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Hwang J.,San Antonio Uniformed Services Health Education Consortium
Journal of Family Practice | Year: 2015

Our patient's history provided 2 important clues (one vascular, one not) to explain the painless ulcer that had been on his right shin for a year. A punch biopsy made the diagnosis clear. © 2015, Dowden Health Media, Inc. All rights reserved.


Coombs J.B.,Joint Venture Hospital | Coombs B.L.,Des Moines University | Chin E.J.,San Antonio Uniformed Services Health Education Consortium
Journal of Emergency Medicine | Year: 2014

Background Acute spontaneous subdural hematomas (ASSDH) occur by a variety of pathological processes and are less common than trauma-related acute subdural hematomas (SDH). Both types are usually seen in the elderly, and only 22 cases of ASSDH in patients aged < 40 years have been reported in the medical literature. Objectives: We report a rare case of ASSDH in a middle-aged male with no previous history of head trauma. A literature review comparing the clinical presentations, etiologies, incidence, mortality rates, and prognostic factors of ASSDH in various age groups is discussed. Case Report A 37-year-old man presented to the Emergency Department with headaches, myalgias, and vomiting. Noncontrast computed tomography revealed a unilateral ASSDH with 9 mm of midline shift, despite a normal neurological examination. Upon admission, the patient developed an abducens palsy suggesting increased intracranial pressure and underwent an urgent hemicraniectomy. Pathological sampling revealed large atypical cells indicative of a hematopoietic neoplasm, but various advanced imaging modalities failed to identify signs of cerebral tumor, vascular malformation, or arterial extravasation. Conclusion Given the rarity of SDH in nonelderly patients, this case suggests a broader differential diagnosis for nontraumatic headaches to include arterial and even neoplastic origins. Our literature review confirms the paucity of reported incidences of ASSDH, yet reminds medical providers to closely monitor for developing neurological symptoms and initiate prompt medical intervention when necessary. © 2014 Elsevier Inc.


Xia Y.,San Antonio Uniformed Services Health Education Consortium | Cho S.,Dermatology Clinic | Howard R.S.,U.S. Army | Maggio K.L.,U.S. Army
Journal of the American Academy of Dermatology | Year: 2012

Background: Pseudofolliculitis barbae (PFB) significantly impacts the military population, especially deployed personnel. Objective: This study was designed to determine whether the addition of topical eflornithine to hair laser treatment would improve efficacy in treating PFB. Methods: This was a randomized, double-blinded, placebo-controlled, paired (right and left neck) comparison study examining a combination of eflornithine and hair laser versus placebo and hair laser for the treatment of PFB. In all, 27 male patients with clinical PFB were treated with a long-pulsed neodymium:yttrium-aluminum-garnet laser with an energy fluence of 25 to 30 J/cm2, a pulse duration of 20 to 30 milliseconds, and a 10-mm spot size to the entire bearded neck region. The laser treatment was performed every 4 weeks for a total of 16 weeks. Between laser treatments, patients applied eflornithine and placebo creams twice daily to opposite sides of the bearded neck region. The number of hairs and inflammatory papules were counted bilaterally at each visit. Results: The eflornithine side had a statistically significant decrease in the number of hairs and inflammatory papules compared with the placebo side. At 16 weeks, the eflornithine side had a median hair reduction of 99.5% from baseline (range 48.5%-100.0%), whereas the placebo side had an 85.0% median hair reduction from baseline (range 50.5%-94.5%), P less than.001. Limitations: Patients were not followed up beyond 16 weeks. Conclusion: The addition of topical eflornithine to hair laser treatment decreased hairs and inflammatory papules faster when compared with hair laser therapy alone in the treatment of PFB.


