ABSTRACT
Acute gastric dilation after binge eating may lead to ischaemic necrosis and perforation of the gastric wall. Though rarely seen owing to the rich blood supply of the stomach, its sequelae may be avoided by prompt decompression of the dilated stomach. We present such a case heretofore rarely reported from India.
Subject(s)
Binge-Eating Disorder , Gastric Dilatation , Humans , Gastric Dilatation/etiology , Gastric Dilatation/complications , Binge-Eating Disorder/complications , Stomach/diagnostic imaging , IndiaABSTRACT
BACKGROUND: Residency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance. DESIGN: The authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees' first Step 2 CK scores for analysis. RESULTS: On multivariable analysis, Step 1 performance (standardized ß = 0.45, p < .001) and NBME medicine subject exam performance (standardized ß = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = -3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (ß=0.05, p = .78). CONCLUSION: Despite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.
Subject(s)
Clinical Clerkship , Education, Medical, Undergraduate , Clinical Competence , Educational Measurement , Humans , Licensure, Medical , United StatesABSTRACT
We generated a new Climate Data Record (CDR) of Upper Tropospheric Humidity (UTH) based on observations from the microwave sounders Special Sensor Microwave Temperature - 2 (SSMT-2), Advanced Microwave Sounding Unit - B (AMSU-B) and Microwave Humidity Sounder (MHS). The data record covers the time period between 1994 and 2017 and provides monthly mean 183.31 ± 1 GHz brightness temperatures and derived UTH along with estimates of measurement uncertainty on a 1° × 1° latitude-longitude grid covering the tropical region (30° S to 30° N). For the UTH retrieval we introduce a new definition of UTH. Forgoing the use of the humidity Jacobian as a weighting function, it is easier to apply than the traditional definition without compromising the retrieval accuracy. The same definition can be used to derive UTH from infrared observations, allowing for a more synergistic use of infrared and microwave UTH in the future. The new UTH CDR is validated against an existing UTH data record.
ABSTRACT
PURPOSE: To determine the degree of stress in parents of children operated for intermediate anorectal malformations, and their quality of life (QOL) at follow-up. METHODS: Forty-two of the 166 children who had undergone a sacroperineal pullthrough operation for an intermediate type of anorectal malformation, between 1996 and 2005, in the department of paediatric surgery at Christian Medical College, Vellore, responded to follow-up. The psychosocial well-being of the parents and the QOL of the children were assessed by an independent observer. RESULTS: The main factor which aggravated the stress and caused dissatisfaction with the final outcome was fecal soiling. Mothers bore the brunt of the care of these children, with some help from the fathers and grandparents. The QOL was also significantly affected by soiling, and improvement in soiling resulted in a dramatic improvement in the QOL. CONCLUSION: Managing fecal soiling aggressively in the child with anorectal malformation, and providing social support to the family, are crucial for achieving a better QOL in these children and their families.
Subject(s)
Adaptation, Psychological , Colostomy/psychology , Family/psychology , Parent-Child Relations , Quality of Life/psychology , Adolescent , Adult , Anorectal Malformations , Anus, Imperforate/diagnosis , Anus, Imperforate/psychology , Anus, Imperforate/surgery , Child , Child, Preschool , Colostomy/methods , Fathers/psychology , Female , Follow-Up Studies , Humans , Male , Mothers/psychology , Parents/psychology , Retrospective Studies , Severity of Illness Index , Time Factors , Young AdultABSTRACT
Traumatic tracheoesophageal fistula is a rare complication after blunt chest trauma, with all reported cases being more than 12 years of age. We report a 5-year-old boy with traumatic tracheoesophageal fistula after a blunt injury to the chest.
Subject(s)
Bronchoscopy , Esophagus/diagnostic imaging , Thoracic Injuries/complications , Tracheoesophageal Fistula/diagnosis , Tracheoesophageal Fistula/etiology , Wounds, Nonpenetrating/complications , Child, Preschool , Esophagus/surgery , Humans , Male , Radiography , Surgical Flaps , Suture Techniques , Trachea/surgery , Tracheoesophageal Fistula/surgeryABSTRACT
Tracheosophageal fistula following blunt trauma is rare and diagnosis and management can be difficult. All reported cases have involved victims above 12 years of age. Here we report the anesthesia management, for surgery, of a tracheoesophageal fistula caused by blunt trauma in a 5-year-old boy.