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About one-third of patients with severe ulcerative colitis (UC) do not respond to corticosteroid therapy and receive rescue therapy with infliximab or cyclosporine. Up to 20% of such patients fail to respond to rescue therapy and undergo colectomy.

We investigated the outcomes of infliximab and a plant-based diet (PBD) as first-line therapy for severe UC.

Patients with severe UC defined by the Truelove and Witts criteria were admitted and given standard induction therapy with infliximab (5.0 mg/kg-7.5 mg/kg) at 0, 2, and 6 weeks. Additionally, they received a PBD. The primary endpoint was remission or colectomy in the induction phase and 1 year after discharge. Secondary endpoints were changes in inflammatory markers in the induction phase and the PBD score at baseline and follow-up. A higher PBD score indicates greater adherence to a PBD.

Infliximab and PBD as first-line therapy was administered in 17 cases. The remission rate was 76% (13/17), and the colectomy rate was 6% (1/17) in the induction phase. C-reactive protein values and the erythrocyte sedimentation rate significantly decreased at week 6 from 9.42 mg/dL to 0.33 mg/dL and from 59 to 17 mm/h, respectively (p < 0.0001). At 1-year follow-up, the cumulative relapse rate was 25%, and there were no additional colectomy cases. Mean PBD scores of 27.7 at 1 year and 23.8 at 4 years were significantly higher than baseline scores of 8.3 and 9.9, respectively (p < 0.0001 and p = 0.0391).

This new first-line therapy for severe UC demonstrated a higher remission rate and lower colectomy rate than with the current modality.

This new first-line therapy for severe UC demonstrated a higher remission rate and lower colectomy rate than with the current modality.

Mantle cell lymphoma is an aggressive disease. Limited treatment options are available for refractory or relapsing presentation. We report the first case, to the best of our knowledge, of concurrent radiotherapy and lenalidomide use in this setting, focusing on its possible synergy and tolerance.

A 76-year-old man with a history of mantle cell lymphoma presented with ptosis of the left eyelid, eyelid swelling, and nasal obstruction. Results of positron emission tomography-computed tomography revealed a pathologic fluorodeoxyglucose uptake at the pharynx and left eyelid. He received treatment with ibrutinib, which was stopped 3 months later because of digestive toxic effects. Radiotherapy for the eyelid and pharynx was performed at a dose of 18 Gy, with concurrent lenalidomide administration. Evaluation 3 months later revealed complete disappearance of the 2 relapse sites.

This case highlights the role of concomitant lenalidomide treatment and low-dose radiotherapy in patients with relapsing mantle cell lymphoma. Use of this combination treatment has achieved a complete local control with a safe toxicity profile. The case also illustrates the possible lenalidomide-induced radio sensitization.

This case highlights the role of concomitant lenalidomide treatment and low-dose radiotherapy in patients with relapsing mantle cell lymphoma. Use of this combination treatment has achieved a complete local control with a safe toxicity profile. The case also illustrates the possible lenalidomide-induced radio sensitization.

Catamenial epilepsy (CE) is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy. There is a paucity of literature addressing this condition from a clinical standpoint, and the literature that does exist is limited to the neurological community. This article reviews the diagnosis and management of CE for the non-neurologist. Women with CE have early touch points in their care with numerous health care providers before ever consulting with a specialist, including OB/GYNs, pediatricians, emergency department physicians, and family medicine providers. In addition, women affected by CE have seizures that are more recalcitrant to traditional epilepsy treatment regimens. To optimize management in patients affected by CE, menstrual physiology must be understood, individualized hormonal contraception treatment considered, and adjustments and interactions with antiepileptic drugs addressed.CE.

Liver hematoma is an uncommon feature of Ehlers-Danlos syndrome (EDS) type IV. The limited literature that exists to guide management does not establish a standard of care.

A 26-year-old man presented with acute abdominal pain caused by a large, spontaneous liver hematoma. Invasive prophylactic arterial embolization was done twice, but surgical evacuation was not offered because of concern for poor healing and brittle vasculature, later diagnosed as symptoms of the patient's EDS type IV. During hospitalization the patient died of spontaneous intracerebral and intra-abdominal hemorrhaging.

This case illustrates a nonsurgical management option for spontaneous liver hematoma in a patient with EDS type IV. An interdisciplinary team should help guide care, including consideration of invasive procedures such as arterial embolization and surgery. Patient and family education, genetic testing, and timely medical record documentation may reduce the morbidity and mortality of patients with this syndrome.

