A lymphoma patient with Cytomegalovirus retinitis and post-autologous hematopoietic cell transplantation immune reconstitution uveitis: A case report and review of the literature.

Cytomegalovirus (CMV) retinitis in hematologic malignancies in the absence of hematopoietic cell transplant (HCT) is uncommon. We report a case of a 54-year-old woman with peripheral T-cell lymphoma who develops CMV retinitis and subsequently undergoes an autologous HCT, with eventual development of immune reconstitution uveitis. We further reviewed the PubMed literature on CMV retinitis in patients with lymphoma. We describe that CMV retinitis in patients with lymphoma has variable clinical presentations, may occur at any time during the course of the disease and chemotherapy, and is associated with significant morbidity.

Teaching a perspective-taking component skill to children with autism in the natural environment.

We evaluated procedures for teaching three children diagnosed with autism spectrum disorder the perspective-taking component skill of tacting what others are sensing across all five senses: see, taste, feel, hear, and smell. Using a multiple baseline across participants design, we evaluated a training package consisting of multiple exemplar training, reinforcement, and error correction. The treatment package was implemented in the natural environment and was effective for teaching participants to tact what others sensed. Generalization across untrained stimuli and people was observed from baseline to posttraining for all participants. We discuss how this component skill may be related to teaching further skills related to perspective taking such as tacting what others know, predicting future behavior based upon one's beliefs, and creating false beliefs in others for the purpose of adaptive deceptive behaviors such as keeping secrets, surprises, and bluffing during games.

Improving Infusion Pump Safety Through Usability Testing.

With the recognition that the introduction of new technology causes changes in workflow and may introduce new errors to the system, usability testing was performed to provide data on nursing practice and interaction with infusion pump technology. Usability testing provides the opportunity to detect and analyze potentially dangerous problems with the design of infusion pumps that could cause or allow avoidable errors. This work will reduce preventable harm through the optimization of health care delivery.

Comparison of force exerted on the sternum during a sneeze versus during low-, moderate-, and high-intensity bench press resistance exercise with and without the valsalva maneuver in healthy volunteers.

Sternal precautions are intended to prevent complications after median sternotomy, but little data exist to support the consensus recommendations. To better characterize the forces on the sternum that can occur during everyday events, we conducted a prospective nonrandomized study of 41 healthy volunteers that evaluated the force exerted during bench press resistance exercise and while sneezing. A balloon-tipped esophageal catheter, inserted through the subject's nose and advanced into the thoracic cavity, was used to measure the intrathoracic pressure differential during the study activities. After the 1 repetition maximum (1-RM) was assessed, the subject performed the bench press at the following intensities, first with controlled breathing and then with the Valsalva maneuver: 40% of 1-RM (low), 70% of 1-RM (moderate), and 1-RM (high). Next, various nasal irritants were used to induce a sneeze. The forces on the sternum were calculated according to a cylindrical model, and a 2-tailed paired t test was used to compare the mean force exerted during a sneeze with the mean force exerted during each of the 6 bench press exercises. No statistically significant difference was found between the mean force from a sneeze (41.0 kg) and the mean total force exerted during moderate-intensity bench press exercise with breathing (41.4 kg). In conclusion, current guidelines and recommendations limit patient activity after a median sternotomy. Because these patients can repeatedly withstand a sneeze, our study indicates that they can withstand the forces from more strenuous activities than are currently allowed.

Takayasu retinopathy presenting as amaurosis fugax in a young patient.

PURPOSE: The purpose of this article was to report a case of Stage 3 Takayasu retinopathy with marked venous staining. METHODS: Case report with funduscopic, fluorescein angiography, computed tomography angiography, and magnetic resonance imaging angiography correlations. RESULTS: A 25-year-old woman presented with Stage 3 Takayasu retinopathy with striking venous staining while maintaining visual acuity of 20/30 because of arterial collateralization to the internal carotid arteries. CONCLUSION: Patients with Takayasu arteritis should be evaluated promptly for Takayasu retinopathy even with good vision because stenosis of major vessels off the aorta is associated with worse visual prognosis.

Medulloblastoma presenting as consecutive esotropia after successful lateral rectus muscle recession for infantile exotropia.

Comitant infantile exotropia is a rare entity and is far less common than infantile esotropia. It has been shown to be highly correlated with intracranial pathology. We report a case of a medulloblastoma in a child in whom it presented as an incomitant esotropia after surgical correction for comitant infantile exotropia.

Cecocentral scotoma as the initial manifestation of subacute bacterial endocarditis.

INTRODUCTION: We report a case of a 67-year-old male who presented with a cecocentral scotoma caused by a septic embolus from subacute bacterial endocarditis (SBE). METHODS: A 67-year-old man presented with sudden, painless decreased vision in the left eye. A dilated fundoscopic exam, Humphrey visual field test, transthoracic echocardiogram, abdominal computed tomography (CT), and blood cultures were all performed. RESULTS: A dilated fundoscopic exam revealed temporal segmental optic disc pallor on the left, and Humphrey visual field testing demonstrated a dense left cecocentral scotoma. When the patient developed fever (103. 9°F) and palpitations, transthoracic echocardiogram revealed valvular vegetations, and contrast CT of the abdomen revealed an abscess in the dome of the liver likely due to an infectious thrombus. Blood cultures grew viridians group streptococci in three separate peripheral collections. CONCLUSION: This case illustrates that a sudden cecocentral scotoma may be the initial manifestation of SBE.

