Notes

Heart resynchronization treatment without or with defibrillation: a long-standing controversy.
The workshop followed a predefined structure and was completed as planned. Outcomes suggest that remote simulation delivery using virtual SPs and delivered online via Zoom is feasible and provides an effective environment in which to conduct SP methodology to teach communication and interpersonal skills. The findings suggest that remote simulation and virtual SPs can support experiential education and provide an effective and engaging learning environment. The virtual workshop was successful and laid a foundation for future online training programs for the use of SP methodology. Moreover, it formed an effective outline for subsequent iterations of this virtual training workshop and prompted discussion of plans for future workshops with various programs across a pan-university context.Esophageal adenocarcinoma (EAC) is a malignancy classically seen in the distal esophagus. While many risk factors associated with the condition have been reported, the most common among them are gastroesophageal reflux disease (GERD) and obesity. Histological changes range from metaplasia within the esophagus from stratified squamous epithelium to non-ciliated columnar cells with goblet cells. In contrast, squamous cell carcinoma (SCC) is classically found in the proximal portion of the esophagus and its risk factors include tobacco and alcohol use. We present a unique case of a 59-year-old African American male who presented to the ED with dysphagia, weight loss, and multiple episodes of emesis. Notable medical history included tobacco abuse, alcohol abuse, and alcoholic cirrhosis. Currently, there are numerous case reports delineating unique presentations of esophageal cancers; however, there are few case reports that demonstrate EAC affecting the proximal segment of the esophagus.Background Many dermatologic diseases are implicated in the development of depression. Currently, there is no literature addressing the extent of dermatology residency training on depression screening. Objective Our study aimed to determine the extent of dermatology residency training on depression screening to potentially improve education in this area. Methods We designed a 12-question survey to assess the level of resident training and comfort in depression screening for patients with acne vulgaris, atopic dermatitis, psoriasis, hidradenitis suppurativa, and skin cancer. Fifty-six residents completed the survey, and data for each question was analysed in aggregate. Results Participants found depression screening most important for patients with acne vulgaris, psoriasis, and hidradenitis suppurativa (p less then 0.0001, 95% CI). Ratings of confidence in screening were similar across all conditions. Most residents reported only occasional screening in the setting of these diseases. Sixty-four percent of participants stated that education on depression screening is not included as part of their curriculum or clinical practice, while 23% were uncertain. Conclusions Our results suggest a lack in relevant training during residency, warranting the inclusion of education on depression screening into the dermatology residency curriculum to facilitate better recognition of the mental health comorbidities of dermatologic diseases.Small intestinal bacterial overgrowth (SIBO) is a commonly diagnosed gastrointestinal disorder affecting millions of individuals throughout the United States. It refers to a condition in which there is an excess and imbalance of small intestinal bacteria. Despite its prevalence, it remains underdiagnosed due to the invasive nature of diagnostic testing. Symptoms observed in SIBO, including abdominal distension, bloating, diarrhea, and gas formation, are nonspecific and can overlap with other gastrointestinal disorders. Frequently cited predisposing factors include gastric acid suppression, dysmotility, gastric bypass, and opioids. The diagnostic gold standard remains small bowel aspirate and culture. However, due to its invasive nature, it remains an unpopular method among patients and clinicians alike. Glucose and lactulose breath testing have become the go-to diagnostic method in clinical practice due to its noninvasive nature and low cost. Bindarit molecular weight Treatment is guided towards the eradication of bacteria in the small bowel and usually consists of a prolonged course of oral antibiotics. Due to recent advances in our understanding of the human microbiome, we are surely poised for a transformation in our approach to diagnosing and treating this condition.Hypothermia is not known as a common cause of acute pancreatitis, although there have been previously reported cases. Herein, we describe a 55-year-old man who presented with acute pancreatitis preceded by hypothermia in the absence of the more traditional causative factors, such as gallstones or alcohol consumption. On arrival to the emergency department, he was found to have a temperature of 84.3°F, consistent with moderate hypothermia, a blood pressure of 84/50 mmHg, and a heart rate of 60 bpm. Serum lipase and amylase levels were 2,225 and 980 U/L, respectively. A CT scan of the abdomen with intravenous (IV) contrast revealed peripancreatic fat stranding, consistent with the diagnosis. No evidence of gallstones or common bile duct dilatation was found. He had also developed acute kidney injury and lactic acidosis consistent with end-organ damage. After appropriate triage, he was admitted to the intensive care unit and supportively managed. An external rewarming strategy with IV fluids and antibiotics resulted in improvement in clinical status. Hypothermia can cause subtle changes in the microvasculature and production of free radicals, which can result in acute pancreatitis. It is important to determine the etiology so that appropriate treatment can be instituted with better outcomes.Heparin-induced thrombocytopenia (HIT) and thrombosis affect a small minority of patients exposed to heparin. However, given the high proportion of patients who receive heparin during hospitalization, clinicians should be mindful to keep it on their differential. This case involves a 56-year-old woman who developed HIT during a prolonged hospitalization. She was started on a direct thrombin inhibitor, argatroban, until her platelets recovered, was bridged to warfarin, and later developed warfarin-induced skin necrosis (WISN). Patients with prolonged hospitalizations may have an inherent vitamin K deficiency, leading to erratic changes in international normalized ratio (INR). Currently, there are no guidelines to address very high supratherapeutic INR levels in this setting. Prompt diagnosis and close monitoring during treatment are essential to minimize the risk of morbidity and mortality.
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