Kennedy Memorial Hospital

Large language model (LLM)-based auto-graders, like Claude 3.5 Sonnet, show promise in educational technology. To test their capabilities, we conducted an experiment in which four researchers solved five mathematical programming problems in Python, ranging from easy to complex. The researchers received feedback from Claude, using a 22 -criteria rubric designed to evaluate the following key aspects of coding: “Correctness,” “Efficiency,” “Data Structure Usage,” “Code Readability,” and “Testing” before resubmitting their assignments. The mean score improvement of $\mathbf{1 7 . 5}$ points demonstrates that LLMs can improve code quality, with the highest percentage increases in time complexity $(\mathbf{+} \mathbf{2 5 . 4 5 \%})$, efficiency $(\mathbf{+ 2 2 . 5 9 \%})$, and edge case handling ($+22 \%$).

We report the case of a 45-year-old male who presented to an emergency department with a complaint of myalgias, chills and sore throat of six day duration. The physical exam was essentially unremarkable. The patient tested positive for COVID-19 virus as well as Influenza A virus. The purpose of this brief review is to discuss what is known about coinfection of COVID-19 and influenza A.

IntroductionLiberia recently employed the first neurosurgeon in the country’s history. In a country with a population of 4.7 million people and staggering rates of cranial and spine trauma, as well as hydrocephalus and neural tube defects, neurosurgery is considered a luxury. Our study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, we aim to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty practice in Liberia. MethodsOur institutions, in collaboration with the Korle-Bu Neuroscience Foundation, spent 10 days in Liberia, based in Tappita, and performed 18 surgeries in addition to seeing several hundred clinic patients. This is a retrospective review of the cases performed along with outcomes to investigate obstacles in providing neurosurgical services in the country.ResultsBefore arriving in Liberia, we evaluated, planned, and supplied staff and materials for treating complex neurosurgical patients. Sixteen patients underwent 18 surgeries at a hospital in Tappita, Liberia, in November 2018. Their ages ranged from 1 month to 72 years (average 20 years). Five patients (28%) were female. Ten patients (56%) were under the age of 18. Surgeries included ventriculoperitoneal shunting (VP-shunt), lumbar myelomeningocele repair, encephalocele repair, laminectomy, and a craniotomy for tumor resection. Ten patients (55%) underwent VP-shunting. Two patients (11%) had a craniotomy for tumor resection. Three patients (17%) had laminectomy for lumbar stenosis. Two patients (11%) had repair of lumbar myelomeningocele.ConclusionAfter an aggressive and in-depth approach to planning, conducting, and supplying complex neurosurgical procedures in Liberia, the greatest limiting factor to successful outcomes lie in real-time is access to health care, which is largely limited by overall infrastructure. Our study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, we aim to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty procedural practice in the country of Liberia. Most notably, we focus on infrastructure factors, including power, roads, water, education, and overall health care.

ObjectivesThis study explored lye (caustic soda, sodium hydroxide) use in Liberia, knowledge about its risks and injury prevention programmes.DesignA qualitative semistructured interview study.SettingFocus groups occurred in six Liberian counties between April and August 2016.PatientsTwo previously identified stakeholder groups included parents of children under 5 years and adults identifying as soap makers.InterventionsInterview guides were written. Participants were recruited by convenience and snowball sampling. Transcribed audio-recorded discussions were analysed using the constant comparative approach.Main outcome measuresParticipants were enrolled until thematic saturation was reached.ResultsNinety-six adults participated. Participants described how lye entered the home, its use, storage, lye-related injuries and treatments, and injury prevention programmes.ConclusionsLye is commonly used and stored in Liberian homes despite recognition of its danger. A successful injury prevention programme must interrupt this cycle and find programming and legislative change to which the community is receptive.

It has been hypothesized that many, or even most cancers, utilize a unique immunomodulatory protein, called the progesterone induced blocking factor (PIBF) to allow spread of the cancer. Support for this concept has been provided by cancer cell line studies showing that PIBF is produced by these cancer cells and mifepristone suppresses this protein and inhibits proliferation of these cells. Furthermore, controlled murine studies with several spontaneous different types of cancer showed a clear beneficial effect of mifepristone over placebo control. Finally, there have been a variety of anecdotal reports showing efficacy of mifepristone in providing increased length and quality of life in patients with different types of advanced cancers. Single agent mifepristone was found to provide significant palliative benefit for a 51-year-old male whose metastatic advanced fibroblastic osteosarcoma progressed despite surgery, radiotherapy, multiagent chemotherapy, and targeted therapy. Thus, osteosarcoma can be added to the list of cancers, not necessarily associated with the classic nuclear progesterone receptor, that seem to respond to progesterone receptor antagonist therapy.

There is evidence that a unique immunomodulatory protein, known as the progesterone induced blocking factor (PIBF), is utilized by a large variety of cancers to escape immune surveillance. Mifepristone, a progesterone receptor antagonist/modulator, anecdotally, has been found to increase both length and quality of life in many different types of advanced cancers. Though there was one previous case of pancreatic cancer that showed a significant reduction in pain for the one month she took mifepristone before changing to an experimental drug, the case presented here provided much greater evidence that this drug can markedly improve both length and quality of life, in at least some patients, with very advanced pancreatic cancer. It is hoped that this case report will influence others to prescribe mifepristone off-label and hopefully substantiate this finding of marked palliative benefit in the majority of a larger series of patients.

Case 1 of an investigator-initiated study using oral single agent mifepristone to halt stage IV non-small cell lung cancer whose tumor was devoid of any targeted markers has remained ECOG zero and in good health for over 3 years. Case 2, reported here, is a 68-year-old woman with stage IV non-small cell lung cancer whose tumor was positive for the programmed death ligand-1 (PD-L1) marker. Her cancer progressed despite treatment with a check-point inhibitor (nivolumab), besides 3 rounds of multi-agent chemotherapy. After 1 ½ years of treatment with single agent mifepristone, her cancer remains stable (even some tumor regression) and her quality of life is only impaired by her pre-existing chronic obstructive lung disease, not her cancer. Mifepristone therapy may provide a method to halt metastatic lung cancer positive for the PD-L1 marker when check-point inhibitors are no longer effective.

To present an unusual exam resembling brain death but with a burst-suppressed electroencephalogram (EEG) after buproprion overdose with complete recovery To present an unusual exam resembling brain death but with a burst-suppressed electroencephalogram (EEG) after buproprion overdose with complete recovery

Here we present the case of a 20-year-old male with a known history of an artificial mechanical aortic valve replacement at ages four and twelve, on chronic warfarin therapy, who presented to our community emergency department for the evaluation of vomiting, diarrhea, generalized malaise and abdominal pain. He was seen at a local urgent care for similar symptoms earlier in the day, subsequently discharged with a diagnosis of mild gastroenteritis; however, according to the patient’s sister, upon his return home he looked very unwell and she called an ambulance immediately. He stated the vomiting was nonbloody, nonbilious and without a coffee-ground appearance; the diarrhea likewise was nonbloody, non-melenic, but mucousy. He had chills, but denies recent fevers, urinary complaints, back pain, chest pain, cough, or dyspnea. No recent illnesses, sick contacts, or travel. The patient denied any other medical or surgical history. Importantly, the patient reported no recent adjustments in his warfarin dose, admitted compliance, with last INR 2.1 two days prior to presentation.