Curēus
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The future physician will face a career challenged by a number of significant changes in healthcare, including changes in demographics and disease, an increasing focus on population health and value-based care, and changes in healthcare funding. National organizations have called for medical schools to better prepare students for these challenges, and to incorporate more public health education in medical school. While many medical schools have responded, the topics covered, the timing in the curriculum, and the importance of these topics for graduation vary widely. Florida has been a site of growth in medical education in the last 10 years. Given that new medical schools were developed during a period of increased emphasis on the need for public health education, a survey was developed to assess the state of public health education in medical schools accredited by the Liaison Committee for Medical Education (LCME) in the state of Florida. ⋯ Given the importance of public health content in medical schools, survey methodology using established competencies to assess public health curricula could be used in the US to provide an up-to-date assessment of the strengths and opportunities for improvement in this area.
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Depressed skull fracture, also referred to as a "ping-pong ball" or "pond" fracture in neonates, is a common sign of traumatic brain injury in paediatric patients. The main causes of depressed skull fractures include labour and obstetric trauma in newborns and direct head trauma in older children. Skull depression rarely resolves spontaneously, and the surgical options include open cranioplasty and percutaneous microscrew elevation, among others. ⋯ Here, we present a case-based review along with an illustrative case of depressed skull fracture reduced using the suction cup method via negative pressure. In addition, a Systematic Literature Review was performed to evaluate the safety of applying this procedure. The suction cup method is a feasible method to reduce depressed skull fracture in children, with minimum complications and no apparent long-term impairments.
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The erector spinae plane (ESP) block is a recently defined regional anesthesia technique which is considered as an effective method in postoperative multimodal analgesia. ESP block is usually performed at the thoracic region in pediatric patients, but it is also possible to perform ESP block at the lumbar region. Femur fracture is one of the most common procedures especially in pediatric orthopedic surgery where postoperative pain management is essential. We aim to present a case of effective postoperative analgesia provided by ultrasound-guided lumbar ESP block in a 6-year-old patient after femur fixation surgery.
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Acquired thrombotic thrombocytopenic purpura is a combination of thrombocytopenia with microangiopathic hemolytic anemia. A 62-year-old female was transferred from an outside hospital for rapidly worsening mental status and severe thrombocytopenia. Laboratory studies were significant for reduced hemoglobin and platelet count along with raised blood urea nitrogen, creatinine, and serum lactate dehydrogenase levels. ⋯ Our patient remained refractory to standard therapies and required rituximab and immunosuppressive agents like cyclosporine. We describe the association of active hepatitis C with acquired thrombotic thrombocytopenic purpura that was refractory to plasma exchange, high dose steroids and rituximab. As per our knowledge, this is the first case in the literature to describe a possible association between active hepatitis C and acquired thrombotic thrombocytopenic purpura.
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Case Reports
Double Bladder Sign: Three Cases of an Ultrasonographic Sign that Indicates Ovarian Torsion.
Ovarian torsion is a surgical emergency that can be difficult to diagnose and can therefore lead to delayed treatment and loss of ovarian function. While the diagnosis of ovarian torsion is based clinically, several sonographic findings can suggest ovarian torsion, including an enlarged ovary, presence of an ovarian cyst or mass, or abnormal ovarian blood flow. Less commonly described is the finding of an abnormal ovarian location in a clinical setting concerning for torsion. We present three cases of ovarian torsion where an ultrasonographic finding of a "double bladder sign" aided in early detection of ovarian torsion.