DOCSLIB.ORG

Curricular Guide for Podiatric Medical Education

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Curricular Guide for Podiatric Medical Education AACPM Council of Faculties 2020 Edition Approved by the AACPM Board of Directors February 18, 2020 “The Curricular Guide for Podiatric Medical Education is designed to be a guidance document approved by the Board of Directors of the American Association of Colleges of Podiatric Medicine (AACPM) and represents a collaborative effort by AACPM’s member colleges. The contents of this document are a set of recommendations on what a comprehensive curriculum may look like. AACPM is not responsible for how the contents of this guide may be implemented or used. The Guide is not prescriptive and is not necessarily representative of what is taught at any given institution, nor should it be taken as a set of requirements or standards, the contents of this document represent general guidance and recommendations. A school should consider its own unique facts and circumstances before adopting any of the guidance herein. An educational program not following the guidance contained herein should not be taken as evidence that an educational program is in any way deficient.” 1 AACPM COUNCIL OF FACULTIES CURRICULUM PROJECT CURRICULAR GUIDE TABLE OF CONTENTS AACPM COUNCIL OF FACULTIES 2 ACKNOWLEDGEMENTS 3 AUTHORING GROUPS 4 BACKGROUND 8 COMPETENCIES (July 2016) 10 13 STUDENT LEARNING OBJECTIVES FOR PRECLINCIAL CONTENT AREAS BIOCHEMISTRY (July 2017) 16 COMPOSITE HISTOLOGY (February 2020) 33 EMBRYOLOGY (February 2014) 42 GENERAL ANATOMY (August 2016) 46 LOWER EXTREMITY ANATOMY (July 2017) 58 MEDICAL GENETICS (February 2014) 66 MICROBIOLOGY/IMMUNOLOGY (July 2016) 73 NEUROSCIENCES (formerly Neuroanatomy) (February 2020) 98 PATHOLOGY (July 2016) 104 PHARMACOLOGY (July 2016) 137 PHYSIOLOGY (July 2018) 188 STUDENT LEARNING OBJECTIVES FOR CLINICAL CONTENT AREAS BEHAVIORAL MEDICINE (February 2020) 219 COMMUNITY HEALTH (February 2020) 222 GERIATRICS (February 2014) 227 MEDICINE (July 2016) 229 ORTHOPEDICS (July 2018) 243 RADIOLOGY (July 2016) 278 SURGERY and ANESTHESIOLOGY (July 2016) 286 APPENDIX I: Bloom’s Taxonomy 315 APPENDIX II: Ranking Key 318 APPENDIX III: AACPM Council of Faculties 319 (…) indicates latest revision date or new content area added 2 ACKNOWLEDGMENTS We would like to acknowledge the: Council of Faculties: for establishing the goals, organization, timeline and vision for this project. The Curriculum Committee: for updating the Guide, including standardization of ranking and content, maintaining the organization of the guide, recommending the addition of new areas and writing overarching competencies. Faculty: for their collegial sharing of curriculum; the multiple conference calls and face-to face meetings, and the countless hours spent in ranking objectives. Content Chairs: for coordinating each content area, for chairing the never-ending conference calls, for the thankless job of sifting through thousands of behavioral objectives, for overseeing the ranking process and in some cases assigning most of the ranking, and for the innumerable hours spent hounding colleagues to get their work in by the deadline. Deans: for their continued support of this project. American Association of Colleges of Podiatric Medicine Board of Directors: for financial support. Collegial Organizations: for their willingness to share existing discipline competencies for this project: • American Association of Clinical Anatomists (AACA). A clinical anatomy curriculum for the medical student of the 21st century: gross anatomy. Clin Anat. 1996;9:71-99. • American Physiological Society - APS/ACPD 2000 Objectives and the 2006 Revised Objectives Version. • Knowledge objectives developed by the American Society of Medical Pharmacology Chairs, with the permission of the president at that time, Bonnie Sloane. • Booth SJ, Burges G, Justeman L, Knoop F. Design and Implementation of Core Knowledge Objectives for Medical Microbiology and Immunology. J Int Assoc Med Sci Educ. 2009;19:100-138. • GRIPE, Group for Research in Pathology Education, with permission. • McHanwell S, Davies DC, Morris J, et al. A core syllabus in anatomy for medical students – adding common sense to need to know. Eur J Anat. 2007;11:3-18. • Hyland, KM et al. Medical School Core Curriculum in Genetics 2013. Association of Professors of Human and Medical Genetics. American Association of Colleges of Podiatric Medicine Staff: we want to offer our personal thanks to AACPM for the logistical support of this project. Kelly Foster has kept us organized, facilitated conference calls and gently reminded us whenever we needed to forward materials to keep the project moving. We also want to offer a special thank you to Mori North, for her continued dedication to this project. Eileen Chusid, PhD Shanika