Interest In Medicine Research Articles

A review of the efficacy of complementary and alternative Medicines in managing Pruritus.

Pruritus significantly impacts quality of life, leading to increased interest in complementary and alternative medicines (CAMs) as potential treatments. This review explores the efficacy of various CAMs for pruritus. A comprehensive review was conducted on the effectiveness of several CAMs for pruritus. The Jadad Scale was used to assess the quality of evidence for CAM therapies when relevant. Key CAM therapies reviewed include capsaicin, acupuncture, menthol, camphor, phenol group medicines, oatmeal, and tar. For capsaicin, several RCTs reported efficacy in reducing pruritus but were limited by issues with patient blinding. The average Jadad score was 3.7. Acupuncture RCTs had mixed results, with some suggesting benefits in uremic and histamine-induced pruritus. The average Jadad score was 3. Evidence for other CAMs like menthol, camphor, and oatmeal was limited. While some studies indicate potential anti-pruritic effects of capsaicin and acupuncture, overall evidence quality is moderate due to study design limitations. Future research should pragmatically compare CAMs to conventional therapies, reflecting real-world clinical use. In the meantime, dermatologists can use this evolving research to provide patients with evidence-based guidance on CAM treatments for pruritus.

Reaching the top of Bloom’s Taxonomy: an innovative pilot program for preclinical undergraduate and medical school students to create curricula for STEMM outreach/service-learning programs

Bloom’s Taxonomy is an andragogical tool that classifies educational objectives, learning activities, and assessments into distinct levels of cognitive thinking. Preclinical medical sciences educators aim to promote higher-order thinking in their curricula to help students develop clinical decision-making skills and foster deep learning. However, many courses and curricula remain focused on lower levels of Bloom’s Taxonomy because they are easier to implement and assess. Meanwhile, many service-learning opportunities for medical students focus on developing affective faculties over higher-level cognitive processing of curricular material. We describe a model program in which undergraduate pre-medical education (UPE) and undergraduate medical education (UPE/UME) students at Boston University Charles River Campus (BU CRC) and Boston University Aram V. Chobanian & Edward Avedisian School of Medicine (BU Chobanian & Avedisian SOM) simultaneously engaged in service-learning and the Create level of Bloom’s Taxonomy by developing a supplementary high school (HS) medical science curriculum based on content and instructional models from their preclinical courses. Activities such as mock patient cases, simulated patient interviews, and physical examination training contributed toward a HS curriculum that promotes healthy habits; increases community public health self-efficacy; sparks interest in Science, Technology, Engineering, Math and Medicine (STEMM) concepts; and educates about medical careers through engaging lessons and activities focused on human anatomy and physiology.

How Much Force is Needed to Kill a Single Bacterium?

The interaction between bacteria and nanomaterials, particularly from a physical or mechanical perspective, has emerged as a topic of significant interest in both science and medicine. Mechanobactericidal nanomaterials, which exert antimicrobial effects through purely physical mechanisms, hold promise as alternative strategies to combat bacterial resistance to traditional antibiotics. High-aspect-ratio nanoparticles and surface topographies are being engineered to enhance their mechanobactericidal properties. However, progress in this field is hindered by an incomplete understanding of how these materials induce mechanical cell death in bacteria. This review examines the role of atomic force microscopy (AFM) nanoindentation in quantifying forces required to rupture the bacterial cell wall. The reported values range from nN to a few tens of nN, depending on the type of bacterium and the experimental conditions used. The potential effect of AFM tip properties, loading speed, bacterial immobilization strategy, or environmental conditions on the measured rupture values are discussed. This perspective also highlights the complexities of modeling bacterial cell rupture and the importance of pressure as a parameter for standardizing results across experiments. Furthermore, the implications of these quantitative insights to understand the mechanisms of action of mechanobactericidal nanomaterials are discussed.

Local Chemical Enhancement and Gating of Organic Coordinated Ionic-Electronic Transport.

