Development of a novel sports medicine rotation for emergency medicine residents.

Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational experience when compared to the traditional orthopedics rotation. All SC residents successfully completed their sports medicine rotation, had completed postrotation evaluations by attending physicians, and had no duty hour violations while on sports medicine. In our experience, a sports medicine rotation is an effective alternative to the traditional orthopedics rotation for EM residents.

Combination therapy with terbinafine and amphotericin B in a rabbit model of experimental invasive aspergillosis.

Antagonistic effects of combination therapy using amphotericin B (AmB) with agents which block ergosterol synthesis are a concern. Terbinafine was evaluated with AmB to assess antagonism or synergy in a rabbit model of invasive aspergillosis. Terbinafine had relatively little activity but did not demonstrate antagonism against AmB in our model.

Proteinase detection, DNA typing and antimycotic susceptibility of Candida isolates from Colombian women with vulvovaginal candidiasis.

Forty non-pregnant Colombian women (ages 18-45) with vulvovaginal candidiasis diagnosis (VVC) were enrolled in a blinded study to compare the efficacy of Itraconazole (ITRA) 400 mg vs. Fluconazole (FLU) 150 mg. Sexual partners received similar therapy. Proteinase detection by the Staib method and minimal inhibitory concentration (MIC) for FLU and ITRA by Etest method were performed in all Candida isolates. Patients were followed one year to determine clinical evolution and recurrence of VVC (RVVC). The strain identity of the RVVC isolates was determined by contour-clamped homogeneous electric field (CHEF) gel electrophoresis karyotyping and restriction fragment length polymorphism (RFLP). Thirty patients (75%) had one or two episodes of VVC/year, 83% of these were due to Candida albicans, while ten patients (25%) developed RVVC (three or more episodes/year); seven of them were treated with FLU. Non-C. albicans Candida species were detected in five of 30 (17%) of the patients with VVC and in seven of ten (70%) patients with RVVC (p=0.003). Isolates from nineteen patients were proteinase positive. Proteinase production and type of treatment were not related to recurrence of VVC (p>0.05). DNA typing revealed that in this population RVVC might be due to the same strain, substrain shuffling or different strains and species.