The evolution of cardiac surgery reflects some of the greatest accomplishments in the history of medicine. Early work, staring with closed procedures on stenotic valves and repairs of traumatic injuries, while considered initially high risk, and challenges were associated with very high morbidity and mortality rates. Despite early concerns that surgery on the heart would never evolve beyond the most basic of procedures, devoted clinicians and researchers, motivated by the inability to help those suffering from what was generally considered untreatable or inherently fatal problems, persisted against much skepticism, failures, and lack of reliable and appropriate technology. However, over the years, with tremendous dedication to advancing the field, therapies for coronary artery disease, structural valve disease, arrhythmias, and heart failure evolved. While many consider “cardiac surgery” a separate field from “cardiology,” as our review of the history will demonstrate, much of the pioneering work done in the operating room – either with or without the use of the heart–lung machine (cardiopulmonary bypass) – set the foundation for further technological developments. The natural progression of such “operative surgical” therapies is to evolve into miniature, minimally invasive, or percutaneous catheter-based intervention. While there are clearly volumes written, and often fictionalized, on many of these topics, a basic understandable of the rich history of cardiac surgery should be of interest to all – especially since it serves as the basis for so much what is currently offered to patients to help extend both the quantity and quality of their lives. The following core competencies are addressed in this article: Patient care, Medical knowledge, Practice-based learning and improvement.

Background: This was a prospective, crossover study examining the ability of emergency medicine (EM) residents to identify lumbar puncture (LP) needle entry site by palpation and ultrasound in individuals with varying body mass indexes (BMIs). Materials and Methods: Following a didactic session on the use of ultrasound to identify landmarks for LP needle entry, EM resident physicians were asked to identify LP needle entry sites using ultrasound on several volunteers of varying BMIs (normal [BMI, 18.5–24.9], overweight [BMI, 25.0–29.9], and obese [BMI, 30–39.9]). Measurements of their deviation from an entry point determined by a faculty member with expertise in ultrasound were recorded. Residents were then asked to determine LP needle entry sites using palpation and again the deviation was recorded. Results: Using ultrasound, the transverse and longitudinal deviations from a gold standard were 7.8 mm (standard deviation [SD]: 6.5 and confidence interval [CI]: 1.9) and 7.1 mm (SD: 5.2 and CI: 1.5), respectively, whereas using palpation, the transverse and longitudinal deviations from our gold standard were 4.4 mm (SD: 3.4 and CI: 0.99) and 8.2 mm (SD: 6.6 and CI: 1.9), respectively. Conclusion: There was no difference in the residents' ability to identify LP needle entry sites on volunteers of various BMIs when comparing the use of ultrasound to standard palpation. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge.

Background/Aim: Tsáchilas are an indigenous group living in a rural tropical rain forest of Western Ecuador. Few studies have been conducted in Ecuador where intestinal parasite infections (IPIs) and associated risk factors have been examined. Hence, the aim of this study was to examine the prevalence of IPIs and identify the associated risk factors in Tsáchilas populations. Subjects and Methods: A cross-sectional survey was conducted from August to October 2013 in seven Tsáchilas communities. The study consisted of 586 participants, and stool samples were examined microscopically using the formalin-ether concentration technique. Results: Protozoa infections were more common than helminth infections (54.9% vs. 34.1%), and 68.1% of samples were found to contain one or more parasites. Ascaris lumbricoides was the most prevalent (29.4%), with Giardia duodenalis, Blastocystis hominis, and Entamoeba histolytica/dispar showing a prevalence of 3.9%, 19.6%, and 12.5%, respectively. Ova of Amphimerus and Paragonimus, two unexpected liver and lung flukes, respectively, were also found. A logistic model with forward selection showed the following variables to predict parasite infection: age (6–10 years) (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.5–5.1, P = 0.001), unclean water supply (OR = 1.16, 95% CI = 1.14–2.4, P = 0.01), handwashing practice (OR = 2.5, 95% CI = 1.27–4.97, P = 0.01), and not washing food before eating (OR = 1.6, 95% CI = 1.09–2.21, P = 0.01). Conclusions: The study shows that IPIs are highly prevalent among the Tsáchilas, which might be attributed to their low socioeconomic standards and poor hygienic habits. Educating the communities on risk factors which pose the highest risk of infection, in combination with a mandatory treatment program, would significantly lower the parasitic burden. The following Graduate Medical Education core competencies were addressed: Medical knowledge, Practice-based learning, Communication skills.

