Clinical Images - An Incidental EKG

A routine employment stress test reveals Brugada syndrome, a rare abnormality

Special Article: Physical Activity, Physical Fitness, and Cardiovascular Risk Factors in Childhood

In adults, physical activity and exercise training are associated with reduced cardiovascular morbidity and mortality, a reduced likelihood of developing adverse cardiovascular risk factors, and improved insulin sensitivity. In childhood, participation in appropriate physical activity may prevent the development of cardiovascular risk factors in the future and complement treatment of existing cardiovascular risk factors, including hypertension, dyslipidemia, and overweight. Exercise in children can also significantly improve insulin sensitivity independent of weight loss. These e fects are mediated in overweight children by increases in lean body mass relative to fat mass and associated improvements in inflammatory mediators, endothelial function, and the associated adverse hormonal milieu

Streaming Video: Student Performance and Relative Use in the Preclinical Curriculum

Purpose: To assess the relationship between student utilization of learning resources, including streaming video (SV), and their performance in the pre-clinical curriculum. [See PDF for complete abstract

Development of a Global Health Curriculum at Christiana Care Health System: An Independent Academic Health Center and Member of the Delaware Health Sciences Alliance

Work in Progress (16 PowerPoint slides) The Global Health Program at Christiana Care Health System (CCHS) is an innovative, multi-disciplinary educational program seeking to improve the public health knowledge base and skills of interested health professionals through didactic, simulation and clinical experiences. A recent AAMC survey revealed 30% ofU.S.medical students participated in an international elective in 2006 versus 15% in 1997. In a resident survey at CCHS in 2010, 70% of residents responded that it was important to have global health education. These figures indicate an increasing interest in global health during residency training. In order to draw interest from a variety of backgrounds, we developed a multi-disciplinary global health training program. The curriculum is designed to include CCHS staff and our colleagues at other Delaware Health Sciences Alliance (DHSA) institutions, includingNemoursA.I.DuPontHospitalfor Children,ThomasJeffersonUniversityand the University of Delaware. The core curriculum consists of a monthly lecture series, including local and guest speakers. The lectures are recorded and accessible to CCHS affiliates via intranet. In addition, we plan to incorporate a journal club, a skills workshop and develop a global health site to foster an international partnership and resident elective rotations. Since the program began in August 2011, we have had five meetings. Attendance has steadily increased in number and diversity; attendees now include undergraduates, medical students, residents, fellows, attending physicians, nurses, administrators and medical librarians. We initiated a post-meeting survey at our December meeting which demonstrated a mean increase in the level of awareness of the topic by 27%. Global health awareness allowsU.S.based health professionals to be more culturally competent and effective in advocating for the needs of the underserved in their own communities. By inviting all disciplines at multiple institutions we hope to create a community that supports and sustains global health. Learning Objectives: At the end of this session, participants will: 1. Identify the importance of a global health curriculum for training residents that are culturally aware and equipped to work in underserved populations both locally and abroad. 2. Acquire the information to initiate a global health program in a teaching hospital. 3. Learn how to incorporate a multi-disciplinary approach to global health education

Modern Ventilator Management in Surgical/Trauma Patients

Physicians have a lot to consider when they place a patient on the ventilator. This article reviews the literature and provides the physician with a clear guide to managing the ventilator in the ICU. This manuscript is meant to be a practical guide to managing the ventilator at the patient\u27s bedside

An Unusual Migration of A Stent: A Case Report

Stent dislodgment and embolization is a rare complication of coronary stenting. There are reports of intra-coronary stent entrapment, stripping, and dislodgement during percutaneous coronary interventions causing potentially life threatening complications, including intra-coronary or systemic embolization. Reports of dislodgment and migration of previously placed drug eluting intra-coronary stent several months after deployment are very limited in the literature. We describe a drug eluting stent dislodgment and migration in an 88 year-old male 10 months after its deployment

A Multivariate Surface-Based Analysis of the Putamen in Premature Newborns: Regional Differences within the Ventral Striatum

Many children born preterm exhibit frontal executive dysfunction, behavioral problems including attentional deficit/hyperactivity disorder and attention related learning disabilities. Anomalies in regional specificity of cortico-striato-thalamo-cortical circuits may underlie deficits in these disorders. Nonspecific volumetric deficits of striatal structures have been documented in these subjects, but little is known about surface deformation in these structures. For the first time, here we found regional surface morphological differences in the preterm neonatal ventral striatum. We performed regional group comparisons of the surface anatomy of the striatum (putamen and globus pallidus) between 17 preterm and 19 term-born neonates at term-equivalent age. We reconstructed striatal surfaces from manually segmented brain magnetic resonance images and analyzed them using our in-house conformal mapping program. All surfaces were registered to a template with a new surface fluid registration method. Vertex-based statistical comparisons between the two groups were performed via four methods: univariate and multivariate tensor-based morphometry, the commonly used medial axis distance, and a combination of the last two statistics. We found statistically significant differences in regional morphology between the two groups that are consistent across statistics, but more extensive for multivariate measures. Differences were localized to the ventral aspect of the striatum. In particular, we found abnormalities in the preterm anterior/inferior putamen, which is interconnected with the medial orbital/prefrontal cortex and the midline thalamic nuclei including the medial dorsal nucleus and pulvinar. These findings support the hypothesis that the ventral striatum is vulnerable, within the cortico-stiato-thalamo-cortical neural circuitry, which may underlie the risk for long-term development of frontal executive dysfunction, attention deficit hyperactivity disorder and attention-related learning disabilities in preterm neonates. © 2013 Shi et al

Amphotercin Washout of Fungal Peritonitis in Liver Transplant Recipient: A Novel Approach

Invasive fungal infection has a significant prevalence among organ transplant patients and is associated with high rates of morbidity and mortality. Fungal infection is difficult to identify early and subsequently difficult to effectively treat. In this case presentation we have a 45 y/o orthotopic liver transplant recipient who was profoundly sick from fungal peritonitis and due to the appearance of her abdomen and intestines, with the help of infectious disease, decided to proceed with direct amphotercin washout of the abdomen in the operating room. The patient had complete resolution of her fungal peritonitis and is doing well