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Audience: This tutorial should be utilized for emergency medicine (EM) interns and junior residents. Introduction:Ophthalmology is characteristically a weak area in both medical school and resident education. Medical students are rarely given formal didactic education on the use of the slit lamp or a systematic approach to examining the eye. For EM residents, this leads to inefficient and uncomfortable encounters with patients with eye complaints. We sought to develop a comprehensive emergency ophthalmology tutorial utilizing asynchronous learning followed by a hands-on skill session that would address this need.Educational Objectives: By the end of this small group didactic, learners will be able to: 1) demonstrate ability to focus on the various components of the slit lamp exam 2) demonstrate understanding of a systematic approach to the eye exam 3) demonstrate appropriate use of the Diaton, iCare, and Tonopen tonometers.Educational Methods: This two-hour small group didactic combines hands-on learning sessions to learn the slit lamp exam and tonometry measurement, with a systematic review of the eye exam to help learners better organize their exams and understand the use of necessary tools.Research Methods: The emergency ophthalmology tutorial was initially designed as an education project in which we collected pre-and post-participation surveys regarding resident comfort with various components of the emergency eye exam. After the course residents received a post-course survey to complete. Given the positive feedback we received from our residents regarding the tutorial, we applied for Institutional Review Board (IRB) approval to publish our retrospective survey data. Our IRB waived the need for participant consent.Results: Twelve emergency medicine residents including 11 interns and one post-graduate year (PGY) 2 resident participated in the emergency ophthalmology tutorial as part of our intern boot camp in July of 2 SMALLgroups 2021. Twelve PGY-1 residents initially signed up for the course and filled out the pre-participation survey but one of them was not able to attend their scheduled class, so a PGY-2 resident requested to attend.Prior to the course, we used a Likert scale from 1-7, finding that 61.5% (8/13) of participants felt very uncomfortable with performing slit lamp exams, 84.6% (11/13) felt very uncomfortable with using the Diaton tonometer, 76.9% (10/13) felt very uncomfortable with using the iCare tonometer, and 69.3% (9/13) felt uncomfortable or very uncomfortable with using a systematic approach to examining the eye. After the course, 75% (9/12) of participants felt that the course exceeded expectations in ensuring their ability to perform the subcomponents of the slit lamp exam, 75% (9/12) and 83.3% (10/12) of participants felt that the course exceeded expectations in ensuring their ability to use the Diaton and iCare tonometers, respectively, and 91.7% (11/12) felt that the course exceeded expectations in ensuring their ability to perform a systematic eye exam.Discussion: Participation in...

Background Current guidelines and trials (OK04, KalMo) support the Highly-Active AntiRetroviral Therapy (HAART) simplification, but long-term experience with this treatment is still limited. Purpose To assess the Efficacy, Safety, Adherence and Costs related to HAART based on Ritonavir-boosted protease inhibitors (r/PI) versus the standard combinations based on reverse-transcriptase inhibitors (RTI) in long-term stable patients. Materials and methods The virological and immunological laboratory tests, the adverse events (AE) profile and the Karnofsky score, along with the pharmacy withdrawal registry and the calculated monthly costs per patient were monitored at 3, 6, 9 and 12 months after simplification and compared with the average for the previous period. Databases: Andalusian digital or paper medical records and the outpatient database (Farmatools). Results 13 patients were enrolled: 2 female versus 11 male, mean age: 44 years (29-68), mean HIV+ diagnosis and HAART: 61 months (3-88) and 53 months (4-93). Previous RTIs: emtricitabine/tenofovir, abacavir/lamivudine, abacavir/tenofovir and didanosine/lamivudine in 8, 3, 1 and 1 cases, respectively. HAART in the previous period included r/PIs (atazanavir/ritonavir, saquinavir/r and lopinavir/r) in 84% of the cases, though 92% were not maintained after simplification. Patients were switched to DRV/r and LPV/r in 11 and 2 cases, respectively. Comparative outcomes: sustained Viral Load <50 copies/mL (100% both groups) and CD4+ >350 cells/µL: 10 versus 11 patients (up to 76.9% of patients experienced increased lymphocyte levels after simplification). S (in the previous period): neurotoxicity (1 case), mild-to-moderate lipodystrophy (2) and cotrimoxazole-related skin disease (1). No noticeable AEs after simplification. Karnofsky: 100% (both groups). A: 5(±2) versus 2(±1) missed intakes. C: 859 versus 492€ (57.2% reduction). Conclusions In our cohort, monotherapy was an alternative at least as effective as traditional combinations. In addition, it showed better adherence and tolerance, plus remarkable reduction in costs. Therefore this study encourages us to trust the results of large trials intended to demonstrate favourable profiles in long-lasting treatments for selected patients.