Myocardial work during endurance training and resistance training: a daily comparison, from workout session 1 through completion of cardiac rehabilitation.

Patients in cardiac rehabilitation are typically advised to complete a period of supervised endurance training before beginning resistance training. In this study, however, we compared the peak rate-pressure product (RPP, a calculated indicator of myocardial work) of patients during two types of exercise-treadmill walking and chest press-from workout session 1 through completion of cardiac rehabilitation. Twenty-one patients (4 women and 17 men, aged 35 to 70 years) were enrolled in the study; they were referred for cardiac rehabilitation after myocardial infarction, percutaneous coronary intervention, or both. The participants did treadmill walking and chest press exercises during each workout session. Peak values for heart rate (HR) and systolic blood pressure (SBP) were recorded, and the peak RPP was calculated (peak HR multiply sign in box peak SBP). Paired t tests were used to compare the data collected during the two types of exercise across 19 workout sessions. The mean peak values for HR, SBP, and RPP were lower during resistance training than during endurance training; the differences were statistically significant (P < 0.05), with only one exception (the SBP for session 1). Across all 19 workout sessions, the participants performed more myocardial work, as indicated by the peak RPP, during treadmill walking than during the chest press.

Measurement of functional capacity requirements of police officers to aid in development of an occupation-specific cardiac rehabilitation training program.

This study was designed to measure the functional capacity of healthy subjects during strenuous simulated police tasks, with the goal of developing occupation-specific training for cardiac rehabilitation of police officers. A calibrated metabolic instrument and an oxygen consumption data collection mask were used to measure the oxygen consumption and heart rates of 30 Dallas Police Academy officers and cadets as they completed an 8-event obstacle course that simulated chasing, subduing, and handcuffing a suspect. Standard target heart rates (85% of age-predicted maximum heart rate, or 0.85 x [220 - age]) and metabolic equivalents (METs) were calculated; a matched-sample t test based on differences between target and achieved heart rate and MET level was used for statistical analysis. Peak heart rates during the obstacle course simulation were significantly higher than the standard target heart rates (those at which treadmill stress tests in physicians' offices are typically stopped) (t(29) = 12.81, P < 0.001) and significantly higher than the suggested maximum of 150 beats/min during cardiac rehabilitation training (t(29) = 17.84, P < 0.001). Peak MET levels during the obstacle course simulation were also significantly higher than the goal level (8 METs) that patients typically achieve in a cardiac rehabilitation program (t(29) = 14.73, P < 0.001). We conclude that police work requires a functional capacity greater than that typically attained in traditional cardiac rehabilitation programs. Rehabilitation professionals should consider performing maximal stress tests and increasing the intensity of cardiac rehabilitation workouts to effectively train police officers who have had a cardiac event.

Challenging traditional activity limits after coronary artery bypass graft surgery: a simulated lawn-mowing activity.

PURPOSE: Physician advice and restrictions to patients following a cardiac event can, in some instances, lead patients to be fearful regarding their activities even to the point of inactivity. The purpose of this study was to test whether lawn mowing, one of the activities most strongly discouraged after coronary artery bypass surgery, could be safely performed in a supervised setting. METHOD: Subjects participated in a 6-session simulated lawn-mowing protocol, calibrated to match the push and pull forces of using an outdoor nonpropelled lawn mower. Plain chest radiographs were taken before and after the protocol period. During each session, subjects' sternums were carefully palpated and electrocardiograms, heart rates, and blood pressures were monitored. RESULTS: None of the 13 subjects experienced adverse arrhythmia events or detrimental heart rate, blood pressure, or sternal palpation findings that led to study discontinuation. The radiographs taken after protocol completion showed stable sternal wires with no evidence of sternal dehiscence. CONCLUSION: Simulated lawn mowing did not negatively affect the sternal incision, electrocardiogram findings, blood pressure, or heart rate in this small sample.

A community-based organization's integration of HIV and substance abuse treatment services for ex-offenders.

This paper explores the point of intersection of the substance abuse treatment and HIV services industries with the criminal justice system. Section I reviews the literature and "best practices" that have integrated substance abuse treatment and HIV care and prevention services for ex-offenders and which informed the development of a community- based organization's initiative, the VIP STRIVE Project. Section II presents a brief history of VIP in the context of its ability to adapt to its environment and to the changing needs of its target population,with specific reference to the development of HIV and substance abuse treatment services for members of the criminal justice population. The concluding section brings the two previous sections together by explaining how the VIP STRIVE Project can assist VIP in enhancing its capacity to integrate its substance abuse treatment and HIV services in order to improve services for this target population.