capsaicin-induced pain model. Fifteen healthy participants underwent both active and sham HD-tDCS conditions. Capsaicin was applied to induce localized thermal hyperalgesia. Thermal sensory testing was performed before and after stimulation, including heat pain threshold (HPT), thermal sensory limen (TSL), and numeric rating scale (NRS) pain ratings. Repeated-measures ANOVA evaluated the effects of time and stimulation condition. Capsaicin application increased thermal sensitivity and pain ratings across participants. However, no significant stimulation &#xd7; time interaction was observed for HPT, TSL, or NRS scores, indicating no detectable difference between active and sham HD-tDCS conditions. In this pilot study, insular HD-tDCS did not significantly alter thermal sensitivity or pain perception in a capsaicin-induced pain model. These findings may reflect limited statistical power given the small sample size. Larger studies are needed to determine whether targeted neuromodulation of the insula can modulate acute pain processing.

The healthcare industry is the largest private employer in the United States, yet workforce shortages persist. The Health Resources and Services Administration (HRSA) estimates that 92 million people live in primary care health professional shortage areas (HPSAs), 64 million in dental HPSAs, and 137 million in mental health HPSAs. An aging population and rising chronic illness rates place a growing burden on the healthcare system, with projected shortages exceeding 140,000 physicians and 100,000 registered nurses by 2038. Recruiting younger learners into healthcare careers is therefore critical. This study evaluated whether a traditional informational presentation or a presentation combined with hands-on activities was more effective at increasing high school students' interest in healthcare careers. Two medical students visited eight high school chemistry classes, providing either a 30-minute informational presentation with time for questions, or a 10-minute presentation followed by 30 minutes of hands-on healthcare activities, including practicing vital signs and learning intubation techniques. Both presentations discussed motivations for working in healthcare and potential career paths. Students completed anonymous pre- and post-surveys assessing healthcare career interest. Surveys were paired using anonymous identifiers. Parental consent and student assent were obtained per institutional review board requirements. The study included 129 consented participants, primarily 10th-grade students (n=124). Prior healthcare exposure was reported by 54%, and 62% had previously considered a healthcare career. On a scale of 1-10, baseline interest averaged 4.29. Interest increased by 0.64 (&#xb1;1.16) in the presentation-only group and by 0.68 (&#xb1;1.27) in the presentation plus hands-on group. These changes were statistically significant (p<0.001), with no significant difference between groups. Overall, 44% of students reported increased interest, 43% no change, and 12% decreased interest. Both approaches were influential in reaffirming students' interest or disinterest in a healthcare career. However, they did not differ significantly in their effect on interest. Future studies including broader student populations and expanded hands-on activities may better clarify effective strategies for engaging undecided students.

The Female Athlete Triad, characterized by low energy availability, menstrual dysfunction, and impaired bone health, poses short- and long-term health risks for female athletes. Despite its prevalence, awareness and education surrounding the Triad remain limited, contributing to delayed recognition and care. This project assessed baseline knowledge and comfort discussing Female Athlete Triad-related topics among collegiate female athletes and evaluated the impact of a brief educational intervention on knowledge, attitudes, and help-seeking intentions. A community-based educational initiative was conducted among collegiate female athletes at a South Dakota university. Participants completed anonymous pre- and post-surveys surrounding a 30-minute educational session on the Female Athlete Triad. Surveys assessed prior education, knowledge of the Triad and its components, likelihood of seeking medical care for menstrual irregularities, and comfort discussing related concerns. Paired t-tests analyzed changes in Likert-scale items, and a chi-square test evaluated changes in comfort discussing health concerns. A total of 79 female athletes completed both surveys. While most participants reported prior education on nutrition (72), fewer had received education on bone (31) or menstrual health (37). Following the intervention, mean knowledge scores improved for understanding of the Female Athlete Triad (3.00 to 4.27), the role of nutrition (3.95 to 4.35), and factors affecting bone health (2.46 to 4.22) (all p < 0.001). The likelihood of seeking care for irregular menses increased (3.19 to 4.10, p < 0.001). Comfort discussing Triad-related concerns also improved, with more participants selecting "yes" and fewer selecting "unsure" (p = 0.002). A brief educational session significantly improved collegiate female athletes' knowledge of the Female Athlete Triad and enhanced comfort with help-seeking behaviors. These findings support the feasibility and impact of concise educational interventions as a preventive strategy and highlight opportunities to integrate Triad education into athletic programs and pre-participation sports physicals.

