BACKGROUND: Transverse spinal cord infarction (SCI) is rare but highly disabling. Aortic thrombosis was described as one of the most common etiologies. Thromboembolic complications associated with intravenous immunoglobulin (IVIG) have been reported.
METHODS: A previously well, 64-year-old man who was given the treatment of IVIG (0.4 g/kg/d for 5 days) for exfoliative dermatitis 2 weeks before, progressively developed flaccid paraplegia of lower extremities, loss of all sensations below T3 level and urinary incontinence within 50 minutes.
METHODS: A diagnosis of SCI and pulmonary embolism was made. IVIG was considered the possible cause.
METHODS: Anticoagulation treatment and continuous rehabilitation were administered.
RESULTS: The neurologic deficiency of the patient was partially improved at the 3-year follow-up.
CONCLUSIONS: The rapid development of severe deficits within 4 hours mostly contributes to the diagnosis of SCI. Heightened awareness of possible thrombotic events is encouraged for a month-long period following IVIG therapy.

BACKGROUND: Case-based clinical reasoning (CBCR) is the proposed method to improve clinical reasoning. This brief report aimed to evaluate CBCR effectiveness to improve clinical reasoning via an online course.
METHODS: This study is a brief report of a before-after quasi-experimental study to evaluate CBCR in medical students of Shahid Beheshti University of Medical Sciences.
METHODS: Ten online weekly 2-hour sessions of CBCR presentations were instructed to medical students. Each session started with an illness script, and then, the instructor posed the students\' five clinical questions in five steps according to the CBCR approach. The clinical reasoning ability of students was evaluated before and 2 weeks after the online courses using four types of standard clinical questions.
METHODS: A Wilcoxon signed-rank test was used to assess the difference between pretest and posttest examination scores.
RESULTS: This brief report revealed that twenty-one medical students participated in all ten sessions of the CBCR online course and were evaluated in pretest and posttest examinations. A significant improvement in the clinical reasoning total scores in the posttest examination compared with the pretest examination was observed (P = 0.001). In terms of specific types of clinical questions, the mean posttest scores for clinical reasoning problem (CRP) and key feature (KF) examinations were higher than the pretest scores (P = 0.001 and P = 0.005, respectively).
CONCLUSIONS: Applying the CBCR approach improved the total clinical reasoning score of medical students during the course. Further studies are needed to evaluate whether this improvement would persist in workplace settings or not.

BACKGROUND: The hallux plays a crucial role in maintaining standing balance and facilitating forward and backward movements during gait.
METHODS: A 21-year-old Japanese patient, suffering from a traumatic hallux deficit with only a portion of the basal phalanx intact, underwent rehabilitation treatment. The thenar area exhibited instability, leading to impaired balance and walking difficulties. Biomechanical assessment revealed the need for a rehabilitation strategy for the foot, as well as the knee, hip, and trunk. A rehabilitation protocol was designed to enhance medial foot loading during walking and standing, including balance and trunk strength training. After a 12-week rehabilitation period, the patient\'s gait showed significant improvement. Specifically, the load response and single-support phases of the gait cycle on the affected side increased from 46.9% to 49.3%, while the pre-swing phase decreased from 14.6% to 11.6%. The vertical component of the ground reaction force rose from 599.8 to 647.5 N. The enhanced stability from balance training and increased muscle strength contributed to the patient\'s improved walking and balance.
CONCLUSIONS: A patient with a traumatic hallux deficit underwent conservative treatment through strategic rehabilitation according to biomechanical assessment. This case report underscores the value of biomechanical gait analysis in the conservative management of similar conditions.

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The challenges of practicing medicine in small ships on remote sites involve limited resources, lack of specialized support, and longer interactions with a patient in an isolated environment. This report describes the successful management of a patient who suffered a major injury after fell from the stairs in an expedition ship in the Southern Ocean in the Antarctic route. The patient was managed by the onboard physician for four days until the medical evacuation was possible.

Modern medicine has evolved toward ultra-specialization and sectoralization of medical specialties. This approach may provide an advantage for the quality of care of a single disease but implies the risk of not appropriately addressing comprehensive care. It may sometimes result in overall diagnostic delays due to the prescription of additional diagnostic tests, that could be appropriate considering the single specialist approach but do not consider the overall clinical context of the patient. We describe the case of a patient with multiple comorbidities, who experienced a multiple specialistic approach, without a holistic view.

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In recent years, many postgraduate medical institutions are transitioning to a competency based medical education (CBME). This paradigm shift offers many advantages but has also been criticized for its potentially reductionist approach of targeting competency as the end goal. In this context, coaching may be an interesting intervention as it has been employed with success in other professional settings to go beyond achieving competency with a focus on continuous development. Currently there is little published data on this intervention in the medical field. Our study aims to describe a coaching intervention between two dyads of a coach and physician as well as exploring the repercussions of the intervention on their professional practice by analyzing interviews conducted per the value creation framework. Results of our study show the unique learning journeys of both dyads as well as the creation of value in each cycle for both participants. In conclusion, coaching in medicine is an interesting intervention with the potential to complement the existing medical training programs in order to achieve optimal professional development.

Scapulothoracic dissociation due to a trauma is exceptional. The purpose of this study was to share our experience with a case of scapulothoracic dissociation and to explain the advantages of our approach. We report the case of a 12-year-old right-handed schoolgirl admitted to hospital with a blunt trauma to the right thoracic limb complicated by infection after a week of traditional treatment (massage, bandaging with reed splints). Surgical neck fracture of the right humerus complicated by wet gangrene of the entire limb and severe anaemia was diagnosed. Blood transfusion, triple antibiotic therapy and scapulohumeral disarticulation were required. Progressive excision of necrotic tissue followed by scapulectomy (day 24) for scapular necrosis made it possible to sterilise the site and to perform a skin graft (day 43). The patient was discharged after 2 months. Physiotherapy was combined with psychological treatment and the patient had a simple post-operative course during the 7-month follow-up period. Failure of conventional treatment for limb fractures can be life-threatening and cause severe sequelae.