Superior properties in organic mixed ionic-electronic conductors (OMIECs) over inorganic counterparts have inspired intense interest in biosensing, soft-robotics, neuromorphic computing, and smart medicine. However, slow ion transport relative to charge transport in these materials is a limiting factor. Here, it is demonstrated that hydrophilic molecules local to an interfacial OMIEC nanochannel can accelerate ion transport with ion mobilities surpassing electrophoretic transport by more than an order of magnitude. Furthermore, ion access to this interfacial channel can be gated through local surface energy. This mechanism is applied in a novel sensing device, which electronically detects and characterizes chemical reaction dynamics local to the buried channel. The ability to enhance ion transport at the nanoscale in OMIECs as well as govern ion transport through local chemical signaling enables new functionalities for printable, stretchable, and biocompatible mixed conduction devices.

Gamma-irradiated hydroxyapatite based electrochemical sensor for simultaneous detection of rutin and quercetin flavonoids

Semi-synthetic flavonoids, such as rutin and its aglycone, quercetin, are of considerable interest in nutraceuticals, pharmaceuticals, and traditional medicine due to their health benefits. Here, we report the synthesis of hydroxyapatite (HA), its subsequent modification through gamma irradiation, and fabrication of an electrochemical sensor for the selective and simultaneous determination of quercetin (QR) and rutin (RT). Under optimized conditions, the GI-HA modified glassy carbon electrode (GCE) showcased sharp peaks at 0.29 V and 0.39 V corresponding to the oxidation potentials of QR and RT respectively in phosphate-buffered saline at pH 6. The fabricated sensor exhibited the lowest detection limits of 0.02 µM for QR and 0.018 µM for RT over a wide linear concentration range from 0.02 to 800 µM for both compounds. Furthermore, the sensor displayed excellent storage stability, reproducibility, and repeatability, with relative standard deviations of less than 5 %. The practical applicability of the sensor was demonstrated by measuring QR and RT in amaranthus viridis (a perennial medicinal herb), red onions, and pharmaceutical samples. Interestingly, a transition from RT to QR has been observed in the amaranthus viridis during its cooking in water at temperatures ranging from 80 to 100 ℃. Additionally, the sensor demonstrated a notable increase in QR levels in red onions exposed to sunlight over the course of a week. Thus, the 100 kGy GI-HA modified GCE has the potential to monitor QR and RT in food and pharmaceutical samples, either independently or simultaneously.

Examining dimensions of career intentions: insights from medical and nursing students at a private not-for profit university in Vietnam

BackgroundUnderstanding students’ career intentions through evidence-based approaches is crucial for developing effective career guidance and intervention strategies. Although there has been considerable attention in this field, research remains limited, particularly in low- and middle-income countries (LMICs) in Asia. These regions have unique socioeconomic conditions and cultural norms that potentially shape decision-making processes. This study provides insights into the career intentions of medical and nursing students and identifies the key determinants influencing their choices at a newly established private institution (VinUniversity) in Vietnam.MethodsThis study employs a mixed-methods design. The quantitative phase involved a survey of all undergraduate medical and nursing students. The qualitative phase consisted of in-depth 11 individual interviews with a purposive sample until data saturation.ResultsA total of 198 students (77%) participated in the quantitative phase. The majority of students (75.8%) expressed interest in clinical practice, with preferences notably high for surgical specialties (30.9%), internal medicine (10.1%), and pediatrics (10.1%). 22.7% of students expressed a desire to work overseas, and a significant number (70.7%) indicated the lack of a career guidance program. Qualitative data revealed that personal interest, family influence, financial stability, and societal appreciation were primary influencers in career choice.DiscussionThe study underscores the complex interplay between personal interests, family influence, financial considerations, and societal expectations in shaping career choices. The persistent low interest in family medicine and primary care continued to be a concern.ConclusionThis study provides further insights into the career intentions and influencing factors among medical and nursing students at VinUniversity. The implications for practice include implementing tailored career guidance programs, offering diverse elective tracks that incorporate global health experiences, and establishing structured mentorship programs. It is also recommended to measure the impact of these interventions through longitudinal follow-up studies to enhance career satisfaction, better prepare future healthcare professionals, and contribute to the improvement of healthcare systems.

