Patients with common variable immunodeficiency (CVID) are occasionally recognized to have a concurrent noncaseating granulomatous disease. The granulomatous disease (GD) associated with CVID shares many clinical properties typical of sarcoidosis. Some investigators speculate that the GD-CVID is actually sarcoidosis that is expressed atypically because of the patient's immunodeficiency. Clinical differences, however, have led other investigators to speculate that the GD-CVID is a distinct "sarcoid-like" granulomatous process.

The anticardiolipin antibody syndrome is relatively uncommon. It should be suspected mostly in young people with unexplained embolic or thrombotic events. A young patient with an abnormal prothrombin time, partial thromboplastin time, or venereal disease research lab test with one of the above noted vascular events would be a suspect for this disorder. Though an antibody test that will qualitatively and quantitatively measure antiphospholipid antibodies is available, its clinical application is not entirely clear. The presence of the antibody will support a diagnosis but cannot be used alone for diagnosis or treatment.

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OBJECTIVE: Because training in pediatric disaster medicine (PDM) is neither required nor standardized for pediatric residents, we designed and integrated a PDM course into the curriculum of a pediatric residency program and assessed if participation increased participants' knowledge of managing disaster victims. METHODS: We adapted and incorporated a previously studied PDM course into a small-sized pediatric residency program. The curriculum consisted of didactic lectures and experiential learning via simulation with structured debriefing. With IRB approval, the authors conducted a longitudinal series of pretests and posttests to assess knowledge and perceptions. RESULTS: Sixteen eligible residents completed the intervention. Before the course, none of the residents reported experience treating disaster victims. Pairwise comparison of scores revealed a 35% improvement in scores immediately after completing the course (95% confidence interval, 22.73%-47.26%; P < 0.001) and a 23.73% improvement 2 months later (95% confidence interval, 7.12%-40.34%; P < 0.01). CONCLUSIONS: Residents who completed this course increased their knowledge of PDM with moderate retention of knowledge gained. There was a significant increase in perceived ability to manage patients in a disaster situation after this educational intervention and the residents' confidence was preserved 2 months later. This PDM course may be used in future formulation of a standardized curriculum.

We are reporting an unusual case of cat-scratch disease in a young adolescent girl presenting with recurrent ascites. The illness started with nonspecific symptoms followed by ascites and an axillary lymph node enlargement. She had recurrent ascites for 18 months associated with constrictive pericarditis. Following pericardiectomy, she had a resolution of ascites and was back to her normal life. This is a first documented report of a constrictive pericarditis following cat scratch diseases in English literature.

This is a summary of the guidelines for working with low-income and economically marginalized (LIEM) people developed by the American Psychological Association (APA) task force and approved by the APA Council of Representatives. The task force, consisting of psychologists from a range of psychological specialties and both practice and educational settings, created guidelines in four main categories: Education and Training, Health Disparities, Treatment Considerations, and Career Concerns and Unemployment. Each category includes specific guidelines and recommended interventions. Further, the task force identified two major assumptions that cut across all of the recommendations: (1) The intersection of economic status and other identities is critical to psychological and other aspects of health, and (2) biases and stigma exacerbate the negative experiences of living with LIEM, and must be acknowledged and confronted by psychologists and trainees. Many of the guidelines and corollary interventions reinforce the need for psychologists and trainees to engage in activities that increase their own self-awareness and knowledge of issues and concerns that are exacerbated by economic marginalization, as well as challenge their own implicit and explicit biases related to social class and poverty. The impact of economic marginalization on education, health, and career attainment are addressed, and adaptations to psychological interventions are recommended. The task force concludes with a call to engage psychologists in action that seeks and promotes economic justice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Guided by models of family unpredictability, this study was designed to identify the distinctive sequelae of disorganized interparental conflict, a dimension of interparental conflict characterized by abrupt, inexplicable changes in parental emotional lability, conflict tactics, and verbalizations. Participants included 208 kindergarten children (M age = 5.74 years; 56% girls), mothers, and their caregiving partners from racially diverse backgrounds (e.g., 44% Black) who participated in a longitudinal study with two annual measurement occasions. At Wave 1, trained observers assessed disorganized interparental conflict. Observational and survey assessments were used to assess several family (i.e., interparental conflict, parenting difficulties, parent psychopathology, family instability) and demographic (i.e., children's gender, household income, parent education) characteristics. Assessments of child functioning at each wave included psychological adjustment (i.e., externalizing and internalizing symptoms, prosocial behavior), social information processing difficulties, and attention to emotion cues. Findings from structural equation modeling analyses indicated disorganized interparental conflict significantly predicted decreases in children's prosocial behavior and increases in their externalizing problems, angry reactivity to social problems, and biased attention to angry and sad cues over a one-year period. Results were significant while controlling for established measures of interparental conflict, parenting difficulties, parent psychopathology, family instability, and demographic characteristics. The findings suggest that disorganized characteristics of interparental conflict may be an important domain of clinical change beyond the established targets of family harshness and adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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Physical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participated in the study. Post-surveys indicated most learners: (1) prefer to use standardized patients (SPs) and soft-embalmed cadavers in their physical examination courses, (2) increased their confidence in performing the Lachman exam on real patients, and (3) enhanced their Lachman technique. SPs ultimately cannot volitionally reproduce the physical exam findings of ACL deficiency. Consequently, learners cannot accurately identify positive versus negative examination findings. Thiel-embalmed cadavers are a valuable resource for physical examination education. (Journal of Surgical Orthopaedic Advances 30(2):112-115, 2021).