Abstract. In 2008, the UCLA Department of Medicine established a three-week clinical elective in Malawi, Africa, for Medicine and Medicine/Pediatrics residents. We sought to determine whether the elective resulted in improved medical knowledge, alterations in career trajectory, and whether the opportunity for the elective influenced selection of UCLA for residency. A 29-question survey was distributed to all graduates of the elective from 2009-2013. Surveys were distributed to 40 individuals, with 33 responses (82.5%). Thirty-one participants (93.9%) reported increased medical knowledge and 24 participants (72.7%) reported the rotation altered their career trajectory. Among the 23 residents who came to UCLA after the elective was established, 13 (56.5%) stated it had an influential role in their selection of UCLA for residency. The Malawi elective resulted in self-reported increases in medical knowledge, alterations in career trajectory, and has played an important role in attracting individuals to UCLA for residency.

Liver abscess is a rare but serious complication of Crohn's disease. Patients with Crohn's disease are at risk for pyogenic liver abscesses due to immunosuppressive therapy, fistulous disease, and intraabdominal abscesses. Inflammatory bowel disease patients are also known to have a greater prevalence of amebiasis compared to the rest of the population; however, a higher incidence of amebic liver abscess has not been reported. We describe a case of a liver abscess in a patient with Crohn's disease that was initially presumed pyogenic but later determined to be amebic in origin. Epidemiology, clinical presentation, diagnosis, and treatment of amebic and pyogenic liver abscesses are discussed.

Introduction: The increasing incidence of Neisseria gonorrhoeae infections and emergence of cephalosporin-resistant strains means the threat of disseminated gonococcal infection and endocarditis needs to be reimagined into the differential diagnosis for patients treated in the emergency department (ED) for sexually transmitted infections and for endocarditis itself. Only 70 cases of disseminated gonococcal infection (DGI) with endocarditis had been reported through 2014.1-4 In 2019, however, an outbreak of DGI with one case of endocarditis was reported.5 This case series of three patients with DGI and endocarditis, in addition to the recent outbreak, may represent a warning sign for reemergence of this threat. Case Report: We describe three cases within a recent three-year period of gonococcal endocarditis as seen and treated at our institution. These cases show divergent presentations of this insidious disease with both classical and atypical features. One case displayed a classic migratory rash with positive urine testing and a remote history of sexually transmitted infections, while another patient developed isolated culture-confirmed endocarditis with negative cervical testing and imaging, and the final case was a male patient who presented to the ED with fulminant endocarditis as the first ED presentation of infection. Conclusion: Secondary to an overall rise in incidence and possibly due to increasing antibiotic-resistance patterns, gonococcal endocarditis should be included in the differential diagnosis of any case of endocarditis. Reciprocally, increased vigilance should surround the evaluation of any patient for sexually transmitted diseases while in the ED for both the development of DGI and endocarditis.

BackgroundFecal microbiota transplantation (FMT) is the treatment of choice for recurrent C. difficile infection (CDI), but limited data exist on long-term real world outcomes of FMT and optimal routes of administration.MethodsWe performed a survey of patients who received FMT for CDI at UCLA Health. The online survey was adapted from the NIH PROMIS gastroenterology (GI) symptom scale to assess various GI symptoms in the week prior to FMT and the week prior to taking the survey (long-term follow-up). Additional questions addressed route of FMT, timing of improvement, and recurrence of symptoms or CDI. Chart review provided demographic information and time to follow-up. Changes (pre/post) were assessed using the Wilcoxon signed-rank test.ResultsNinety-six FMTs were performed from December 2014 through September 2017. Forty-five of 88 alive patients completed the survey (response rate 51.1%). Ages ranged from 18 to 90 years old (average 61.2 years, SD 18.0). Time from FMT to survey completion ranged from 14 to 1,044 days (average 526 days, SD 253.9). Route of initial FMT included 14 capsule and 31 lower GI tract FMTs (28 colonoscopies, threeother). Five patients had a second FMT after initial failure (second FMTs: one capsule and four colonoscopy). In total, we included 50 FMTs (15 capsule [30%] and 35 lower [70%]). Overall success rate was 76% (38/50), with 10 failed FMTs (20%) and 2 of unclear outcome. There was a higher success rate of lower FMTs at 85.7% (30/35) compared with capsule at 66.7% (10/15), but this difference was not statistically significant (P = 0.312). Comparing GI symptoms pre- and post-FMT, there was a statistically significant decrease in days with diarrhea (P < 0.001), frequency and severity of abdominal pain (both P < 0.001), bloated feeling (P < 0.001), and improvement in appetite (P < 0.001) at long-term follow-up. Comparing capsule vs. lower FMTs, post-FMT symptoms appeared similar.ConclusionFMT led to a high rate of long-term cure, with significant improvement in multiple GI symptoms months to years after transplant. The route of FMT did not impact symptom relief, but there was a higher rate of failure with capsule FMT compared with lower FMTs. More studies are needed to understand the impact of routes of FMTs on long-term outcomes of patients with CDI. Disclosures E. Martin, Pfizer: Investigator, Salary.