Pharmacological Innovations in Space: Challenges and Future Perspectives.

Since the first human experience in space, the interest in space research and medicine to explore universe is growing day by day. The extreme space conditions mainly radiation and microgravity effects on human physiology, antimicrobial susceptibility, and efficacy, safety, and stability of drugs. Therefore, the aim of this review is to address the impact of extreme space conditions, mainly microgravity and radiation, on human physiology and highlights the need for future approaches by evaluating the effectiveness of strategies to prevent or mitigate health problems. Published papers and NASA technical documents were searched in Pubmed and Google Scholar databases using the keywords ''antimicrobial susceptibility or drug resistance or drug stability or innovations or pharmacokinetic or pharmacodynamics'' and ''radiation or microgravity or space environments or space medicine or space pharmacy'' to prepare this review. In this review, the challenges regarding physiological effects and drug-related problems are examined through the evaluation of extreme conditions in space. Medications used in spaceflight are summarized, and the role of pharmacists specializing in space medicine is briefly explained. Last but not least, to overcome the aforementioned issues, novel approaches have been addressed, such as personalised treatments, development of space-resistant formulations and various microbial applications. Further research in the space medicine is required to facilitate the safe and healthy travel of humans to the Moon, Mars and other extraterrestrial destinations. One bear in mind that space research will contribute not only to the exploration of the universe, but also to the advancement of health and technological discoveries on Earth.

Reprogramming macrophages to treat liver diseases

Cutting-edge research has expanded our understanding of the macrophage activation programs in liver diseases making this immune cell type a therapeutic target. Clinical data on macrophage infiltration and polarization states have been used to help predict mortality or poor prognosis in patients with liver cirrhosis and/or hepatocellular carcinoma. The latest single-cell and spatial transcriptomics studies have dissected unforeseen aspects depicting the immense heterogeneity of macrophages and their multifaceted role on both promoting and resolving hepatic inflammation, injury, and fibrosis. Hepatic macrophages (resident tissue Kupffer cells and monocyte-derived macrophages) display such plasticity and phenotypic diversity that macrophages with antagonistic functions may coexist in adjacent regions of the liver. In this scenario, the analysis of macrophage-derived inflammatory and anti-inflammatory circulating soluble markers in patients with liver disease only offers a partial picture of the full complexity of the hepatic macrophage subsets. The reprogramming of macrophages involves understanding the multiple regulatory mechanisms and diverse populations of hepatic macrophages and the design of macrophage-targeted therapeutic interventions to restore hepatic homeostasis. Here we review the potential targets to modulate macrophage behavior in liver diseases and nanoscale therapeutics that aim to target and treat macrophages. We will summarize current knowledge on the diverse macrophage programs activated in chronic liver inflammation, cirrhosis and hepatocellular carcinoma that may be of therapeutic interest for precision medicine.

Synthesis of the C1-C15 Fragment of Incednine

We report on our progress towards the synthesis of the exotic, delicate and tense polyketidic macrolactam of incednine. This work constitutes a significant advancement towards the total synthesis of a family of molecules of biological and medicinal interest. Some of the key features of this synthesis required evolutions from the initially designed strategy, leading to the use of a HWE to build the C2-C9 tetraene. For this purpose, a polyfunctionalized phosphonate was used and obtained through an unprecedented Pd-catalyzed cross-coupling involving the zinc anion of diethyl methylphosphonate. The resulting desired C1-C15 fragment displays a carboxylic acid ester at C1 and a vinyl iodide at C15, both functions being ready for subsequent amide coupling with the C16-C23 fragment and final Suzuki cyclization respectively.