Context: There is no study evaluating the teaching orientation regarding polymerase chain reaction (PCR) in leprosy. Aims: The aim of the study is to assess the level of teaching orientation and knowledge of medical interns regarding PCR in leprosy. Settings and Design: It is a cross-sectional study done in Central Leprosy Teaching and Research Institute (CLTRI), Chengalpattu, during October to December 2017. Subjects and Methods: A pretested and well-structured questionnaire consisting of 13 questions (11 – option question, 1 – wrongly introduced accessing question, and 1 – the intern's attitude question) was administered to interns posted in CLTRI on day 2 and the same day after orientation. The questions were grouped under different headings and covered various aspects of PCR. Statistical Analysis Used: Paired t-test was used to determine significance at P < 0.05. Results: A total of 42 interns were surveyed. The male and female were 16 (38%) and 26 (62%), respectively. The posttest analysis after teaching orientation was statistically significant and also helps in exploring the molecular aspect of leprosy for the junior medical interns in academic settings. Conclusion: This is the first study done in this rare area of molecular aspect of leprosy teaching and this also helped us to know the medical interns' inclination toward working in molecular laboratory. The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice.

Background: Emergency department (ED)-based screening for substance use, suicide, and safety is commonly conducted in the United States. We sought to adopt this ED-based strategy in South Africa to determine the potential unmet needs of this population. Materials and Methods: This prospective, observational study was conducted at two sites in the Eastern Cape from June to September 2017. Adult patients presenting to the ED with noncritical conditions were approached to collect demographic data, respond to screening questions, and receive point-of-care human immunodeficiency virus testing. Screening questions assessed primary care access, substance use, suicidal thoughts, and home safety. The data analysis was performed using STATA v. 15 (StataCorp LLC, College Station, TX, USA). Descriptive statistics and cross-tabulations were performed to assess the proportion of patients with access to primary care, substance use, suicidal thoughts, and home safety. Relative risks were calculated using a generalized linear model for the appropriate exposures and outcomes. Results: Among the 2,074 patients approached, 1,880 consented to data collection. Half of the participants were male, and the median age was 34 years (interquartile range: 25–54 years). Screening questions revealed that 384 (20%) used alcohol in excess, 372 (20%) used tobacco, 174 (9%) lacked access to primary care, 69 (4%) had suicidal thoughts, and 55 (3%) felt unsafe at home. Most of those reporting substance use were male and between 25 and 34 years. Conclusions: One in five patients reported substance use, of which one in five did not have routine interaction with the health-care system. Routine ED-based screening could reach this missed population for timely intervention. The following core competencies are addressed in this article: Patient care, Practice-based learning and improvement, and Systems-based practice.

Dupuytren's disease (DD) is a debilitating fibroproliferative disorder of the palmar fascia. The clinical approach and management of DD is often challenging for clinicians. The purpose of this image in academic medicine is to review the pathophysiology, diagnosis, and treatment of DD. The following core competencies are addressed in this article: Patient care, Medical knowledge.

The Academic International Medicine (AIM) Congress is the official annual meeting of the American College of Academic International Medicine (ACAIM), a United States-based organization dedicated specifically to connecting academic physicians from diverse areas of expertise toward the common goals of sustainable global medical outreach and multinational clinical research and education. ACAIM's primary focus is to promote AIM and to establish a platform for individuals and entities to work collectively to create a foundation for efficient, effective, and sustainable resource sharing. World-renowned experts and speakers from the AIM community attended and participated in the Fourth Annual Congress (AIM 2019) held in Philadelphia, Pennsylvania, from July 26 to July 28, 2019. The conference theme Advancing Global Leadership to Promote Health Equity showcased efforts of the AIM community to generate and utilize objective data to achieve global impact. This year's Congress saw an overall increase in attendance compared to 2018. Pre-conference activities incorporated a Global Leadership Certification Course. In addition, the Congress featured the Third Annual Scientific Forum as a platform for exchanging scientific knowledge among scholars. Here, we present an overview of this major academic event, including the listing of podium presentations from the 2019 Scientific Forum. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Systems-based practice, Interpersonal and communication skills, Professionalism.