Splenic infarction: an update on William Osler\u27s observations.

BACKGROUND: Osler taught that splenic infarction presents with left upper abdominal quadrant pain, tenderness and swelling accompanied by a peritoneal friction rub. Splenic infarction is classically associated with bacterial endocarditis and sickle cell disease. OBJECTIVES: To describe the contemporary experience of splenic infarction. METHODS: We conducted a chart review of inpatients diagnosed with splenic infarction in a Jerusalem hospital between 1990 and 2003. RESULTS: We identified 26 cases with a mean age of 52 years. Common causes were hematologic malignancy (six cases) and intracardiac thrombus (five cases). Only three cases were associated with bacterial endocarditis. In 21 cases the splenic infarction brought a previously undiagnosed underlying disease to attention. Only half the subjects complained of localized left-sided abdominal pain, 36% had left-sided abdominal tenderness; 31% had no signs or symptoms localized to the splenic area, 36% had fever, 56% had leukocytosis and 71% had elevated lactate dehydrogenase levels. One splenectomy was performed and all patients survived to discharge. A post hoc analysis demonstrated that single infarcts were more likely to be associated with fever (20% vs. 63%, p \u3c 0.05) and leukocytosis (75% vs. 33%, P = 0.06) CONCLUSIONS: The clinical presentation of splenic infarction in the modern era differs greatly from the classical teaching, regarding etiology, signs and symptoms. In patients with unexplained splenic infarction, investigation frequently uncovers a new underlying diagnosis

Memoryscapes of the homeland by two generations of British Bangladeshis

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When migrants become hosts and nonmigrants become mobile: Bangladeshis visiting their friends and relatives in London

Most studies of migrants visiting their friends and relatives (VFR) are on homeland visits. In this article, we reverse the transnational optic and study nonmigrants from the country of origin visiting their migrated friends and relatives abroad. We draw on participant observation and 57 interviews with migrant hosts and nonmigrant visitors carried out in London and in the Sylhet region of Bangladesh. Visits from the homeland to the diaspora are found to be deeply meaningful for the maintenance of transnational familyhood, especially at critical moments such as weddings, childbirth, and end of life. They are performative acts of belonging with unwritten rules of mutual obligations and choreographed itineraries to the houses of relatives and friends and to tourist sites. They also represent inequalities in economic status and social mobility between the migrants and their left‐behind relatives and friends in Bangladesh. Most visits are enjoyable for all concerned, but subtle tensions can arise, for instance, in the hosts' difficulty in managing their ongoing working lives with duties of hospitality and acting as guides and in visitors' intense schedule of duty visits to many relatives and lack of agency in stepping out of the Bangladeshi community in London. Furthermore, in an increasingly hostile environment for getting visas to visit the United Kingdom, an unequal and inhumane situation arises of blocked mobility

FREE RADICAL REDUCTION THROUGH THE USE OF ELECTRO STIMULATION OF ACUPUNCTURE NEEDLES ON THE SHEALY RING OF CRYSTAL

The purpose of this study was to correlate statistically the electro-stimulation of key acupuncture points with a reduction in free radicals and an improved emotional state. h built upon previous work conducted by C. Normal Shealy, but differed in several key areas. This experiment employed a different electro-stimulation than was used in Shealy's experiments, and only a subset of the original points was stimulated with the electro-stimulation. Pre-and post-intervention free radical values were obtained by using an OxiData urinalysis test to measure the presence of malondialdehyde, a precursor to the free radical lipid peroxidase. OxiData was administered to all subjects before and after the experiment. The subjects' stress levels were also measured using two tools. The first was a mechanical measurement of the conductivity of key acupuncture points using an MSA-21, a recognized tool for acupuncture practices. The second was a battery of self-assessment tests whose results were then interpreted by the principal investigator. More than eighty subjects were used in this test. Respondents covered a wide diversity in ages and backgrounds, although seventy-two percent of them were female. The intervention group received three acupuncture treatments (one per day over three consecutive days) along specific acupuncture points known as the Shealy Ring of Ctystal. These were a combination of needling and electro-stimulation. Both the intervention group and control group received lectures and teaching materials about free radicals and acupuncture. Both were also tested at the same time for the presence of free radicals and a measurement of stress levels. Pre-treatment values were compared with post-treatment values. Statistical data were mixed. OxiData results indicated a trend (p = 0.11), but did not show a close statistical significance. The MSA-21 BioMeridian stress test was used to assess the variance ofenergetic values linked to emotional values. Three out of more than 20 test combinations indicated a statistical significance, correlating reductions ofstress to the intervention treatment. However, these reductions were not detected in the self-assessment evaluations

Training Students on the Effective Use of Translator Services: How Can You Treat Someone You Don’t Understand?