Ethnomedicinal Knowledge among the Local Communities in the Kodaikanal Foothills of the Southern Western Ghats in Tamil Nadu, India

India has a rich history of traditional medicine, including Ayurveda, Siddha, and Folk medicines. The Folk system, although not extensively documented, is widely practiced by native communities, with valuable knowledge passed down orally through generations. We carried out an ethnobotanical study from June 2022 to December 2023 in six settlements at the foothills of Kodaikanal, within the Devadanapatti block, an underexplored and biodiversity-rich region in the Western Ghats. The research sought to identify knowledgeable Paliyar tribes and traditional healers in the Kodaikanal foothills of Devadanapatti block in Theni District and document their ethnomedicinal knowledge through open and semi-structured face-to-face interviews. A comprehensive cataloging effort identified 113 plant species spanning 100 genera and 46 families, used for treating various ailments ranging from headaches and skin diseases to kidney stones and viral infections. The most represented families were Fabaceae, Apocynaceae, Amaranthaceae and Solanaceae. The traditional healers stated that the availability of several native medicinal plants, including Acorus calamus, Aegle marmelos, Albizia lebbeck, Phyla nodiflora, Sphagneticola calendulacea, Tabernaemontana divaricata and Thespesia populnea have declined over the years due to over-exploitation. The utilization of plants by local communities underscores their interest in herbal medicine. Further investigations into the pharmacological properties of previously unstudied species may lead to the discovery of novel bioactive compounds.

Crystallographic and Selectivity Studies on the Approved HIF Prolyl Hydroxylase Inhibitors Desidustat and Enarodustat.

Prolyl hydroxylase domain-containing proteins 1-3 (PHD1-3) are 2-oxoglutarate (2OG)-dependent oxygenases catalysing C-4 hydroxylation of prolyl residues in α-subunits of the heterodimeric transcription factor hypoxia-inducible factor (HIF), modifications that promote HIF-α degradation via the ubiquitin-proteasome pathway. Pharmacological inhibition of the PHDs induces HIF-α stabilisation, so promoting HIF target gene transcription. PHD inhibitors are used to treat anaemia caused by chronic kidney disease (CKD) due to their ability to stimulate erythropoietin (EPO) production. We report studies on the effects of the approved PHD inhibitors Desidustat and Enarodustat, and the clinical candidate TP0463518, on activities of a representative set of isolated recombinant human 2OG oxygenases. The three molecules manifest selectivity for PHD inhibition over that of the other 2OG oxygenases evaluated. We obtained crystal structures of Desidustat and Enarodustat in complex with the human 2OG oxygenase factor inhibiting hypoxia-inducible factor-α (FIH), which, together with modelling studies, inform on the binding modes of Desidustat and Enarodustat to active site Fe(II) in 2OG oxygenases, including PHD1-3. The results will help in the design of selective inhibitors of both the PHDs and other 2OG oxygenases, which are of medicinal interest due to their involvement inter alia in metabolic regulation, epigenetic signalling, DNA-damage repair, and agrochemical resistance.

Extracellular matrix mimetic supramolecular hydrogels reinforced with covalent crosslinked mesoporous silica nanoparticles.