Hill, DPM Chair, Council of Faculties Chair Elect, Council of Faculties 3 Authoring Group The authoring groups listed in this edition include all faculty members that have participated in the current revision. Content Area Participants (leaders are listed first, and bolded) General Anatomy Bruce Richardson, PhD CSPM Linda Walters, PhD AZPod Bibi Singh, DPM BUSPM Donald Matz, PhD CPMS Stephanie Belovich, PhD KSUCPM Maria Moschella, PhD NYCPM Derek Talbot, D.C. SCPM William Merbs, MSc WUCPM Neuroscience (formerly Neuroanatomy) Donald Matz, PhD CPMS Christopher Heesey, PhD AZPod Allen Smith, PhD BUSPM Rhea Kimpo, PhD CSPM Michael Landers, PhD KSUCPM Fortunato Battaglia, MD, PhD NYCPM Daniel Bareither, PhD SCPM William Robinson, PhD TUSPM Edie Sperling, PT, DPT, CMPT WUCPM Lower Extremity Anatomy Bruce Richardson, PhD SCPM Lance Wissman, DPM AZPod Bibi Singh, DPM BUSPM Donald Matz, PhD DMU-CPMS Kathy Siesel, DPM KSUCPM Daria Dykyj, PhD NYCPM Derek Talbot, DC SCPM Nicole Griffin, DPM TUSPM Mathew Wedel, PhD WUCPM Biochemistry Peter Barbosa, PhD NYCPM Gloria Yueh, PhD AZPod Graham Shaw, PhD BUSPM Mary Premenko-Lanier, PhD CSPM Martin Schmidt, PhD DMU-CPMS Tim Whittingham, PhD KSUCPM Robert Intine, PhD SCPM Kathleen Giangiacomo, PhD TUSPM Thomas Squier, PhD WUCPM 4 Embryology Bruce Richardson, PhD CSPM Linda Walters, PhD AZPod Donald Matz, PhD DMU-CPMS Ronald Wright, PhD KSUCPM Robert Bressler, PhD NYCPM Daniel Bareither, PhD SCPM Judith Litvin Daniels, PhD TUSPM Craig Kuehn, PhD WUCPM Genetics Ronald Wright, PhD KSUCPM Gloria Yueh, PhD AZPod Gerhild Packert, PhD BUSPM Mary Premenko-Lanier, PhD CSPM Martin Schmidt, PhD DMU-CPMS Kenneth Astrin, PhD NYCPM Robert Intine, PhD SCPM Raghbir Athwal, PhD TUSPM Katherine Mitsouras, PhD WUCPM Raj Kandpal, PhD WUCPM Histology Eileen Chusid, PhD NYCPM T. Bucky Jones, PhD AZPod Allen Smith, PhD BUSPM Carol Gilson, PhD CSPM Sarah Werning, PhD DMU-CPMS Joann Eble, MS KSUCPM Derek Talbot, DC SCPM Judith Litvin Daniels, PhD TUSPM Mathew Wedel, PhD WUCPM Physiology John Becker, PhD SCPM John VandenBrooks, PhD AZPod Sanjay Sesodia, PhD BUSPM Carol Gilson, PhD CSPM Kim Tran, PhD, DMU-CPMS Ronald Wright, PhD KSUCPM Patricia Wade, PhD NYCPM John S. Martin, PhD TUSPM Colleen Talbot, PhD WUCPM Microbiology/Immunology Kathryn Leyva, PhD AZPod Mary Premenko-Lanier, PhD CSPM Peter Barbosa, PhD NYCPM Ronald Wright, PhD KSUCPM Michael Fennewald, PhD SCPM Marion Chan, PhD TUSPM Gerald Thrush, PhD WUCPM 5 Pathology Mary Mooney, MD KSUCPM Dana Devine, DO AZPod Amiclar Castellano-Sanchez, MD BUSPM Henry Sanchez, MD CSPM Kevin Carnevale, MD DMU-CPMS Erin Klein, DPM SCPM Aileen Grace Arriola, MD TUSPM Edward Yoon, MD TUSPM Chaya Prasad, MD WUCPM Pharmacology Pamela Potter, PhD AZPod John Nelson, DPM BUSPM Richard Rocco, PhD CSPM Matthew Henry, PhD DMU-CPMS Kay Kyllonen, PharmD KSUCPM Ann Snyder, PhD SCPM Ziad Labbad, DPM, MD TUSPM Don Walters, PhD WUCPM Geriatrics Kent Myers, MD AZPod Ben Zier, MD CSPM Gregory Kolbinger, PA DMU-CPMS Abe Osbourne, DPM KSUCPM Anthony Iorio, DPM NYCPM Robert Joseph, PhD SCPM Anna Yeung, PhD TUSPM Medicine Edweana Robinson, MD KSUCPM William Finch, MD AZPod Jacqueline Buchman, DPM BUSPM Ben Zier, MD CSPM Richmond Robinson, DPM SCPM Tracey Vlahovic, DPM TUSPM Professionalism and Cultural Competencies Tanya Thoms, DPM AZPod Irma Walker-Adame, MS CSPM Rich Salas, PhD DMU-CPMS Abe Osbourne, DPM KSUCPM Johanna Godoy, DPM NYCPM Karona Mason, DPM SCPM Lesly Robinson, DPM TUSPM Kathleen Satterfield, DPM WUCPM 6 Radiology Larry Osher, DPM KSUCPM Janna Kroleski, DPM AZPod Albert Armstrong, DPM BUSPM Eric Stamps, DPM CSPM James Mahoney, DPM CPMS Jose Loor, DPM NYCPM Robert Joseph, DPM SCPM Ebony Love, DPM TUSPM Robert Christman, DPM WUCPM Orthopedics/Biomechanics Tanya Thoms, DPM AZPod Luis Rodriquez, DPM BUSPM Tim Dutra, DPM, MS, MHCA CSPM Scott Spencer, DPM KSUCPM Loretta Logan, DPM NYCPM Beth Jarrett, DPM SCPM James Furmato, PhD TUSPM Jarrod Shapiro, DPM WUCPM Surgery/Anesthesia Martin Yorath, DPM SCPM Don Curtis, DPM AZPod Louis Rodriguez, DPM BUSPM Ajitha Nair, DPM CSPM Kevin Smith, DPM CPMS Kevin Jules, DPM NYCPM Duane Ehredt, DPM KSUCPM Jane Pontious, DPM TUSPM Jennifer D'Amico, DPM WUCPM Community Health Adam Fleischer,DPM SCPM Andre Yorganson, DO AZPod Jimmy Trang, DPM BUSPM J.D. Shih, DPM CSPM John Bennett, DPM DMU-CPMS Tom Brewer, PhD, M.Jur, CHC KSUCPM Loretta Logan, DPM NYCPM Dyane Tower, DPM MS MPH SCPM Jacqueline Troung, DPM WUCPM Behavioral Medicine (new content area) James Mahoney, DPM DMU-CPMS M. Elicia Nademin, PhD, ABPP AZPod Edward Suarez, Jr., PsyD, LMHC BUSPM Sara West, MD KSUCPM Richmond C.O. Robinson, DPM SCPM Yadi Fernandez-Sweeney, PsyD, MS, CRNA WUCPM 7 Background The 2005 APMA House of Delegates adopted Resolution No. 2-05. This resolution charged APMA to do the following: RESOLVED, That the APMA commit
Recommended publications

