A 9-year-old boy with exertional syncope.

BACKGROUND: Syncope in the pediatric population is a common and mostly benign event. There is a subset of patients, however, in whom exertional syncope is the manifestation of a life-threatening cardiac abnormality. OBJECTIVE: We present a rare but serious cause of syncope in children that often presents as sudden cardiac death. CASE REPORT: A 9-year-old boy presented to the Emergency Department (ED) after an episode of exertional syncope while in physical education class. This was the patient's second episode of exercise-induced syncope within a 2-year period. There was no family history of sudden death or cardiac disease. The child had not undergone any prior diagnostic work-up for the syncope. He was admitted to the hospital for further evaluation, and was found to have an anomalous left coronary artery on transthoracic echocardiogram. CONCLUSION: As a potential precursor of sudden death, exertional syncope in pediatric patients should prompt a thorough evaluation for a cardiac etiology.

Managing hypertension in the elderly: a common chronic disease with increasing age.

BACKGROUND: Hypertension increases with age, affecting approximately 66% of the elderly population (aged ≥65 years). By the year 2030, 1 of 5 Americans will be aged ≥65 years. A number of placebo-controlled clinical trials have demonstrated that blood pressure (BP) control reduces cardiovascular events in elderly patients, even in those aged >80 years. Despite advances in medical care, hypertension control rates remain low, especially in the elderly population. OBJECTIVE: The goal of this article is to review the information that addresses hypertension in the elderly and current strategies that can facilitate improvement in the management of this common, chronic, and life-threatening condition, which is often undertreated or inappropriately managed. DISCUSSION: The goals and strategies of treating hypertension in the elderly population are different from, and more challenging than, those in younger patients. Lifestyle modification is effective in this population, but it is difficult to maintain. Many antihypertensive medications are available, with thiazide diuretics being the preferred first-line treatment. Beta-blockers and alpha-blockers are generally not recommended in this population. A majority of older patients will require 2 or 3 antihypertensive medications to reach BP goal. This article reviews current data on hypertensive treatment in the elderly and summarizes the strategies and challenges healthcare providers face when dealing with this population. CONCLUSION: Understanding the strategies and challenges that apply to the management of hypertension in the US elderly population can help providers and payers better address the growing need for improving the management of this condition in the elderly, because their numbers are expected to increase dramatically in the coming decades.

Diabetes medications and cancer risk: review of the literature.

BACKGROUND: Cancer and diabetes are major public health problems for the United States and the world. Diabetes remains the leading cause of blindness, kidney failure, and nontraumatic lower limb amputation, whereas cancer continues to be a major cause of death, accounting for approximately 1 of 4 deaths in the United States. Recently, a potential link between diabetes and cancer has been suggested in the medical literature. OBJECTIVE: To review the current literature on any potential link between diabetes medications and the risk for cancer. DISCUSSION: Increasing evidence suggests that diabetic patients are at increased risk of developing cancer. The exact mechanism for the increased cancer risk in patients with diabetes is unknown. Because of a potential correlation between diabetes and cancer, studies are emerging that evaluate the cancer risk of medications used to treat diabetes. This article reviews the current data in the literature regarding the association between the various drug classes indicated for the treatment of diabetes and cancer development or prevention. CONCLUSION: Despite many studies showing a correlation between some medications for diabetes and the development of cancer, there is no clear evidence of a direct causation between these drugs and cancer. Therefore, providers and patients should continue to use medications to control diabetes as before, because the correlation between uncontrolled diabetes and cancer is stronger than the correlation between medications for diabetes and cancer.

Rural immersion as an instructional method in northern community health.

In 2004, a class of six students traveled with three faculty mentors to seven Alaska communities as part of a course designed to ground young researchers' aspirations in the pragmatics of collaborative, community-based research. This paper, authored by the students involved, discusses the process from start to finish. Beginning researchers in rural health are often daunted not by a lack of ability or ideas, but by basic issues of logistics, trust and respect. Unfortunately, they tend to remain unacquainted with these considerations until something goes wrong, and come to frame the research process as a succession of hindrances to be overcome rather than a fluid and collaborative endeavor. By placing students in working relationships with rural residents and Native elders at an early stage, the project aims to minimize common missteps and shorten the learning curve. It is hoped that our experiences can point the way toward similar efforts.

The separation of hypericin's enantiomers and their photophysics in chiral environments.

We report the first separation of the enantiomers of hypericin. Their steady-state optical spectra and ultrafast primary photoprocesses are investigated in chiral environments. Within experimental error, there is no difference between the two enantiomers in any of the systems considered. This is consistent with the emerging picture that the rich and extended absorption spectrum of hypericin is not a result of ground-state heterogeneity. It is also consistent with the observation that the spectra and photophysics of hypericin are generally insensitive to environments in which it does not aggregate.