Acute gastric dilatation in a patient with severe anorexia nervosa: a case report.

BACKGROUND: Acute gastric dilatation (AGD) leading to gastric necrosis and perforation has been reported to be a rare but fatal complication in young patients with eating disorders, particularly anorexia nervosa. CASE PRESENTATION: We report a case of a Canadian female patient presenting with mild abdominal pain, with a history of anorexia nervosa, the binge/purge subtype, who was found to have severe acute gastric dilatation on subsequent computed tomography imaging. Her clinical course was uncomplicated after gastric decompression. The cause of her AGD was thought to be secondary to dysmotility disorder caused by her anorexia nervosa. CONCLUSION: Our case report demonstrates the importance of clinical identification of AGD and subsequent diagnosis and management. Because of the urgency to rule out obstruction or perforation through consultation or additional imaging modalities, recognition and correct diagnosis of this condition is necessary for appropriate patient management. In addition, our case report adds to an underreported but important complication of anorexia nervosa.

Drug induced hepatitis mimicking Wilson's disease secondary to the use of complex naturopathic regimens: a case report.

BACKGROUND: Drug induced liver injury (DILI) is an important cause of acute liver injury and accounts for approximately 10% of all cases of acute hepatitis. Both prescription and natural health products (NHPs) have been implicated in DILI. There is a dearth of studies on NHPs induced liver injury. CASE PRESENTATION: A previously healthy 37-year-old female presented with subacute hepatitis, in the context of a previous admission to a separate institution, months prior for undiagnosed acute hepatitis. Importantly, she had disclosed taking complex regiments of natural health products (NHPs) for months. Her only other medication was rivaroxaban for her homozygous Factor V Leiden deficiency. She had an extensive work up for causes of acute and unresolving hepatitis. She discontinued several but not all of her NHPs after her initial presentation for acute hepatitis at the first institution and continued taking NHPs until shortly after admission to our institution. The predominant pathological features were that of drug induced liver injury, although an abnormal amount of copper was noted in the core liver biopsies. However, Wilson's disease was ruled out with normal serum ceruloplasmin and 24-urine copper. After 2 months of stopping all the NHPs, our patient improved significantly since discharge, although there is evidence of fibrosis on ultrasound at last available follow up. CONCLUSION: NHPs are a well-established but poorly understood etiology of DILI. The situation is exacerbated by the unregulated and unpredictable nature of many of the potential hepatotoxic effects of these agents, especially in cases of multiple potential toxic agents. This highlights the importance of acquiring a clear history of all medications regardless of prescription status.

The role of video-assisted feedback sessions in resident teaching: A pre-post intervention.

This article was migrated. The article was marked as recommended. Purpose: Despite providing a large component of teaching to trainees, internal medicine residents receive little feedback on their teaching ability. Methods: This was a single-center, mixed methods study of 19 senior internal medicine residents in Canada. Classroom-based teaching sessions delivered by the participants were individually video recorded. The individual recording was then watched by the participant and by two feedback facilitators, who then met for face-to-face feedback. Participants completed a self-reflective exercise after this intervention. Audience members of the recorded session and a post-feedback teaching session completed an evaluation form. Scores from the evaluation forms from each phase were analyzed with the Wilcoxon Signed-Rank Test. Inductive coding was performed for qualitative data from the feedback sessions and reflective exercises. Results: 19 residents participated. There was no statistical difference in the evaluation form scores between the pre-intervention and post-intervention teaching sessions. Mean scores varied from 4.6 to 5.0 out of 5.0 on combined pre-and post-intervention evaluations. 89% of participants found viewing their recorded session useful. 94% of residents stated the intervention was worth continuing. Common themes of feedback and self-evaluation included "time-management," "organization," "communication," and "environment." Conclusion: Video-assisted feedback of teaching improved self-perception of a resident's teaching ability.

Iodine nutrition during pregnancy in Toronto, Canada.

OBJECTIVE: To evaluate the status of iodine nutrition among pregnant women presenting for routine antenatal care in Toronto, Canada, as determined by the median urine iodine concentration (UIC) of this population. METHODS: A cross-sectional, observational study was conducted involving 142 pregnant women recruited from four low-risk antenatal outpatient clinics in Toronto, Canada. Subjects completed a questionnaire and provided a spot urine sample for the measurement of iodine concentration. RESULTS: Mean maternal age was 33.8 ± 4.3 years. Mean gestational age was 29.3 ± 7.8 weeks. The median UIC was 221 µg/L (interquartile range, 142 to 397 µg/L). Six women (4.2%) had urine iodine levels <50 µg/L, and 36 women (25.4%) had levels between 50 and 150 µg/L. CONCLUSION: This cohort of primarily Caucasian, well-educated, and relatively affluent pregnant women in Toronto, Canada, are iodine sufficient, perhaps due to universal salt iodization and/or other dietary and lifestyle factors.