The extracellular matrix (ECM) is a dynamic environment that is primarily built up from fibrous proteins (e.g., elastins, fibronectins, collagens, and laminins) and plays a vital role in tissue regeneration processes. Therefore, the development of supramolecular hydrogels that can mimic the ECM's dynamicity and fibrous structure is of great interest in regenerative medicine. However, such hydrogels generally have weak mechanical properties and poor structural stability, which significantly limits their potential applications. To overcome this drawback, we developed a new type of hybrid network composed of supramolecular assemblies with covalent nanoparticle-based crosslinkers. The ECM mimetic hydrogels were created through UV-initiated thiol-ene crosslinking between norbornene functionalized benzene-1,3,5-tri carboxamide (NBTA) macromonomers and thiol functionalized mesoporous silica nanoparticles (MSN). We hypothesized that the MSN would improve the mechanical properties by crosslinking the NBTA supramolecular fibrous hydrogels. Notably, the covalent incorporation of MSNs did not disrupt the fibrous morphology of the resulting NBTA-MSN nanocomposites. Furthermore, these supramolecular nanocomposites demonstrated higher structural stability and elasticity compared to pristine NBTA hydrogels. Rheology studies showed that the mechanical properties of NBTA-MSN hydrogels could be tuned by adjusting MSN wt%. Interestingly, NBTA-MSN nanocomposites exhibited self-healing and injectability despite the covalent crosslinking of MSNs. In vitro studies confirmed that NBTA-MSN nanocomposites showed good cytocompatibility and maintained the viability of encapsulated MG63 cells. As a proof of concept, we also demonstrated that MSNs could act as ion reservoirs for calcium and phosphate within the hydrogel networks in addition to being covalent crosslinkers. Taken together, our work offers a promising strategy to create hybrid, biomimetic supramolecular nanocomposite materials for various applications such as injectable materials for bone tissue engineering, and reinforced bioinks for 3D printing applications.

‘Shades of grey’: a focus group study on diagnostic uncertainty among general practitioners using point-of-care ultrasound

Background Point-of-care ultrasound (POCUS) has long been a diagnostic tool in family medicine, although most Norwegian general practitioners (GPs) who use POCUS, scans infrequently. The broad scope of family medicine, the relatively low prevalence of illnesses and infrequent use of POCUS imply that GPs may experience diagnostic uncertainty regularly. Aim To explore how GPs perceived and managed diagnostic uncertainty when using POCUS. Design and setting A qualitative focus group study among Norwegian GPs using POCUS. Methods Four focus group discussions were conducted. Total number of participants were 21. The interview guide was piloted, the focus group discussions were audio-recorded and transcribed, and Systematic Text Condensation, a thematic cross-case analysis, was used to analyse the data. Results Diagnostic uncertainty using POCUS was considered as aligning to the general clinical uncertainties in family medicine, but there were also POCUS-specific uncertainties in clinical decision-making. We generated six themes: emotional, cognitive, and ethical uncertainty using POCUS, communicating uncertainty to patients, interaction with specialists when using POCUS, and coping strategies of participants. POCUS results were the only results the participants sometimes withheld when communicating with other specialists. POCUS itself stimulated a renewed interest in family medicine. Scanning enough patients was the recommended coping strategy. Conclusion POCUS-using GPs experienced diagnostic uncertainty when using POCUS that aligned with other diagnostic uncertainties they experienced in everyday practice. However, they did not treat the results like other findings, as the GPs at times withheld their POCUS findings when interacting with secondary care specialists. This requires further investigation.

Knowledge and Attitudes of Saudi Medical Students Toward Forensic Medicine as a Subspecialty: A Cross-Sectional Study.

The field of forensic medicine, also known as medical jurisprudence, plays a vital role in civil and criminal legal proceedings by applying medical principles to establish facts. Despite its critical importance, there is a significant shortage of experts in this subspecialty. Understanding the factors influencing medical students' interest in forensic medicine is crucial. The study was an observational cross-sectional conducted among medical students at Taif University, Saudi Arabia. Data was collected through online questionnaires distributed through social media applications (WhatsApp, Twitter, and Facebook) through Google Forms. Data was analyzed using StatisticalPackage for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk,NY) to obtain important insights. The majority of the medical students (65.2%) demonstrated good knowledge of forensic medicine. Furthermore, an overwhelming majority, 94.6%, agree that forensic medicine is a fundamental part of the medical field. Further, our study showed that 87% of the medical students have received formal education related to forensic medicine, though only 38% feel that the education was adequate. In comparison, nearly half (44.6%) of students felt that the education they received regarding forensic medicine was inadequate. Almost three-quarters of the medical students (70.7%) believe it would be beneficial to incorporate the forensic medicine module in their curriculum. The key motivating factors for choosing forensic medicine as a career were personal interest (39.1%) and the nature of the work (32.6%).Gender was not significantly associated with knowledge of forensic medicine (p-value<0.05). Medical students strongly recognize the importance of forensic medicine and support its inclusion in the curriculum. However, many feel underprepared for medico-legal responsibilities, indicating a gap in current education. Personal interest and the nature of the work are key motivators, with lectures playing a crucial role in career decisions. The study found no significant gender differences in knowledge or attitudes toward forensic medicine. It recommends that medical schools incorporate a comprehensive forensic medicine module to address these educational gaps.

Predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adult outpatients in Jordan: a cross-sectional study

ObjectivesTo examine the predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adults in Jordan.DesignA cross-sectional, correlational study.SettingData were collected by a graduate nursing student from five outpatient clinics...

Exploring the Role of Narrative Medicine in the Cultivation of Humanistic Spirit among Respiratory Medicine Interns

Objective: To explore the role of narrative medicine in cultivating the humanistic spirit of respiratory medicine interns. Methods: Thirty interns were selected, all of whom were received by the respiratory department of our hospital from September 2023 to June 2024 and underwent narrative medicine teaching. Scores on narrative medicine knowledge, empathy ability, humanistic care ability, and teaching recognition were compared before and after the internship. Results: Compared to before the internship, the interns’ scores on narrative medicine knowledge were significantly higher after the internship, as were their empathy and humanistic care scores (P &lt; 0.05). Among the 30 interns, 25 expressed interest in narrative medicine, and 29 were willing to continue with the narrative medicine teaching model. Conclusion: The application of narrative medicine in respiratory medicine internship teaching is highly effective. It cultivates the humanistic spirit of interns, improves their empathy and humanistic care abilities, and is worthy of wider implementation.

Factors Influencing Non-Attendance of Elderly at Rural and Urban Comprehensive Health Centers from Healthcare Providers' Perspective

Background. Studies have shown that comprehensive urban and rural health centers can provide 80% of the health needs of the elderly population. However, elderly individuals often do not utilize these services. The present study aimed to investigate the reasons why elderly individuals do not access services provided by comprehensive rural and urban health centers in the southwest of Khuzestan Province, from the perspective of health center staff. Methods. This descriptive-analytical study utilized a multi-stage random sampling method to select 338 employees of comprehensive health centers in southwestern Khuzestan. A survey questionnaire was developed and administered to collect information, including demographic data and 39 questions regarding reasons for non-attendance at health centers. The validity and reliability of the survey questionnaire were assessed prior to data collection. Results. The majority of participants in this study were female (77.81%), married (74.26%), and had a bachelor's degree (32.25%). From the healthcare providers' perspective, preference for the private sector and personal factors related to the elderly or their families were identified as the main reasons for non-attendance at health centers. However, factors related to the physical condition of the centers, the quality of services provided, and the level of trust between elderly patients and healthcare providers were not found to have a significant impact on utilization of health center services. Conclusion. The elderly population's willingness to utilize first-level services in the health and treatment networks was not viewed favorably by healthcare providers. Integrating some level two and level three services into the first level of service could potentially incentivize the elderly to make greater use of these services. In addition, healthcare providers suggested that traditional medicine services should be considered and incorporated at the first level of service, given the interest in traditional medicine among the elderly population.

Impact of an Inpatient Family Medicine Exposure: Changing Student Perception.

