Congenital bullous syphilis in a newborn: A novel approach to diagnosis using immunohistochemical staining on a blister roof.

We describe a rare presentation of congenital bullous syphilis in a premature neonate born with extensive skin desquamation. The newborn was noted to have diffuse erythema with widespread, superficial skin desquamation in addition to plantar bullae and erosions, and an absence of mucosal involvement. Immunohistochemical syphilis diagnostic staining was performed on a blister roof, highlighting a novel diagnostic approach for congenital bullous syphilis.

Infection following strabismus surgery.

PURPOSE OF REVIEW: To provide the most up to date information on postoperative infection associated with strabismus surgery, its diagnosis, management, and prevention. RECENT FINDINGS: Recent studies show that topical povidone-iodide is effective in reducing the bacteria colony count at the incision site and preventing contamination during strabismus surgery. Repeating povidone-iodide 5% drops after surgical preparation and presoaking the sutures in povidone-iodide reduces bacterial contamination further. There is no single postoperative day that would be best to detect the onset of a postoperative infection. Infection can follow a normal postoperative visit. SUMMARY: Infection continues to be a concerning complication of strabismus surgery. Early detection and treatment is needed to obtain a good outcome. Patients and their families should be educated on the early signs and symptoms of postoperative infection and to contact their ophthalmologist if any occur.

Insisting on the Healer's Art: The Implications of Required Participation in a Medical School Course on Values and Humanism.

THEORY: Elective courses, by definition, allow medical students to self-select for participation in the class. In a small-group learning setting, students uninterested or not ready for a particular learning topic might change the educational experience ("poison the well") for those students most interested in the topic. It is not known how medical students required to take a course in humanism (that they otherwise would not have elected to take) might be impacted by the course or how their presence might affect students originally interested in the course. HYPOTHESES: Medical students in a required course on humanism and values in medicine will have different experiences based on whether a particular student might have or not have elected to enroll in the course. Students uninterested in taking a course in humanism and values, but required to enroll, will limit the benefit of the course for those students originally interested in participating. METHOD: In 2012, all 1st-year students at a U.S. medical school were required to take the Healer's Art, an elective on professional values and humanism offered at more than 90 other schools in the United States and internationally. Students completed pre/postcourse surveys assessing emotional exhaustion, work engagement, positive emotions, and cynicism. We analyzed differences between those who would have elected to take the course (Elective students) and those who would not have elected to take it (Required students). RESULTS: Elective students did not differ from Required students in baseline demographic characteristics, emotional exhaustion, work engagement, or positive emotions. At baseline, Elective students did report feeling safer to talk openly, a greater sense of community, and higher levels of cynicism. Over time, there were no differences in course evaluations or outcomes between Elective and Required students. CONCLUSIONS: Required students do not differ greatly from those who would have elected to take Healer's Art, and all students appear to have similar experiences in the course.

Three-class antiretroviral resistance in a patient with acute HIV-1 infection.

Antiretroviral resistance in treatment-naïve patients with HIV-1 infection is on the rise in both resource-rich and resource-poor countries. We report a case of three-class primary antiretroviral resistance detected by a genotypic assay in a 19-year-old woman with acute HIV-1 infection. Her risk factor for HIV acquisition was unprotected sexual intercourse with a HIV-positive man. At diagnosis, her HIV-1 RNA level was 730,376 copies per milliliter, and 2 weeks later her CD4+ cell count was 465 cells/mm(3). The patient's antiretroviral therapy was chosen based on the genotype of the source patient. Subsequent analysis of our patient's virus revealed an identical genotype to that of the source patient. The patient tolerated therapy well and continues to be virologically suppressed after 1 year of therapy. Her current CD4+ cell count is 537 cells/mm(3) and HIV-1 RNA is less than 400 copies per milliliter. This case supports the current recommendations from several HIV therapy guidelines to perform resistance testing in patients with acute HIV-1 infection.