  • Health Hazard Evaluation Report 1983-0019-1562

    r ILi:. llUr I Health Hazard . Evaluation HETA 83-019-1562 I BERLEX LABS. Report WAYNE., NEW JERSEY . "'-':'. ·· J· PREFACE .......~ The Hazard Evaluation~ ·- ~nd .. "rechni cal Assistance Branch of NIOSH conducts field i nyesti gations of possible hea.lth hazards i n the workplace. These investigations ~are conducted ~under the authority of Section 20(a)(6) of the Occupational Safety and.,Heal'ttr Act of 1970 , 29 u ~ s.c. 66~(a)(6) which authorizes t he Secretary of Health·and Human Services, following a written request from any employer of~ au~horized representative of employees, to determine whether any substance normally found in the place of employ~nt has potentiall~ toxic· .effects in such concentrations as used or fotmd. The Hazard Evaluations and Technical Assistance Branch also provides, upon request, medical, nursing, and industrial hygiene technical and consultative assistance (TA) to Federal, state, and local agencies; labor; industry and other groups or individuals to control occupational health hazards and to prevent related trauma and disease. Mention of company nair.es or products does not constitute e ndorsement by the National Institute for Occupational Safety and Health. HETA 83-019-1562 Investigators: SEPTEMBER, 1985 REVISED Raja Igliewicz, RN, MS BERLEX LABS. Michael Schmidt, MD WAYNE, NEW JERSEY Peter Gann, MD 1. SUMMARY In October, 1982, the National Institute for Occupational Safety and Health (NIOSH) received a request to evaluate workers involved in the production of a drug, quinidine gluconate at Berlex Laborateries, Wayne, N.J. These workers had developed work-related skin rashes and respiratory symptoms. Staff from the Occupational Health Program of the New Jersey State Department of Health performed the investigation under a cooperative agreement with NlOSH.