Currently there is a primary care physician shortage in the United States, and this shortage is expected to worsen into the foreseeable future. In 2023, only 7.5 % of US allopathic graduates entered family medicine (FM) residencies. Opportunities to create increased interest in family medicine as a career choice and address hidden curriculum messages in career choice must be explored to address shortages in family medicine. A 5-day inpatient experience with family medicine residents on a family medicine inpatient service was implemented during a required third-year core medical student clerkship in family medicine. Students who participated in this clerkship change were invited to complete a survey on how this experience altered their perceptions on the roles of family medicine physicians in inpatient medical care, intrapartum care, and care of the newborn, and how it affected their view of FM as a career choice. Of the eligible students, 34% completed the survey. Participating in the FM inpatient experience significantly enhanced students' perceptions about the depth of knowledge and skill needed for the specialty, increased students' respect for the specialty, and contradicted students' perceptions about the complexity of cases treated in the specialty. Adding an inpatient component to a third-year FM clerkship experience significantly can change the perceptions of medical students about the specialty of FM. Brief inpatient exposure to medical students has an impact on hidden curriculum messaging about family medicine.

Acute Adrenal Insufficiency in Childhood: Etiopathogenesis, Clinical Picture, and Intensive Care

Introduction. Acute adrenal insufficiency (AAI) is a severe endocrinopathy whose victims include children and adolescents and which can be life-threatening despite its low incidence. Analysis of issues associated with intensive care of children with this pathology is of vital interest for pediatric anesthesiology and critical care medicine. The aim of this work was to assess current views on the etiopathogenesis, clinical pathology and intensive treatment of pediatric AAI.Materials and methods. The topic was researched by analyzing publications found in the Cochrane Library, PubMed and Medscape using the following search terms: “acute adrenal insufficiency, children and adolescents, intensive therapy, fluid management”, with 65 published sources chosen.Results and discussion. In AAI, caused by a sharp deficiency of cortisol (and mineralocorticoids), which triggers an inflammatory reaction, electrolyte imbalance and hemodynamic disorders. AAI presents with dehydration, nausea and vomiting, feelings of pain, hypotension, tachycardia, seizures and impaired consciousness up to coma. Laboratory tests in children often reveal hyperkalemia, hyponatremia, hypoglycemia and hypercalcemia. Intensive management of AAI in the ICU relies on parenteral corticosteroids (preferably intravenous hydrocortisone). Two or three days later, when the child is stable, they are switched to oral hormones. Meanwhile, fluid management is performed over 2 to 3 days to increase the circulating blood volume and relieve dehydration with crystalloid fluids.Conclusion. A clearer understanding of the etiopathogenesis, clinical manifestations and diagnostic features of AAI, along with knowledge of emergency care algorithms, will improve the quality of intensive therapy of pediatric patients with this condition.

Pediatric pain physician workforce: an assessment of supply and demand.

Many youth with pain lack access to pediatric pain expertise. There is a critical shortage of pediatric pain physicians, due partly to a paucity of training programs in Pediatric Pain Medicine. Pain fellowships are Anesthesiology-based and there is no pathway to fellowship training or Pain Medicine board certification for pediatricians. This workforce assessment sought to examine the current state of Pediatric Pain Medicine in the United States and future interest in pursuing Pain Medicine among pediatricians. A multidisciplinary working group of Pain Medicine clinicians designed three surveys to examine pediatric comprehensive pain programs in the US, practice patterns of pediatricians and their motivations and opinions regarding Pain Medicine board certification, and current residents' exposure to and interest in Pediatric Pain Medicine. Wait times for initial evaluations are two months or longer for two-thirds of responding centers, and barriers to increase staff size and resources were reported, including an inadequate number of trained or available physicians. Pediatricians expressed interest in earning board certification in Pain Medicine, given the opportunity. Additionally, there is interest among pediatric residents in pursuing Pediatric Pain Medicine, and qualitative data highlight information residents perceived needing in order to pursue a career in the field. Results demonstrate the need for increased training opportunities in pediatric pain medicine. A formal pathway to Pain Medicine for Pediatricians should be developed to increase the potential workforce and to address the lack of trained pediatric pain specialists, thereby improving access to care for youth with pain.