Uterine fibroids affect an estimated 70% of women worldwide. Adenomyosis has an estimated prevalence ranging from 8.8% to 61.5% in hysterectomy cases over the past 50 years. Both conditions affect millions, yet remain underdiagnosed and poorly understood by patients. Transvaginal ultrasonography (TVUS) is the first line diagnostic imaging modality for detecting both uterine fibroids and adenomyosis. Despite advancements in diagnostic imaging, 50% of patients with uterine fibroids are unaware of their diagnosis even after TVUS detection, and one third of patients experience diagnostic delays of 5 or more years. Further, traditional 2D imaging such as MRI or ultrasound can be challenging for patients to interpret, potentially hindering understanding and affecting decision-making regarding treatment. A multiparous woman with large uterine fibroids and two prior cesarean sections developed intermittent right lower quadrant pain along her c-section scar which persisted for nine years. Ultrasound and CT imaging repeatedly showed a markedly enlarged, fibroid uterus with no clear etiology. Hysterectomy was suggested as definitive treatment. Using CT data, the patient generated a 3D printed pelvic model of the uterus filling the pelvis, displacing intestines, compressing the bladder and pressing on the rectum. After visualization of this distortion, the patient elected to move forward with a hysterectomy which completely resolved her chronic pain and urinary symptoms. This case underscores the importance of effective education and communication in managing gynecological conditions, especially when patients face complex decisions regarding treatment options such as undergoing a hysterectomy. Further the case emphasizes the possibility of enhancing patient education through 3D printing technology. As the American College of Obstetricians and Gynecologists (ACOG) notes, "Shared decision-making is a key component of patient-centered care, especially when multiple reasonable management options are available and the best choice depends on patient preferences and values."

Operating rooms (OR) require precise management to ensure patient safety, with temperature regulation serving as one key factor in reducing surgical complications. This review explores the impact of OR temperature on staff performance, infection rates, and hypothermia outcomes, as well as strategies to minimize adverse effects. This literature review synthesizes findings from peer-reviewed studies, meta-analyses, and clinical guidelines identified through PubMed and Google Scholar. A focus was placed on publications written in the past 25 years to maintain the most updated information. The included articles emphasized the effects of OR temperature on staff performance, infection rates, and hypothermia-related outcomes, and all references were cross-checked by two authors for accuracy. Ambient temperature guidelines of 20-24&#xb0;C (68-75&#xb0;F) from the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) help reduce heat-related stress in the operating room (OR). Cooler environments minimize distractions, fatigue, and impaired performance among staff in the sterile field. Ambient temperatures above guideline ranges are associated with an increased risk of infection, particularly from gram-negative bacteria. Intraoperative hypothermia, however, poses its own risks, including altered pharmacodynamics, increased blood loss, and coagulopathies, while prolonged hypothermia can extend recovery times and hospital stays. OR temperature plays a critical role in maintaining surgical efficiency and patient safety. Multiple variables must be considered and several intervention methods exist to optimize surgical team performance and patient outcomes.

In the United States, colorectal cancer ranks as the third most commonly diagnosed malignancy and the second leading cause of cancer-related death in both men and women. Colorectal cancer incidence is rising among people under the age of 50 who account for an estimated 13% of cases. Colon cancer typically develops slowly over the course of five to ten years, so primary care physicians should maintain a high index of suspicion for early clinical indicators of potential malignancy to promote timely detection. We report the case of a 40-year-old male with a history of morbid obesity (BMI 54 kg/m2), type 2 diabetes mellitus, and hypertension with isolated microcytosis (MCV 77.1 fL, hemoglobin 13.9 g/dL) and iron deficiency (iron 35 ug/dL, ferritin 68 ng/mL) during an annual wellness visit. The patient re-established care five years later and reported intermittent rectal bleeding that he owed to hemorrhoids. Labs were notable for iron deficiency anemia (hemoglobin 11.7 g/dL, MCV 69.2 fL, iron 17 ug/dL, ferritin 26 ng/mL). Colonoscopy revealed a partially obstructing infiltrating and circumferential tumor in the descending colon and several large, scattered pedunculated polyps. Biopsies confirmed invasive adenocarcinoma with intact expression of mismatch repair genes. Staging CT scan was unable to localize a colonic mass but identified clustered enlarged metastatic lymph nodes. Stage IIIb colon adenocarcinoma (cT3 cN1b cM0) was treated with neoadjuvant chemotherapy (mFOLFOX 6) followed by a left hemicolectomy eight months after the diagnosis with remission. Iron deficiency anemia is a well-known clinical indicator for colorectal cancer. Any early signs of anemia including isolated microcytosis in men or post-menopausal women should be further investigated for gastrointestinal blood loss. With rising incidence of colorectal cancer in younger adults, laboratory abnormalities warrant thorough evaluation as they may be the only indicator of occult blood loss from malignancy.