This case illustrates a nonsurgical management option for spontaneous liver hematoma in a patient with EDS type IV. An interdisciplinary team should help guide care, including consideration of invasive procedures such as arterial embolization and surgery. Patient and family education, genetic testing, and timely medical record documentation may reduce the morbidity and mortality of patients with this syndrome.In collaboration with the American Medical Women's Association, The Permanente Journal is pleased to present this special issue in celebration of Women in Medicine Month in September 2020. This designation was created by the American Medical Association to recognize the growing number of women in the profession. We aim to introduce the history, education, leadership, society beliefs and inequities faced, reflections on bias, and perspectives on work-life-balance. We hope you will allow the personal stories, commentaries, and research reports to inspire you to create workplaces and life moments with a view toward equity and inclusion.Women physicians have a long history of advocacy, dating to the 19th century women's suffrage movement. As history recounts the work of the suffragists, many women physicians bear mention. Some were leaders on the national scene, and others led suffrage efforts in their own state. MSU-42011 clinical trial In this article, we provide a snapshot of 7 prominent suffragists who were also physicians Mary Edwards Walker, Mary Putnam Jacobi, Esther Pohl Lovejoy, Marie Equi, Mattie E. Coleman, Cora Smith Eaton, and Caroline E. Spencer. In sharing their stories, we hope to better understand some of the challenges and struggles of the suffrage movement and how their advocacy paved the way not only for women's voting rights but also the role of women physicians as advocates for change.Implicit or unconscious bias is a lens through which we see our world based on our past experiences and learned stereotypes. Within health care, this lens of bias has typically had a negative impact on patient care, particularly for marginalized populations. We sat down with 3 physicians within Kaiser Permanente East Bay to learn about their personal experiences of bias in patient care. We also discuss the importance of acknowledging bias and practicing cultural humility in order to best ally with our patients. We are hopeful our conversation with these physicians will inspire more of the same, leading to improved health care for those that have suffered from bias in the past.

Physician burnout, wellness, and resilience have become increasingly important topics of discussion worldwide. While studies have assessed burnout globally in various individual countries, few studies directly compare or analyze gender-based physician burnout among different global regions.

Female physicians attending the Medical Women's International Association (MWIA) Centennial Congress completed the Copenhagen Burnout Inventory (CBI) which evaluates personal-, work-, and patient-related burnout using a scale of 0 to 100. Results were analyzed using descriptive statistics and 1-way ANOVA to compare burnout scores amongst women physicians from different global regions.

Of 100 physicians invited to participate, 76 provided responses and 71 met the inclusion criteria. Mean burnout scores were highest amongst women from Africa in all categories. Mean work-related, patient-related, and personal-related burnout scores were significantly lower for physicians in Europe compared to Africa (p = 0.05) when evalpractice during childbearing years, and significant physician shortage. Through this study, we have begun to explore the cultural and geographical context related to women's mental and physical wellbeing in the medical field. Further research should focus on the gender-specific contributors to burnout among different global regions, so that methods can be implemented on a systemic level to alleviate burnout.Gender inequities date back thousands of years, with women expected to be caregivers at home and men expected to be leaders with occupations outside the home. In more recent history, women have trained in various professions, including medicine. Although the number of female physicians has risen consistently over the past several decades and half of US medical students now are women, gender inequities persist and are due, at least in part, to implicit (unconscious) biases held by doctors, other health care professionals, and patients and their families. Implicit biases negatively affect women in their medical careers and contribute to slower advancement, less favorable evaluations, underrepresentation in leadership positions, fewer invited lectures, lower salaries, impostor syndrome, and burnout. Despite efforts to address gender biases, studies in academic medical centers indicate no major change over a 20-year span. Management of implicit gender bias at the organizational level is imperative. Strategies include implicit bias training for doctors and other staff; development of a transparent and equitable compensation plan; and transparent processes for promotion and hiring, mentorship, and sponsorship of women physicians for grand rounds, lectureships, committees, leadership positions, and awards. Achievement of equity for women physicians requires effort and ultimately a culture change. Gender equity in the medical profession will lead to improved physician wellness, retention of women physicians, and improved access to and quality of health care.In this commentary, a female early-career academic physician reflects on her experiences with microinequities in the workplace. Using a recent publication describing the experience of midcareer academic women physicians as a launching point, the author discusses the experiences that early-career women in medicine commonly have. In training and early career, women are exposed to subtle barriers, aggressions, and inequities, which build over time. By midcareer, some women leave medicine or if they remain in medicine, they have likely not reached the salary or promotion levels of men. Ultimately, the author questions if trainees and early-career women in academic medicine are simply in a "preinvisible" phase of their careers. Ways to address the microinequities are offered.