OBJECTIVES: Pessaries are a common first-line therapy for pelvic organ prolapse and stress urinary incontinence (SUI). The primary objective was to determine if defecatory dysfunction was associated with pessary failure. The secondary objective was to determine other risk factors for pessary failure. MATERIALS AND METHODS: This was a retrospective cohort study of all women undergoing first pessary placement at one academic center from 4/2014-1/2017. Defecatory dysfunction was defined as the presence of constipation, rectal straining, rectal splinting, and/or incomplete defecation. Data were extracted from a standardized new patient intake form and the Pelvic Organ Prolapse Distress Inventory short form (PFDI-20) which all new patients complete. Pessary failure was defined as <1 year of pessary use and not using at most recent visit. RESULTS: Charts of 1,092 women were reviewed and 1,071 were included. Women who failed a pessary fitting were excluded. Mean age was 62 AE 15 years, mean BMI was 28 AE 6 kg/m 2 , mean parity was 2 AE 1, with 68% white, 73% menopausal, and 41% sexually active. Reason for pessary use included prolapse (46%), SUI (24%), or both (30%). Overall pessary failure rate was 77%. The overall rate of defecatory dysfunction was 45%. Factors associated with pessary failure included defecatory dysfunction symptoms of incomplete defecation (p < 0.001) and rectal splinting (p ¼ 0.001), as well as rectocele (p ¼ 0.031), fecal incontinence (p ¼ 0.002), diarrhea (p ¼ 0.046), absence of bulge symptoms (p < 0.001), lesser degree of prolapse on examination (p ¼ 0.003), SUI as reason for pessary use (p < 0.001), younger age (p < 0.001), Hispanic race (p ¼ 0.001), and being sexually active (p < 0.001). In a logistic regression model, defecatory dysfunction in the form of incomplete defecation remained significantly associated with pessary failure (OR ¼ 3.29, 95% CI ¼ 1.43-7.52). Absence of bulge symptoms (OR ¼ 2.18, 95% CI ¼ 1.22-3.90) and younger age (OR ¼ 1.02, 95% CI ¼ 1.02-1.05) also remained significantly associated with pessary failure. CONCLUSION: Pessary failure was common, with over two-thirds of the study population not achieving long-term use. Defecatory dysfunction in the form of incomplete defecation had the strongest association with pessary failure. Women with incomplete defecation were three times as likely to fail pessary use compared to those without this form of defecatory dysfunction. Other predictors of pessary failure included absence of bulge symptoms and younger age. Understanding predictive factors of pessary failure may help guide clinicians and patients when choosing treatment options for pelvic floor dysfunction. OBJECTIVES:To identify risk factors for inpatient admission after laparoscopic and robot-assisted myomectomy to improve preoperative counseling and postoperative care. MATERIALS AND METHODS: Retrospective cohort study including patients undergoing minimally invasive myomectomy from January 2014 to December 2016 at an urban university hospital center by fellowship trained m...

La Esquistosomiasis constituye la enfermedad parasitaria producida por helmintos de mayor importancia a nivel mundial. El diagnóstico se realiza con el hallazgo de huevos del parásito, aunque en ocasiones, para alcanzar un diagnóstico definitivo, hay que recurrir a pruebas mínimamente invasivas como la cistoscopia. El tratamiento de elección es el praziquantel. El objetivo de este trabajo fue determinar y evaluar la prevalencia de Esquistosomiasis vesical, su tratamiento y la realización de pruebas diagnósticas en pacientes con Esquistosomiasis genitourinaria. Para ello se realizó un estudio retrospectivo de 4 años de duración en un hospital comarcal. Variables recogidas: demográficas, parasitación concomitante, patologías asociadas, otros síntomas (hematuria, eosinofilia), confirmación diagnóstica, biopsia vesical, exploraciones complementarias (ecografía, radiología, cistoscopia flexible), tratamiento y necesidad de re-tratamiento. Se trataron a 247 pacientes con Esquistosomiasis genitourinaria. Se realizó cistoscopia a 44 pacientes, presentando 28 de ellos hallazgos significativos compatibles con Esquistosomiasis. Todos los pacientes recibieron tratamiento con praziquantel, de los cuales 22 fueron retratados. La elevada prevalencia de Esquistosomiasis entre la población inmigrante exige una alto nivel de sospecha clínica en estos pacientes, sobre todo cuando presentan hematuria. La cistoscopia flexible permite obtener confirmación diagnóstica de la enfermedad. El tratamiento con praziquantel presenta buena tolerancia y elevada tasa de curación.