  • The Structure and Function of Breathing

    CHAPTERCONTENTS The structure-function continuum 1 Multiple Influences: biomechanical, biochemical and psychological 1 The structure and Homeostasis and heterostasis 2 OBJECTIVE AND METHODS 4 function of breathing NORMAL BREATHING 5 Respiratory benefits 5 Leon Chaitow The upper airway 5 Dinah Bradley Thenose 5 The oropharynx 13 The larynx 13 Pathological states affecting the airways 13 Normal posture and other structural THE STRUCTURE-FUNCTION considerations 14 Further structural considerations 15 CONTINUUM Kapandji's model 16 Nowhere in the body is the axiom of structure Structural features of breathing 16 governing function more apparent than in its Lung volumes and capacities 19 relation to respiration. This is also a region in Fascla and resplrstory function 20 which prolonged modifications of function - Thoracic spine and ribs 21 Discs 22 such as the inappropriate breathing pattern dis- Structural features of the ribs 22 played during hyperventilation - inevitably intercostal musculature 23 induce structural changes, for example involving Structural features of the sternum 23 Posterior thorax 23 accessory breathing muscles as well as the tho- Palpation landmarks 23 racic articulations. Ultimately, the self-perpetuat- NEURAL REGULATION OF BREATHING 24 ing cycle of functional change creating structural Chemical control of breathing 25 modification leading to reinforced dysfunctional Voluntary control of breathing 25 tendencies can become complete, from The autonomic nervous system 26 whichever direction dysfunction arrives, for Sympathetic division 27 Parasympathetic division 27 example: structural adaptations can prevent NANC system 28 normal breathing function, and abnormal breath- THE MUSCLES OF RESPIRATION 30 ing function ensures continued structural adap- Additional soft tissue influences and tational stresses leading to decompensation.
  • Trauma-Associated Pulmonary Laceration in Dogs—A Cross Sectional Study of 364 Dogs

    Trauma-Associated Pulmonary Laceration in Dogs—A Cross Sectional Study of 364 Dogs

    veterinary sciences Article Trauma-Associated Pulmonary Laceration in Dogs—A Cross Sectional Study of 364 Dogs Giovanna Bertolini 1,* , Chiara Briola 1, Luca Angeloni 1, Arianna Costa 1, Paola Rocchi 2 and Marco Caldin 3 1 Diagnostic and Interventional Radiology Division, San Marco Veterinary Clinic and Laboratory, via dell’Industria 3, 35030 Veggiano, Padova, Italy; [email protected] (C.B.); [email protected] (L.A.); [email protected] (A.C.) 2 Intensive Care Unit, San Marco Veterinary Clinic and Laboratory, via dell’Industria 3, 35030 Veggiano, Padova, Italy; [email protected] 3 Clinical Pathology Division, San Marco Veterinary Clinic and Laboratory, via dell’Industria 3, 35030 Veggiano, Padova, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-0498561098 Received: 5 March 2020; Accepted: 8 April 2020; Published: 12 April 2020 Abstract: In this study, we describe the computed tomography (CT) features of pulmonary laceration in a study population, which included 364 client-owned dogs that underwent CT examination for thoracic trauma, and compared the characteristics and outcomes of dogs with and without CT evidence of pulmonary laceration. Lung laceration occurred in 46/364 dogs with thoracic trauma (prevalence 12.6%). Dogs with lung laceration were significantly younger than dogs in the control group (median 42 months (interquartile range (IQR) 52.3) and 62 months (IQR 86.1), respectively; p = 0.02). Dogs with lung laceration were significantly heavier than dogs without laceration (median 20.8 kg (IQR 23.3) and median 8.7 kg (IQR 12.4 kg), respectively p < 0.0001). When comparing groups of dogs with thoracic trauma with and without lung laceration, the frequency of high-energy motor vehicle accident trauma was more elevated in dogs with lung laceration than in the control group.
  • A Hepatic Outflow Obstruction (Budd-Chiari Syndrome) Case Due

