Case Report: Profound Anemia in a 2-Year-Old Boy Associated with a Leech in the Oropharynx.

A 2-year-old boy presented to Kapsowar Mission Hospital in Kenya with a history of general tiredness associated with mild, unilateral epistaxis and one episode of hematemesis. On admission, he had a hemoglobin value of 3.5 g/dL, with a white cell count of 20.6 × 109/L. The child was examined by the physician on call, with no source of bleeding found. Later that day, after a local physician noted that the presentation could be due to an unrecognized leech infestation, a deep examination of the oropharynx was performed with a laryngoscope and revealed a leech attached deep in the oropharynx. The anesthetist visualized the leech with a laryngoscope and removed it with Magill forceps. After the procedure and blood transfusion, the child's hemoglobin level improved to 10.4 g/dL, and on the following day, the child was much improved in energy and was playing outside. He was discharged home on iron supplements and made a full recovery.

Writing Support Group for Medical School Faculty-A Simple Way to Do It.

Problem: Writing for publication is a core activity for many medical school faculty, but faculty report numerous challenges to publication. To help address these challenges, some medical schools establish writing support programs, but those programs are often resource-intensive, involving didactic courses, accountability groups, formal mentorships, and even assistance from professional writers. Not all medical schools, however, provide resources for such programs, and many faculty members, especially clinicians, lack time needed to participate. Furthermore, success of these programs is typically judged by the total number of papers published. However, many clinicians would judge success as publication of the occasional papers they decide to write, not the total number of papers they or the group publish. With these issues in mind, we established a low-resource writing program focused on individual acceptance rates rather than total publications. Intervention: Our writing program is an informal group that meets monthly. Members bring their ideas for papers and drafts of papers, and other members provide critique and suggestions for improvement. Members then revise their papers to address that critique prior to journal submission. There are no formal or assigned mentors, courses, lectures, or writing assistants. Context: The program takes place in our family medicine department, in which faculty have various roles. Some group members are clinician-educators seeking to publish occasional clinical reviews or research articles; others are PhDs seeking to publish on aspects of their work. Impact: During the six years of the program, 86% of papers reviewed by the group were accepted for publication and 94% of those were accepted by the journal to which they were first submitted. Publication success rate of individual members averaged 79%. This exceeds the 30-40% acceptance rate for scholarly journals worldwide. Group members published an average of 5.2 papers per member, with some publishing as few as 2-3 papers and others as many as 10-11. Lessons Learned: An informal, low-resource writing program in medical school departments can help faculty reach their publication goals. We found that members were satisfied by having the group help them publish whatever number of papers they decided to write. The program's simple, informal approach fostered a culture of respectful and collegial interactions, in which members learned to depend on and accept critiques from colleagues. Finally, an unexpected benefit of our program resulted from membership of both clinicians and non-clinicians. This provided feedback from individuals with different perspectives, which enhanced development of manuscripts.

Border Crosser Deaths in the Arizona-Mexico Desert: Data on Remains 2001-2020.

INTRODUCTION: Increased enforcement at U.S.-Mexico border-crossing sites may lead migrants to cross in remote desert areas. METHODS: We reviewed data on migrants' bodies found along the Arizona-Mexico border from 2001 to 2020. We analyzed causes of death, condition of bodies, age, and sex, and the relationship of deaths to enforcement (arrests) by U.S. Border Patrol. RESULTS: From 2001-2020, 3,378 border-crosser bodies were found in the desert. As enforcement increased, bodies were found in more remote areas and later stages of decomposition. Skeletonized bodies increased from 19% in 2001-2004 to 49.1% in 2017-2020. When the cause of death could be identified, exposure to the elements was the most common cause. Abrupt increases in arrests and deaths over the immediately preceding period of 2013-2016 occurred in 2017-2020. CONCLUSIONS: Undetermined cause of death and increased skeletonization became more common, indicating bodies are discovered later. Enforcement does not decrease individuals crossing the border; rather, individuals cross in more remote areas.

From Dehydration to Fractures: Medical Issues Faced by People Crossing the United States: Mexico Border.

To quantify the number of Border Crossers seen at our hospitals, broken down by diagnoses and age. We used our electronic medical record to identify the number of patients in custody of the United States Border Patrol who were seen at Banner-University: South and University Campuses during the calendar year 2016. 734 patients were identified, and the electronic medical record was used to identify the primary diagnosis and age for each one. We then manually categorized them into groups of common diagnoses. We also compared the number of border crosser emergency department (ED) visits to overall ED visits. Of 734 patients, 77% were male, 60% were between 16 and 40 years of age, and 18% were under age 18 years. They made up 1.3% of ED visits to South Campus, but less than 0.1% to University Campus. The top categories were musculoskeletal trauma (n = 235, 32%), and dehydration and rhabdomyolysis (n = 95, 13%). The age range of border crossers brought to our EDs varies widely, as do their primary diagnoses, although trends can be seen. They make up a 1.3% of overall emergency department visits at South Campus hospital.

Apparent marked reduction in early antivenom reactions compared to historical controls: was it prophylaxis or method of administration?

OBJECTIVE: Serious morbidity and mortality following snakebite injuries are common in tropical regions of the world. Although antivenom administration is clinically effective, it carries an important risk of early anaphylactic reactions, ranging from relatively benign nausea, vomiting, and urticaria to life-threatening angioedema, bronchospasm and hypotension. Currently, no adequately powered study has demonstrated significant benefit from the use of any prophylactic drug. A high rate of anaphylactic reactions observed during a trial of three different antivenoms in Ecuador prompted adoption of premedication with intravenous (i.v.) hydrocortisone and diphenhydramine together with dilution and slower administration of antivenom. DESIGN: In a rural mission hospital in Eastern Ecuador, 53 consecutive snakebite victims received a new antivenom regimen in 2004-2006, comprising prophylactic drugs and i.v. infusion of diluted antivenom over 60 min. They were compared to an historical control cohort of 76 patients treated in 1997-2002 without prophylactic drugs and with i.v. "push" injection of undiluted antivenom over 10 min. All these patients had incoagulable blood on admission and all were treated with Brazilian Instituto Butantan polyspecific antivenom. RESULTS: Baseline characteristics of the historical control and premedicated groups were broadly similar. In the historical group, early reaction rates were as follows: 51% of patients had no reaction; 35% had mild reactions; 6% moderate; and 6% severe. In the premedicated/slow i.v. group, 98% of patients had no reaction; 0 mild; 0 moderate; and 2% severe. The difference in reaction rates was statistically significant (p<0.001). CONCLUSIONS: Premedication with intravenous hydrocortisone and diphenhydramine together with dilution of antivenom and its administration by i.v. infusion over 60 min appeared to reduce both the frequency and severity of anaphylactic reactions. A randomized blinded controlled trial is needed to confirm these encouraging preliminary findings.