Why culture and language matter: the clinical consequences of providing culturally and linguistically appropriate services to children in the emergency department

As the proportion of racial, ethnic, and cultural minorities in the United States continues to expand, pediatric emergency medicine providers are increasingly likely to encounter cultural and language barriers in practice. This paper reviews a conceptual framework encompassing the decision to seek emergency care, the process of providing such care, and the adherence to treatment plans and follow-up. The ways in which cultural and language barriers can negatively impact each element of this model are discussed in detail. Specific examples include provider ignorance of dangerous folk beliefs, communication barriers secondary to inappropriate interpreter use, and discriminatory assumptions regarding child abuse, pain management, and sexual activity. The practitioner is then provided with concrete recommendations to reduce these negative effects.     

Granulocytic sarcoma: An atypical presentation in the oral cavity

Acute myelogenous leukemia (AMU is a hematologic disorder that is characterized by an abnormal proliferation of immature myeloid cells. Granulocytic sarcomas are clusters of leukemic myeloid cells that may develop as a result of AML. Oral manifestations of AML are common and often involve enlargements of the gingiva and/or mucosal tissue from direct leukemia cell infiltration. We describe the case history of a 50-year-old man who had an ulcera-tive lesion of the oral mucosa that was determined to be a granulocytic sarcoma of AML-M0 subtype. The combination of both the subtype and clinical presentation of the leukemia makes this presentation unusual, and to the best of our knowledge, of a type that has not been previously reported in the literature.     

Effect of exogenous thyroxin on renal ion-regulating and acid-secreting functions in white rats

Experimental hyperthyreosis was stimulated by intraventricular injections of sodium solithyroxin (T4) suspension on 1% starch gel during 10 days at a dose of 10 microg/100 g of body mass (n = 15) or 20 microg/100 g of body mass (n = 15). Renal function was tested by 5 % water loading after 24 hrs. since the last T4 injection. Urine and blood plasma samples were analyzed for creatinine; in addition, urine was analyzed for sodium and potassium ions of titrated acids, ammonium cations, and pH. Thyroxin was found to decrease creatinine clearance and expedite renal excretion of sodium and potassium ions irrespective of the amount of exogenous T4; at the same time, exaggerated excretion of titrated acids and ammonium cations correlated with T4 dose.