    A Hepatic Outflow Obstruction (Budd-Chiari Syndrome) Case Due

    OLGU SUNUMU / CASE REPORT Gülhane Tıp Derg 2014;56: 110-113 © Gülhane Askeri Tıp Akademesi 2014 doi: 10.5455/gulhane.13835 A Hepatic Outflow Obstruction (Budd-Chiari Syndrome) Case Due to Multiple Hypercoagulable Status Yusuf Yazgan (*), Kemal Oncu (*), Mustafa Kaplan (*), Alpaslan Tanoglu (*), İrfan Küçük (*), Halil Onur Ozari (*), Levent Demirturk (*), Murat Velioglu (**) Introduction: SUMMARY Primary Budd-Chiari syndrome (BCS) is a rare disorder We present here a case of a 22-year-old male patient with Budd- caused by thrombosis of the hepatic veins or the terminal Chiari syndrome owing to alliance of multiple hypercoagulable portion of the inferior vena cava. Its estimated incidence ranges conditions. The patient was admitted to our hospital for from 0.2 to 0.8 per million per year (1). In developed countries, assesment of hepatosplenomegaly and ascites. By doppler the hepatic vein thrombosis is the most frequent presentation, ultrasonography, computed tomography and vena cavagraphy, however in developing countries membranous blockade is the Budd-Chiari syndrome was diagnosed. Results of diagnostic tests most common cause of the BCS. BCS is closely associated exhibited decreased activity, decreased antigenic concentration of Antithrombin, low protein C activity, heterozygote Factor with prothrombotic conditions especially with hematologic V Leiden mutation. In clinical progress, acute severe hepatic disorders. For example primary myeloproliferative diseases failure with encephalopathy occured and the patient was (i.e. polycythemia vera) may account for nearly half of the transferred to an another medical center for liver transplantation. all cases (2). Tumors, pregnancy, infections are also other common reasons. Oral contraceptives raise the risk of BCS Key words: Budd-Chiari Syndrome, Antithrombin deficiency, low by nearly two-fold (3).
  • Antimicrobial Resistance and Disinfectants Susceptibility of Persistent Bacteria in a Tertiary Care Hospital

    Antimicrobial Resistance and Disinfectants Susceptibility of Persistent Bacteria in a Tertiary Care Hospital

    Journal of Microbiology and Antimicrobials Vol. 2(7), pp. xx-xx, October 2010 Available online http://www.academicjournals.org/JMA ISSN 2141-2308 ©2010 Academic Journals Full Length Research Paper Antimicrobial resistance and disinfectants susceptibility of persistent bacteria in a tertiary care hospital Maria Lucia Morcerf Bouzada1, Vania Lucia Silva1, Felipe Augusto Sa Moreira1, Girlene Alves Silva2 and Claudio Galuppo Diniz1* 1Department of Parasitology, Microbiology and Immunology, Laboratory of Bacterial Physiology and Molecular Genetics, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora/MG,36036-900, Brazil. 2Department of Applied Nursing, School of Nursing, Federal University of Juiz de Fora, Juiz de Fora/MG, 36036-900, Brazil. Accepted 22 October, 2010 It is well known that putative pathogenic bacteria are ubiquitous and widely distributed in the hospital environment. This study aimed to detect bacterial persistence in the nosocomial environment (different critical areas of the hospital) after mopping by the cleaning staff. Susceptibility patterns to antimicrobial drugs and disinfectants commonly used in health services were also investigated by disk diffusion and agar dilution tests. Rinse water from mops was processed for isolation of Enterobacteriaceae (GNR), non-fermenting Gram-negative rods (NFGNR), coagulase-negative staphylococci (CNS) and enterococci (ENT). Microorganisms were biochemically characterized and 547 strains were recovered. Only CNS and NFGNR were isolated in all critical areas. Overall 67% of the isolated bacteria were resistant to more than three drugs, being considered as multiresistant. Disinfectants were effective in concentrations ranging from 0.125 to 1%. Hospitals provide reservoirs of multiresistant microorganisms borne by patients and staff, but the hospital environment may be an important repository.
  • Pharmacology/Therapeutics Ii Block 1 Handouts – 2015-16

