Background: Combination anti-obesity medications (AOMs) to treat postoperative bariatric surgery weight regain have limited data on their use in the clinical setting.Understanding the optimal treatment protocol in this cohort will maximize weight loss outcomes. Methods: A retrospective review of bariatric surgery patients (N = 44) presenting with weight regain at a single academic multidisciplinary obesity center who were prescribed AOM(s) plus intensive lifestyle modification for 12 months. Results: Age: 28-76 years old, 93% female, mean weight 110.2 � 20.3 kg, BMI 39.7 � 7.4 kg/m 2 , presenting 5.2 � 1.6 years post-bariatric surgery [27 (61.4%), 14 (31.8%), and 3 (6.8%) laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic vertical sleeve gastrectomy (VSG), and open RYGB, respectively], with 15.1 � 11.1 kg mean weight gain from nadir. Mean weight loss after medical intervention at 3-, 6-, and 12-month time points was 4.4 � 4.6 kg, 7.3 � 7.0 kg, and 10.7 � 9.2 kg, respectively. At 12 months, individuals prescribed 3 or more AOMs lost more weight than those prescribed one (−14.5 � 9.0 kg vs. −4.9 � 5.7 kg, p < 0.05) irrespective of age, gender, number of comorbidities, initial weight or BMI, type of surgery, or GLP1 use. RYGB patients lost less weight overall (7.4% vs. 14.8% VSG respectively; p < 0.05).Conclusions: Combination AOMs may be needed to achieve optimal weight loss results to treat post-operative weight regain.

Background Strongyloides stercoralis is an intestinal nematode parasite classified as a soil-transmitted helminth, endemic in tropical and subtropical regions. Strongyloides stercoralis can remain dormant for decades after the initial infection. Case We describe a patient who was diagnosed with Strongyloides stercoralis infection three weeks after a left inguinal hernia repair and discuss approaches to prevention, diagnosis, and treatment. Conclusions Physicians in the United States often miss opportunities to identify patients with chronic strongyloidiasis. Symptoms may be vague and screening tests have limitations. We review current strategies for diagnosis and treatment of chronic intestinal strongyloidiasis in immigrant patients who have significant travel history to tropical regions and discuss the clinical features and management of the infection.

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Fecal occult blood test (FOBT) was traditionally used as a non-invasive screening tool for colorectal cancer (CRC) screening, however it is increasingly used in the inpatient setting despite the controversy for indications other than CRC screening. Moreover, FOBT has a high false positive rate which may lead to an increased in unnecessary investigations and health care cost. In phase I of this 2 phase study, we aim to identify and evaluate practice trends in utilizing FOBT in the inpatient setting and its impact on clinical management and patient outcomes. METHODS: We performed a retrospective chart review of patients admitted to an urban-community teaching hospital who underwent FOBT from January 1, 2019 to June 31, 2019. Patient demographics, admission details, indications for FOBT, and the impact of FOBT results on endoscopic procedures performed and clinical outcomes were assessed. Statistical analysis was performed using SPSS version 25 (IBM, USA). RESULTS: A total of 752 patients were identified, out of which 455 (60.5%) had a resulted FOBT. The mean and median ages were 65 and 66 respectively. African Americans represented 81.7% of the study population (p¼0.0001). Female representation (53.6%) was slightly higher than males (p¼0.02). Medical specialties requested significantly more FOBT (85.1%) compared to surgical specialties (p¼0.0001). The most common indication for FOBT was anemia (53.4%) followed by GI bleeding (GIB) (32%). FOBT was positive in a total of 107 cases (23.5%). The likelihood of a positive FOBT in patients with GIB (60/146) was higher than those admitted for anemia (41/243) (p¼0.0001). FOBT was negative in 83% of patients undergoing testing for anemia. Among patients with a positive FOBT, 34 underwent endoscopic evaluation (7.5%). Patients with positive FOBT presenting with GIB were more likely to undergo inpatient endoscopic evaluation than those presenting with anemia and positive FOBT (p¼0.0036). The most common endoscopic findings were gastric ulcer/gastritis, both representing 55.9% of cases. The overall odds ratio of having endoscopic evaluation for positive FOBT was 6.02 (CI 3.39 -10.7, P<0.05). There was no significant difference in positive endoscopic findings explaining the indication of the endoscopic procedure between patients who underwent endoscopy with a positive or negative FOBT (p¼0.2). There were no statistically significant effect of using Aspirin/NSAIDs, Iron supplement or anticoagulation or vitamin C on the results of FOBT. CONCLUSION: Inappropriate and overutilization of FOBT in the inpatient setting is common, and its use is associated with increased cost but no change in clinical management or patient outcomes. We propose limiting inpatient use of FOBT in the setting of acute illness. Phase II of our study will be aimed towards education of providers regarding the indications of FOBT use, and a 6

Bird fancier's lung (BFL) is a form of hypersensitivity pneumonitis (HP) caused by an exaggerated immune response to avian antigen. BFL is much less common in smokers. In this case, development of BFL occurred in a previously asymptomatic patient with long-standing exposure to avian antigen after withdrawal of secondhand smoke. CASE PRESENTATION: A 71-year-old female presented with worsening exertional dyspnea and non-productive cough for 3 months. She denied fever or weight loss. She denied occupational exposure or new pets but has owned a cockatoo for 29 years. She is a lifetime non-smoker. Her husband smoked 1.5 packs per day for 50 years but quit 3 months prior to onset of her symptoms. Lung auscultation revealed diffuse, fine crackles. Nail clubbing was not present. On 6-minute walk test, her O2 saturation decreased from 96% to 88% and she required supplemental O2. Pulmonary function testing revealed a non-obstructive FEV1/ FVC of 87%. DLCO was moderately decreased at 8.8 mL/min/mmHg, VC was 73% of predicted. Chest CT revealed diffuse ground-glass opacification. Autoimmune assays were unremarkable. Serologic studies revealed antibodies against cockatiel droppings and parrot serum antigens. BFL was suspected as the underlying etiology. Steroid therapy resulted in rapid symptom improvement. Five weeks after re-homing her bird and deep cleaning her home, she experienced complete resolution of her symptoms.

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