Des Moines University Osteopathic Medical Center

Introduction: Bipolar disorder (BD) is a mood disorder characterized by manic episodes, depressive episodes, mixed states, and psychotic symptoms. It affects over 2% of the global population and is associated with higher suicide rates than the general population. Treatment options include antipsychotics, anticonvulsants, and lithium, which are effective for long-term management and suicide prevention. Lithium has long been the gold standard for BD treatment; however, it can cause thyroid and parathyroid dysfunction. Patients receiving medications for medical comorbidities can be at higher risk for side effects. Case Report: In this case, a 66-year-old female with bipolar I disorder and multiple endocrine abnormalities was admitted during a manic episode with psychotic features that followed their discontinuation of lithium. Conclusion: This case illustrates the complexities of managing BD with concurrent endocrine disorders and the importance of collaboration between specialty providers to maintain patient medical and psychiatric safety.

Persistent blue light exposure has been increasingly recognized as a significant factor influencing melanocyte activity and contributing to hyperpigmentation, particularly in individuals with skin of color. Blue light, a high-energy visible (HEV) light spectrum emitted by digital devices, artificial lighting, and sunlight, penetrates deeper into the skin than ultraviolet radiation, directly affecting dermal and epidermal cells. In skin of color, melanocytes exhibit heightened sensitivity to blue light, leading to increased melanin production through the activation of signaling pathways, including the upregulation of reactive oxygen species (ROS) and the induction of pro-inflammatory cytokines such as IL-6 and TNF-α. These pathways stimulate melanogenesis via microphthalmia-associated transcription factor (MITF) and its downstream targets, tyrosinase and tyrosinase-related proteins, resulting in persistent hyperpigmentation. Studies have shown that blue light exposure exacerbates conditions such as melasma, post-inflammatory hyperpigmentation (PIH), and uneven skin tone, posing a significant aesthetic and psychosocial concern for individuals with darker skin types. Recent evidence also suggests that blue light-induced oxidative stress compromises skin barrier integrity, further intensifying pigmentary disorders. Preventative and therapeutic strategies targeting blue light-induced hyperpigmentation are advancing, with antioxidants such as niacinamide, vitamin C, and plant-derived polyphenols demonstrating efficacy in mitigating oxidative stress and reducing melanin production. Broad-spectrum sunscreens containing iron oxides and tinted formulations have been shown to offer superior protection against blue light-induced pigmentation compared to traditional UV-only blockers. An evaluation of the molecular and cellular effects of blue light on melanocyte activity highlights the importance of tailored photoprotection and antioxidant-based therapies in managing hyperpigmentation in skin of color, addressing a critical gap in dermatological care for diverse populations.

The Impella is a ventricular assist device (VAD) that provides circulatory assistance to patients with impaired heart function during percutaneous coronary intervention (PCI). It ejects blood from the left ventricle directly into the aorta. Although most cases of Impella-assisted PCI are done using two access ports, the single access technique was described by Jason Wollmuth et al. An inherent drawback of multiple access is the heightened susceptibility to vascular complications like thrombosis, hematoma, pseudoaneurysm, and retroperitoneal bleeding. Single access for high-risk PCI (SHiP) reduces complications from PCI access and is useful in patients with limited arterial access. This study presents a case of extension of SHiP technique used in a case of complex high-risk intervention and CTO with dual access using an Impella single-access sheath.

This study evaluates the accuracy of two AI language models, ChatGPT 4.0 and Google Gemini (as of August 2024), in answering a set of 79 text-based pediatric radiology questions from "Pediatric Imaging: A Core Review."Accurate interpretation of text and images is critical in radiology, making AI tools valuable in medical education. The study involved 79 questions selected from a pediatric radiology question set, focusing solely on text-based questions. ChatGPT 4.0 and Google Gemini answered these questions, and their responses were evaluated using a binary scoring system. Statistical analyses, including chi-square tests and relative risk (RR) calculations, were performed to compare the overall and subsection accuracy of the models. ChatGPT 4.0 demonstrated superior accuracy, correctly answering 83.5% (66/79) of the questions, compared to Google Gemini's 68.4% (54/79), with a statistically significant difference (p=0.0255, RR=1.221). No statistically significant differences were found between the models within individual subsections, with p-values ranging from 0.136 to 1. ChatGPT 4.0 outperformed Google Gemini in overall accuracy for text-based pediatric radiology questions, highlighting its potential utility in medical education. However, the lack of significant differences within subsections and the exclusion of image-based questions underscore the need for further research with larger sample sizes and multimodal inputs to fully assess AI models' capabilities in radiology.

PURPOSE: The necessity of longer admissions following autologous breast reconstruction has come into question. Our institution has progressively shortened the length of stay following DIEP flap reconstruction and begun discharging patients on POD1. The purpose of this study is to document our experience with POD1 discharges while also identifying pre-operative and intra-operative factors that may identify patients as candidates for earlier discharge. METHODS: An IRB-approved, retrospective review of patients undergoing DIEP flap breast reconstruction from January 2019-March 2022 at Atrium Health was completed consisting of 510 patients and 846 DIEP flaps. Patient demographics, medical history, operative course and postoperative complications were collected. R statistical software was used for statistical analysis, including summary statistics and Welch’s two-sample T-tests. RESULTS: 23 Patients totaling 33 DIEP flaps were discharged on POD1 following reconstruction. Standard protocol through all phases of surgery was outlined. Factors associated with POD 1 discharge include BMI less than 30 and shorter operative time. No major complications occurred in the POD1 group. CONCLUSION: POD1 discharge following DIEP flap breast reconstruction is safe for select patients. Lower BMI and shorter operative times may be predictive in identifying patients as candidates for earlier discharge.

Undergraduate medical education continually adapts to evolving healthcare demands. This article delves into two transformative approaches—curriculum mapping and student-centric learning—that have reshaped medical education. Curriculum mapping is a structured process enhancing educational programs by aligning them with goals, fostering student-centered learning, and facilitating continuous improvement and accreditation monitoring. Student-centric learning tailors education to individual needs, encouraging engagement, critical thinking, and problem-solving. Integrating these approaches empowers learners, deepens comprehension, nurtures lifelong learning, and equips students for success in a dynamic healthcare environment. Aligning objectives, content, and assessments with students' needs creates a holistic educational experience.