    Pharmacology/Therapeutics Ii Block 1 Handouts – 2015-16

    PHARMACOLOGY/THERAPEUTICS II BLOCK 1 HANDOUTS – 2015‐16 55. H2 Blockers, PPls – Moorman 56. Palliation of Contipation & Nausea/Vomiting – Kristopaitis 57. On‐Line Only – Principles of Clinical Toxicology – Kennedy 58. Anti‐Parasitic Agents – Johnson Histamine Antagonists and PPIs January 6, 2016 Debra Hoppensteadt Moorman, Ph.D. Histamine Antagonists and PPIs Debra Hoppensteadt Moorman, Ph.D. Office # 64625 Email: [email protected] KEY CONCEPTS AND LEARNING OBJECTIVES . 1 To understand the clinical uses of H2 receptor antagonists. 2 To describe the drug interactions associated with the use of H2 receptor antagonists. 3 To understand the mechanism of action of PPIs 4 To describe the adverse effects and drugs interactions with PPIs 5 To understand when the histamine antagonists and the PPIs are to be used for treatment 6 To describe the drugs used to treat H. pylori infection Drug List: See Summary Table. Histamine Antagonists and PPIs January 6, 2016 Debra Hoppensteadt Moorman, Ph.D. Histamine Antagonists and PPIs I. H2 Receptor Antagonists These drugs reduce gastric acid secretion, and are used to treat peptic ulcer disease and gastric acid hypersecretion. These are remarkably safe drugs, and are now available over the counter. The H2 antagonists are available OTC: 1. Cimetidine (Tagamet®) 2. Famotidine (Pepcid®) 3. Nizatidine (Axid®) 4. Ranitidine (Zantac®) All of these have different structures and, therefore, different side-effects. The H2 antagonists are rapidly and well absorbed after oral administration (bioavailability 50-90%). Peak plasma concentrations are reached in 1-3 hours, and the drugs have a t1/2 of 1-3 hours. H2 antagonists also inhibit stimulated (due to feeding, gastrin, hypoglycemia, vagal) acid secretion and are useful in controlling nocturnal acidity – useful when added to proton pump therapy to control “nocturnal acid breakthrough”.
  • Part 1 the Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3

    Part 1 the Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3

    ECA1 7/18/06 6:30 PM Page 1 Part 1 The Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3 Surface anatomy and surface markings The experienced clinician spends much of his working life relating the surface anatomy of his patients to their deep structures (Fig. 1; see also Figs. 11 and 22). The following bony prominences can usually be palpated in the living subject (corresponding vertebral levels are given in brackets): •◊◊superior angle of the scapula (T2); •◊◊upper border of the manubrium sterni, the suprasternal notch (T2/3); •◊◊spine of the scapula (T3); •◊◊sternal angle (of Louis) — the transverse ridge at the manubrio-sternal junction (T4/5); •◊◊inferior angle of scapula (T8); •◊◊xiphisternal joint (T9); •◊◊lowest part of costal margin—10th rib (the subcostal line passes through L3). Note from Fig. 1 that the manubrium corresponds to the 3rd and 4th thoracic vertebrae and overlies the aortic arch, and that the sternum corre- sponds to the 5th to 8th vertebrae and neatly overlies the heart. Since the 1st and 12th ribs are difficult to feel, the ribs should be enu- merated from the 2nd costal cartilage, which articulates with the sternum at the angle of Louis. The spinous processes of all the thoracic vertebrae can be palpated in the midline posteriorly, but it should be remembered that the first spinous process that can be felt is that of C7 (the vertebra prominens). The position of the nipple varies considerably in the female, but in the male it usually lies in the 4th intercostal space about 4in (10cm) from the midline.
  • Case Report a Case of a Patient Who Is Diagnosed with Mild Acquired Hemophilia a After Tooth Extraction Died of Acute Subdural Hematoma Due to Head Injury

    Case Report a Case of a Patient Who Is Diagnosed with Mild Acquired Hemophilia a After Tooth Extraction Died of Acute Subdural Hematoma Due to Head Injury

