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Yekosani Mitala,1 Brian Ssenkumba,1 Rita Nabulya,1 Francis Nsumba Kitenda,1 Habert Tumwesigye,1 Abraham Birungi,1 Richard Dratu Chau,1 Branchard Mushabe,2 Nichole Baker,3 Raymond Atwine1 1Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda; 2Department of Pediatrics, Mbarara Regional Referral Hospital, Mbarara City, Uganda; 3Department of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USACorrespondence: Yekosani Mitala, Email yekomitala@gmail.comIntroduction: Primary breast Burkitt lymphoma is extremely rare. Commonly endemic Burkitt lymphoma presents with abdominal, jaw, periorbital, or genitourinary mass.Case Presentation: We report a case of a 16-year-old girl with rapidly enlarging left breast swelling associated with evening fevers. This was later confirmed to be stage 1 primary breast Burkitt lymphoma involving the left breast. This represents the first described case of primary breast endemic Burkitt lymphoma in Uganda. She was started on chemotherapy and exhibited an impressive response to the drugs.Conclusion: This case raises awareness of rare sites for endemic Burkitt lymphoma in Uganda. Accurately diagnosing this case was of great importance since it determined the treatment modality (mastectomy or not) which would have an everlasting impact on her life.Keywords: primary breast Burkitt lymphoma, Uganda, a case report

Karem H Alzoubi,1 Zuhair Bani Ismail,2 Mohamed K AL-Essa,3 Osama Y Alshogran,1 Reem F Abutayeh,4 Nareman Abu-Baker5 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Physiology, Faculty of Medicine, University of Jordan, Amman, Jordan; 4Department of Medicinal Chemistry and Phytochemistry, Applied Science Private University, Amman, Jordan; 5Philadelphia Biomedical Products Development Center, Amman, Jordan Introduction: This study explored d-ribose pharmacokinetics after intravenous (IV) and oral administration to healthy rabbits. Materials and methods: D-ribose was administered once as 420 mg/kg (N=4) or 840 mg/kg (N=6) dose intravenously, or as an oral dose of 420 mg/kg (N=3) or 840 mg/kg (N=3). Serum was obtained at various time points, up to 210 minutes after administration. Urine was also collected after IV administration. Pharmacokinetic parameters were determined from drug concentration–time data using Kinetica software. Results: The findings showed that D-ribose follows a dose-dependent kinetic profile. With doubling the IV dose, AUCtotal was significantly increased by threefold, while the clearance was decreased by 44%. The half-life was 1.7-fold longer at the higher dose. Similar nonsignificant trends were also observed at oral administration. D-ribose was rapidly absorbed (Tmax=36–44 minutes) and rapidly disappeared from plasma (within

Richard Amini, Lori A Stolz, Parisa P Javedani, Kevin Gaskin, Nicola Baker, Vivienne Ng, Srikar Adhikari Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ, USA Background: Emergency medicine milestones released by the Accreditation Council for Graduate Medical Education require residents to demonstrate competency in bedside ultrasound (US). The acquisition of these skills necessitates a combination of exposure to clinical pathology, hands-on US training, and feedback. Objectives: We describe a novel simulation-based educational and assessment tool designed to evaluate emergency medicine residents’ competency in point-of-care echocardiography for evaluation of a hypotensive patient with chest pain using bedside US. Methods: This was a cross-sectional study conducted at an academic medical center. A simulation-based module was developed to teach and assess the use of point-of-care echocardiography in the evaluation of the hypotensive patient. The focus of this module was sonographic imaging of cardiac pathology, and this focus was incorporated in all components of the session: asynchronous learning, didactic lecture, case-based learning, and hands-on stations. Results: A total of 52 residents with varying US experience participated in this study. Questions focused on knowledge assessment demonstrated improvement across the postgraduate year (PGY) of training. Objective standardized clinical examination evaluation demonstrated improvement between PGY I and PGY III; however, it was noted that there was a small dip in hands-on scanning skills during the PGY II. Clinical diagnosis and management skills also demonstrated incremental improvement across the PGY of training. Conclusion: The 1-day, simulation-based US workshop was an effective educational and assessment tool at our institution. Keywords: point-of care ultrasound, simulation education

Richard Amini, Lori A Stolz, Nicholas C Hernandez, Kevin Gaskin, Nicola Baker, Arthur Barry Sanders, Srikar AdhikariDepartment of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USAStudy objectives: Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students’ ultrasound education and provide critical problem-solving exercises.Methods: This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions.Results: One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%–89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%–95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00).Conclusion: At our institution, we successfully integrated ultrasound and critical problem-solving instruction, as part of a 1-day workshop for undergraduate medical education.Keywords: point-of-care ultrasound, undergraduate medical education, protocol-driven education, problem-based learning