Knight R.B.,San Antonio Uniformed Services Health Education Consortium | Hudak S.J.,San Antonio Military Medical Center | Morey A.F.,Southwestern Medical Center
Urologic Clinics of North America | Year: 2013

This article presents a review of the literature regarding surgical techniques and outcomes for reconstruction of strictures involving the upper ureter. The preoperative assessment for proximal ureteral stricture is briefly reviewed, followed by a discussion of ureteroureterostomy, transureteroureterostomy, ureterocalicostomy, bladder flaps, downward nephropexy, bowel interposition grafts, onlay or tubular grafting, renal autotransplantation, and nephrectomy. The future direction for reconstruction of the proximal ureter is proposed. © 2013.


Flanagan B.A.,U.S. Air force | Collins C.,San Antonio Uniformed Services Health Education Consortium | Parra S.,San Antonio Uniformed Services Health Education Consortium
Cutis | Year: 2012

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominant disorder. The disease has been formally characterized with epistaxis, cutaneous and mucosal telangiectases, a first-degree relative with HHT, and visceral lesions such as arteriovenous malformations (AVMs). Hereditary hemorrhagic telangiectasia has been underreported for many years. Wider recognition of this disorder in recent years has prompted researchers and physicians to recognize milder cases and focus on earlier treatment. This article highlights different treatments used to control epistaxis and screen for other complications associated with HHT. © Cutis 2012.


Elam C.A.L.,San Antonio Uniformed Services Health Education Consortium | McCleskey M.P.E.,U.S. Air force
Pediatric Dermatology | Year: 2014

We report a neonate who presented at birth with multiple, scattered, white macerated plaques. Punch biopsy confirmed epidermal nevi. At 3 months of age the patient presented with infantile spasms and, after full evaluation, was diagnosed with tuberous sclerosis complex (TSC). We suggest that physicians consider TSC in a neonate with epidermal nevi inconsistent with any described epidermal nevus syndrome. © Published 2012. This article is a U.S. Government work and is in the public domain in the USA.


Kalwerisky K.,San Antonio Uniformed Services Health Education Consortium | Davies B.,San Antonio Uniformed Services Health Education Consortium | Mihora L.,San Antonio Uniformed Services Health Education Consortium | Czyz C.N.,262 Neil Avenue | And 2 more authors.
Ophthalmology | Year: 2012

Purpose: To report the use of the Boston Ocular Surface Prosthesis (BOSP) in patients with severe periorbital thermal injuries. Design: Retrospective, interventional case series. Participants: Patients with severe periorbital thermal injuries treated with the BOSP. Methods: Chart review of 10 consecutive patients (16 eyes) who sustained severe periorbital thermal injuries during combat missions in Iraq and Afghanistan and were treated for exposure keratopathy with the BOSP, a Food and Drug Administration-approved gas-permeable, scleral contact lens. Main Outcome Measures: Corneal epithelial defect healing, uncorrected and best-corrected visual acuity, and BOSP wear time. Results: Exposure keratopathy occurred after severe periorbital thermal injuries and followed a predictable course of scar contracture. In all patients, vision-threatening ocular surface disease developed as a result of chronic ocular exposure. Rehabilitation of the ocular surface was accomplished using the BOSP, with 10 of the 16 treated eyes achieving a corrected visual acuity of 20/70 or better. Five eyes achieved a best-corrected visual acuity of 20/40 or better. The BOSP also was used as a drug-delivery vehicle to treat corneal ulcers successfully in 6 eyes. The only eye that required penetrating keratoplasty was an early intervention believed to be a direct sequelae of the original thermal burn, rather than a failure of the BOSP regimen. The mean BOSP wear time was 16 hours per day. Conclusions: The BOSP can play an important role in rehabilitation of the ocular surface for patients with severe periorbital thermal injuries and resultant exposure keratopathy. Use of the BOSP should be considered as a treatment option for these difficult cases of severe periorbital thermal injuries. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.