    Hindawi Case Reports in Dentistry Volume 2018, Article ID 7185263, 3 pages https://doi.org/10.1155/2018/7185263 Case Report A Case of a Patient Who Is Diagnosed with Mild Acquired Hemophilia A after Tooth Extraction Died of Acute Subdural Hematoma due to Head Injury Tomohisa Kitamura,1 Tsuyoshi Sato ,1 Eiji Ikami,1 Yosuke Fukushima,1 and Tetsuya Yoda2 1Department of Oral and Maxillofacial Surgery, Saitama Medical University, 38 Moro-hongou, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan 2Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan Correspondence should be addressed to Tsuyoshi Sato; [email protected] Received 13 September 2018; Revised 12 November 2018; Accepted 25 November 2018; Published 9 December 2018 Academic Editor: Yuk-Kwan Chen Copyright © 2018 Tomohisa Kitamura et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Acquired hemophilia A (AHA) is a rare disorder which results from the presence of autoantibodies against blood coagulation factor VIII. The initial diagnosis is based on the detection of an isolated prolongation of the activated partial thromboplastin time (aPTT) with negative personal and family history of bleeding disorder. Definitive diagnosis is the identification of reduced FVIII levels with evidence of FVIII neutralizing activity. Case report. We report a case of a 93-year-old female who was diagnosed as AHA after tooth extraction at her home clinic. Prolongation of aPTT and a reduction in factor VIII activity levels were observed with the presence of factor VIII inhibitor.
  • 1-Dr Zamirian

    1-Dr Zamirian

    IJMS Vol 32, No 1, March 2007 Original Article Contrast Enhanced Echocardiography for Detection of Intrapulmonary Shunts in Liver Transplant Candidates M. Zamirian, A. Aslani Abstract Background: Intrapulmonary vascular abnormalities associated with liver cirrhosis may result in intrapulmonary right-to-left shunt and hypoxemia. The aim of this study was to use con- trast enhanced echocardiography to detect intrapulmonary vascular abnormalities in patients with liver cirrhosis candi- dates for liver transplantation. Methods: One hundred and two adult patients underwent contrast enhanced echocardiography to determine the prevalence of in- trapulmonary right-to-left shunt and its relationship to the severity of hepatic disease, arterial oxygenation, and spider angioma. Results: The rate of patients with positive and negative con- trast enhanced echocardiography was 44% and 56%, respec- tively. There was no significant difference in age, sex, or eti- ology of liver cirrhosis in patients with and without intrapul- monary shunt. Patients with intrapulmonary right-to-left shunt had more severe hepatic disease compared with those without shunt (Child-Pugh score 12±2 vs 8±2). There was significant difference in the partial arterial oxygen pressure (PaO2) values + + in patients with grade 3 to 4 left ventricular opacification by microbubbles compared with those without evidence of in- trapulmonary right-to-left shunt (64±6 vs 82±10 mmHg). Twenty eight of the patients with intrapulmonary right-to-left shunt had cutaneous spider angioma. Conclusion: The findings suggest that there was a significant relation between severity of liver cirrhosis and presence of intrapulmonary right-to-left shunt or severity of hypoxemia. The data also indicate that cirrhotic patients with cutaneous spider angioma most likely have the shunt.
  • Identification of Genes Involved in Acid Tolerance, Antimicrobial Resistance and Virulence of Enterococcus Faecium

    Identification of Genes Involved in Acid Tolerance, Antimicrobial Resistance and Virulence of Enterococcus Faecium

    Identification of genes involved in acid tolerance, antimicrobial resistance and virulence of Enterococcus faecium Thesis submitted by Hashimatul Fatma binti Hashim For the degree of DOCTOR OF PHILOSOPHY in the Faculty of Medical Sciences University College London Division of Microbial Diseases UCL Eastman Dental Institute 256 Gray’s Inn Road London WC1X 8LD UK 2016 Declaration I hereby certify that the work embodied in this thesis is the result of my own investigation, except where otherwise stated. 2 Abstract Enterococcus faecium is an opportunistic human nosocomial pathogen that has developed resistance to many existing antimicrobial therapies. Treatment of enterococcal infections is becoming increasingly challenging and there are limited therapeutic options against multidrug-resistant enterococci. The work described in this thesis aimed to identify genes involved in resistance to host stresses and virulence as these could potentially be future therapeutic targets. An E. faecium transposon mutant library was screened for altered resistance to lysozyme and to nisin as a model antimicrobial peptide. This approach led to the identification of several genes that contribute to lysozyme and nisin resistance. A number of mutants that were sensitive to nisin had a transposon insertion in a gene predicted to encode a tyrosine decarboxylase. It was shown that the tyrosine decarboxylase plays a role in acid tolerance and mediates virulence of E. faecium in a Galleria mellonella larvae infection model. A targeted genetic approach was used to examine the role of an E. faecium serine threonine protein kinase (Stk1) in antimicrobials resistance, host cell stresses and virulence. Disruption of the stk1 gene led to higher sensitivity to antibiotics that target the penicillin- binding proteins and bile salts compared to the wild type.
  • Pediatric MSK Protocols

