Cape Fear Valley Medical Center

The popularity of escape rooms as a teaching tool in medical education has grown in recent years due to their ability to increase knowledge, self-confidence, and promote team-based skills. To increase efficacy in learning head and neck anatomy, a virtual escape room was built and employed as a review with a Health Professions Anatomy course. The concept was that students were trapped within the brain and had to determine the correct cranial nerve exit. One hundred thirty-nine students participated in a pre-post single-arm pilot. There was a significant difference (p < 0.01) in the overall pretest score (55.08%) compared with the posttest (70.17%). On the post-activity survey, 82.1% of students agreed/strongly agreed that the activity was a productive use of time; 90.5% thought it was an effective team-building activity; 96.8% thought it encouraged the use of communication and collaborative skills; 66.32% felt more confident about the material after the activity; 92.6% said it helped expose gaps in knowledge; and 75.8% planned to play the escape room again as a review for their exam. Overall, the use of a virtual escape room was an effective mechanism to increase students' knowledge and confidence related to anatomy and is an active learning strategy that encourages teamwork and communication skills.

Vitamin C deficiency, or scurvy, is an often-overlooked nutritional disorder in modern clinical practice, particularly in high-income countries, such as the United States. It is most commonly associated with food insecurity, poverty, and generalized malnutrition. However, this case underscores an equally important yet less recognized risk factor: autism spectrum disorder (ASD). Individuals with ASD are at high risk given their sensory sensitivities and food selectivity, and frequently exhibit restricted dietary patterns that limit their nutritional intake.We present the case of a 24-year-old male with a known diagnosis of ASD who was admitted with symptomatic anemia, hematuria, spontaneous bruising, and mucosal bleeding. Initial workup revealed severe normocytic anemia with poor reticulocyte response and evidence of renal dysfunction, necessitating multiple transfusions. Physical examination findings, which included perifollicular hemorrhage and corkscrew hairs, and a detailed dietary history revealed a highly restricted intake. His serum vitamin C level was subsequently found to be undetectable. After several days of vitamin C supplementation and multiple transfusions, the patient showed significant clinical improvement, with resolution of hematuria and normalization of hemoglobin levels on follow-up.This case illustrates the diagnostic challenges posed by micronutrient deficiencies presenting with nonspecific and severe clinical manifestations, such as anemia, hematuria, and renal dysfunction. It also reinforces the importance of considering atypical etiologies in patients with developmental disorders, particularly those with restrictive eating behaviors. Early dietary assessment and nutritional screening should be integral components of care for patients with ASD, especially when clinical presentations are unexplained or involve bleeding, bruising, or fatigue.

The authors declare no conflict of interest.

In recent years, there has been a significant reduction in the use of warfarin, as many patients have transitioned to direct oral anticoagulants (DOACs) for the management of atrial fibrillation. However, a considerable number of patients continue to rely on warfarin due to financial limitations and the specific requirement for its use in individuals with mechanical heart valves, given the insufficient data on the effectiveness of DOACs in these scenarios. While warfarin is recognized for its high efficacy, it possesses a narrow therapeutic window, necessitating careful monitoring to avoid excessive bleeding. Consequently, regular assessments of the international normalized ratio (INR) are essential to ensure that anticoagulation remains within the therapeutic range, guiding appropriate dosage adjustments. This report details a case involving a 69-year-old male with a history of atrial fibrillation who was on warfarin therapy and subsequently developed a significant rectus sheath and extraperitoneal hematoma after receiving doxycycline for pneumonia. His INR was recorded at over 8 (facility laboratory limit highest at the time of this case). He was initially managed with vitamin K and prothrombin complex concentrate, followed by interventional radiology consultation for embolization of the right inferior epigastric artery due to the presence of an expanding rectus sheath hematoma observed on CT imaging. Doxycycline may potentiate the anticoagulant effects of warfarin by competing for albumin binding, which may elevate the risk of severe bleeding complications. Therefore, it is imperative to exercise caution when prescribing doxycycline to patients undergoing warfarin therapy.

Purpose: To evaluate the clinical and optical coherence tomography (OCT) characteristics associated with progression of vitreomacular traction (VMT) to a full-thickness macular hole (FTMH) and lamellar macular hole (LMH). Methods: A retrospective cohort study of patients with an OCT-confirmed diagnosis of idiopathic VMT and 6 or more months of follow-up was performed. Clinical data included age, sex, race, systemic comorbidities, hormone replacement therapy, corrected visual acuity (VA), subjective visual symptoms, OCT signs, and the presence of or progression to FTMH or LMH. Results: Of the 287 eyes with VMT, 48 (16.7%) progressed to MH. Twelve eyes (4.2%) progressed to LMH, and 36 eyes (12.5%) progressed to FTMH. Female sex (P = .02), myopic refractive status in phakic eyes (P = .02), subjective decreased VA (P = .01), and the presence of an inner segment-outer segment junction disruption on OCT (P = .003) were risk factors for progression from VMT to FTMH. Subjective metamorphopsia was a risk factor for progression to FTMH (P = .001) and LMH (P = .01). In a subgroup analysis, patients who had an FTMH in the fellow eye were significantly more likely to have VMT progress to FTMH in the study eye (24.0% vs 8.7%; P = .04). Having an LMH in the fellow eye was not a risk factor for progression to LMH in the study eye (P = .47). Conclusions: Risk factors were found for the progression of VMT to MH that may be clinically relevant for risk-stratifying patients presenting with VMT.