Peacock J.G.,San Antonio Uniformed Services Health Education Consortium | Grande J.P.,Mayo Medical School
Medical Teacher | Year: 2016

Purpose: The authors presented their results in effectively using a free and widely-accessible online app platform to manage and teach a first-year pathology course at Mayo Medical School. Methods used: The authors utilized the Google "Blogger", "Forms", "Flubaroo", "Sheets", "Docs", and "Slides" apps to effectively build a collaborative classroom teaching and management system. Students were surveyed on the use of the app platform in the classroom, and 44 (94%) students responded. Results: Thirty-two (73%) of the students reported that "Blogger" was an effective place for online discussion of pathology topics and questions. 43 (98%) of the students reported that the "Forms/Flubaroo" grade-reporting system was helpful. 40 (91%) of the students used the remote, collaborative features of "Slides" to create team-based learning presentations, and 39 (89%) of the students found those collaborative features helpful. "Docs" helped teaching assistants to collaboratively create study guides or grading rubrics. Overall, 41 (93%) of the students found that the app platform was helpful in establishing a collaborative, online classroom environment. Conclusions: The online app platform allowed faculty to build an efficient and effective classroom teaching and management system. The ease of accessibility and opportunity for collaboration allowed for collaborative learning, grading, and teaching. © 2015 Informa UK Ltd.


Bowe S.N.,San Antonio Uniformed Services Health Education Consortium
Otolaryngology - Head and Neck Surgery (United States) | Year: 2016

Objectives The Clinical Learning Environment Review focuses on the responsibility of the sponsoring institution for quality and patient safety. Very little information is known regarding the status of quality improvement (QI) education during otolaryngology training. The purpose of this survey is to evaluate the extent of resident and faculty participation in QI and identify opportunities for both resident curriculum and faculty development. Study Design Cross-sectional survey Subjects and Methods A 15-item survey was distributed to all 106 otolaryngology program directors. The survey was developed after an informal review of the literature regarding education in QI and patient safety. Questions were directed at the format and content of the QI curriculum, as well as barriers to implementation. Results There was a 39% response rate. Ninety percent of responding program directors considered education in QI important or very important to a resident's future success. Only 23% of responding programs contained an educational curriculum in QI, and only 33% monitored residents' individual outcome measures. Barriers to implementation of a QI program included inadequate number of faculty with expertise in QI (75%) and competing resident educational demands (90%). Every program director considered morbidity and mortality conferences as an integral component in QI education. Conclusions Program directors recognize the importance of QI in otolaryngology practice. Unfortunately, this survey identifies a distinct lack of resources in support of these educational goals. The results highlight the need to generate a comprehensive and stepwise approach to QI for faculty development and resident instruction. © 2015 American Academy of Otolaryngology-Head and Neck Surgery Foundation.


Peacock J.G.,San Antonio Uniformed Services Health Education Consortium | Grande J.P.,Rochester College
Biochemistry and Molecular Biology Education | Year: 2015

In 2006, small blocks of flexible curriculum time, termed selectives, were implemented in the Mayo Medical School preclinical curriculum. Selectives permitted students to pursue professional endeavors, such as research, service, and career exploration, in the preclinical years. The purpose of this study was to survey current and former Mayo medical students regarding the impact of selectives on their research interest and productivity. The authors surveyed 377 current and former Mayo Medical School students from the 2004 to 2014 graduating classes, 154 participants (41% response rate) responded to the survey. The classes were grouped into pre- and postselective groups for the comparison studies. Postselective students published significantly more (p=0.003) and gave significantly more presentations (p=0.0007) during medical school than preselective students. Thirty-four (72% of the postselective respondents) indicated that selectives had a strong or very strong impact on their current research interest. Respondents spent an average of 4.0 [3.0-5.0] weeks of Selective time on research, resulting in 1.8 [1.4-2.2] publications and 1.8 [1.4-2.2] presentations, which represented 52.5% [40.0-65.0%] and 47.3% [37.1-57.4%] of the students' total medical school publications and presentations, respectively. Flexible selective time during the preclinical years results in significantly more medical student academic productivity. © 2015 The International Union of Biochemistry and Molecular Biology.

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