    Pediatric MSK Protocols

    UT Southwestern Department of Radiology Ankle and Foot Protocols - Last Update 5-18-2015 Protocol Indications Notes Axial Coronal Sagittal Ankle / Midfoot - Routine Ankle Pain Axial = In Relation to Leg "Footprint" (Long Axis to Foot) T1 FSE PD SPAIR T1 FSE Injury, Internal Derangement Coronal = In Relation to Leg (Short Axis Foot) PD SPAIR STIR Talar OCD, Coalition Protocol Indications Notes Axial Coronal Sagittal Ankle / Midfoot - Arthritis Arthritis Axial = In Relation to Leg "Footprint" (Long Axis to Foot) PD SPAIR PD SPAIR T1 FSE Coronal = In Relation to Leg (Short Axis Foot) STIR T1 SPIR POST T1 SPIR POST Protocol Indications Notes Axial Coronal Sagittal Foot - Routine Pain, AVN Axial = In Relation to Leg "Footprint" (Long Axis to Foot) T1 FSE PD FSE T1 FSE Coronal = In Relation to Leg (Short Axis Foot) PD SPAIR PD SPAIR STIR Protocol Indications Notes Axial Coronal Sagittal Foot - Arthritis Arthritis Axial = In Relation to Leg "Footprint" (Long Axis to Foot) T1 FSE PD SPAIR STIR Coronal = In Relation to Leg (Short Axis Foot) PD SPAIR T1 SPIR POST 3D WATS T1 SPIR POST Protocol Indications Notes Axial Coronal Sagittal Great Toe / MTP Joints Turf Toe Smallest Coil Possible (Microcoil if Available) PD FSE T1 FSE PD FSE Sesamoiditis FoV = Mid Metatarsal Through Distal Phalanges PD SPAIR PD SPAIR PD SPAIR Slice thickness = 2-3 mm, 10% gap Axial = In relation to the great toe (short axis foot) Coronal = In relation to the great toe (long axis foot / footprint) Appropriate Coronal Plane for Both Ankle and Foot Imaging UT Southwestern Department
  • Spontaneous Remission of Cancer and Wounds Healing

    Spontaneous Remission of Cancer and Wounds Healing

    Open Access Austin Journal of Surgery Special Article – Spontaneous Remission Spontaneous Remission of Cancer and Wounds Healing Shoutko AN1* and Maystrenko DN2 1Laboratory for the Cancer Treatment Methods, Saint Abstract Petersburg, Russia The associativity of the spontaneous cancer remission with surgical 2Department of Vascular Surgery, Saint Petersburg, trauma is considering in term of the competition of healing process outside the Russia tumor for circulating morphogenic cells, providing proliferation in any tissues *Corresponding author: Shoutko AN, Laboratory for with high cells renewing, malignant preferably. The proposed competitive the Cancer Treatment Methods, A.M. Granov Russian mechanism of Spontaneous cancer Remission phenomenon (SR) assumes Research Center for Radiology and Surgical Technologies, the partial distraction the trophic supply from tumor to offside tissues priorities, 70 Leningradskaya str., Pesochney, St. Petersburg, Russia like extremely high fetus growth, wound healing after incomplete resection, fight with infections, reparation of a multitude of non-malignant cells injured Received: September 24, 2019; Accepted: October 25, sub lethally by cytotoxic agents, and other kinds of an extra-consumption 2019; Published: November 01, 2019 the host lymphopoietic resource mainly in the conditions of its current deficit. The definition of a reduction of tumor morphogenesis discusses as preferable instead of the activation of anticancer immunity. Pending further developments, it assumes that the nature of the SR phenomenon is similar to the rough exhaustion of lymphopoiesis at conventional cytotoxic therapy. The main task for future investigations for more reproducible SR is to elucidate of the phase of a cyclic lymphopoietic process that is optimal for surgery outside the tumor as well as for other activities, provoked morphogenesis in surrounding tissues.