In 2005, the Virginia Commonwealth University School of Medicine partnered with the Inova Health System to create the first regional branch medical campus in Northern Virginia. As a part of this partnership, the VCU School of Medicine Inova Campus accepts a minimum of twenty-four medical students from the third and fourth year classes annually. In an effort to better prepare the incoming students for their clinical years and an extremely diverse patient population, a video was created to demonstrate effective use of translator services

The Socioeconomic Impact on Presentation and Clinical Course of Celiac Disease

Introduction Celiac Disease (CD) is a chronic autoimmune condition primarily affecting the small intestine. CD is triggered by ingestion of gluten and the only effective treatment for CD involves strict and lifelong elimination of dietary gluten. Compliance with the gluten free diet (GFD) relies on purchasing gluten-free foods. Studies have shown the cost of a GFD to be from 76% to 518% more expensive than gluten containing counterparts. Because of this, the economic burden that CD patients face may be substantial, placing these patients at high risk for dietary neglect. Financial limitation aside, GFD availability also varies by differing neighborhoods, resulting in economic food deserts across the country.https://jdc.jefferson.edu/gastrohepposters/1006/thumbnail.jp

Regional Medical Campus Match Data 2007-2009 Comparisons, Analysis, and Trends

Poster created for the 2010 AAMC Workforce Conference, present analysis of match data from all regional medical campuses for 2007-2009

Mesiodistal Crown Dimensions of Permanent Teeth in Bangladeshi Population

Background: Variation in tooth size is influenced by genetic and environmental factors. Several studies have reported tooth size variation between and within different racial groups. In order to improve the quality of dental care available, there is a great need for data on the mesiodistal crown dimensions of the individual teeth of Bangladeshi population. Objectives: To find nominative data on the mesiodistal crown dimensions of permanent teeth in Bangladeshi population and to compare the findings with those reported in other populations. Methods: This observational study was done from January, 2008 to June, 2010 in the Department of Orthodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University. A total of 244 Bangladeshi subjects (77 males and 167 females), aged 7 – 36 years (mean 18.3 years) with no age limit who attended at the above mentioned place for treatment were included in the study. Main outcome measure was mesiodistal crown dimension of each tooth class of permanent dentition. Mesiodistal crown dimensions were measured from dental casts of the permanent teeth. Results: Males had significantly larger teeth than females for maxillary central incisors (p < 0.05) and for the mandibular second premolars (p < 0.001). In both sexes, the maxillary lateral incisors showed the greatest variability [coefficient of variation (CV) 10.7%] and the maxillary canines the least (CV 6.9%) in mesiodistal crown dimension. Mandibular canines displayed greater sexual dimorphism in mesiodistal crown size than in any other tooth classes. Comparisons of the mesiodistal crown dimensions between population groups showed that Bangladeshis have tooth sizes close to those of North Indians, Icelanders and Jordanians but larger than those of North American Whites. Conclusions: From this study, a standard for the mesiodistal crown dimensions of permanent dentition of Bangladeshi males and females are obtained. Key Words: Crown dimension; Mesio-Distal width; Permanent dentition. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8635 BSMMU J 2011; 4(2):81-8

School-based Sexuality Education Experiences across Three Generations of Sexual Minority People

Sexual minority people face greater risk for compromised sexual health than their heterosexual peers, yet school-based sexuality education often excludes them. Little is known about whether or how sexual minority people's sexuality education experiences have varied across sociohistorical contexts of rapid social change in both sexuality education and sexual minority visibility. Semi-structured qualitative interviews were conducted among 191 sexual minority people from three distinct sociohistorical generations (ages 18-25, 34-41, and 52-59, respectively) and four geographic regions of the United States. Data were analyzed using thematic content analysis following a consensual qualitative protocol. Fifty-one participants (i.e., 27%) discussed school-based sexuality education experiences despite the lack of an explicit question in the interview protocol prompting them to do so. Four distinct yet overlapping themes emerged in participants' experiences of sexuality education: 1) Silence; 2) The profound influence of HIV/AIDS; 3) Stigma manifest through fear, shame, and prejudice; and, 4) Comparing school-based experiences to sexuality education outside of school. The presence of themes varied across groups defined by sociohistorical generation. The implications of sexuality education experiences for the wellbeing of sexual minority people are discussed

The crystal structure of Pneumolysin at 2.0 Å resolution reveals the molecular packing of the pre-pore complex

Pneumolysin is a cholesterol-dependent cytolysin (CDC) and virulence factor of Streptococcus pneumoniae. It kills cells by forming pores assembled from oligomeric rings in cholesterol-containing membranes. Cryo-EM has revealed the structures of the membrane-surface bound pre-pore and inserted-pore oligomers, however the molecular contacts that mediate these oligomers are unknown because high-resolution information is not available. Here we have determined the crystal structure of full-length pneumolysin at 1.98 Å resolution. In the structure, crystal contacts demonstrate the likely interactions that enable polymerisation on the cell membrane and the molecular packing of the pre-pore complex. The hemolytic activity is abrogated in mutants that disrupt these intermolecular contacts, highlighting their importance during pore formation. An additional crystal structure of the membrane-binding domain alone suggests that changes in the conformation of a tryptophan rich-loop at the base of the toxin promote monomer-monomer interactions upon membrane binding by creating new contacts. Notably, residues at the interface are conserved in other members of the CDC family, suggesting a common mechanism for pore and pre-pore assembly