Trust Yourself

Jonathan Madara, UPenn

Experiences

      It seemed to be a straightforward ER case: an indoor/outdoor cat with tags had bitten the patient on the right carpus approximately 5 hours prior to presentation. The owner of said cat had slammed the door in the face of the presenting client when the cat was returned, with no mention of rabies vaccination status. I watched the intern, resident, and attending clinician assess the patient with keen interest, eagerly awaiting the confirmation of my treatment plan: Clavamox for the penetrating bite wound and a rabies booster. However, the resident’s concerns did not match my own. We should see if the patient is up-to-date on tetanus vaccination. No interest in rabies. Surprised, I waited for the attending to correct the omission. It was not to be. Rabies is not really a concern in our area. I was shocked and confused. I quietly mumbled if a rabies booster could be considered anyway. We’ll have to call the city health department. I was concerned, disappointed, upset, but mostly…exhausted. My wrist was throbbing from the bite. I wanted some Clavamox for my cat bite. And at 11:30pm on a Saturday night, I just wanted to go home.

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Pou Sante

Sarah Colmer, UPenn

Experiences, Honorable Mention

         It was June of 2014 and the small propeller plane being masterfully guided through scenic mountains and amidst the borders of sparking Caribbean coast contained 13 veterinary students from the University of Pennsylvania, myself included, and one veterinarian from England. We are part of an organization known as Pou Sante: Amar Haiti – translating from Haitian Creole to mean “for health,” and the health of the livestock and farmers is our focus. After fundraising during the year through school events and the generous hearts of donors, we made our trek to Thibeau, a small Haitian village which would be our headquarters for veterinary work for two weeks. We noted the stunning natural beauty of the landscape from our position in the clouds, curious as to the variety of animals and people alike that we would come across on the beautiful island below us. Our plane landed gracefully in the blaring sun on the tarmac lined with looming palm trees. It was a beautiful setting in which to accomplish our goals.

Our journey had two main focuses: one was a mobile clinic to take care of the immediate needs of local farmers. We went to three different villages and held six days of clinics where people came form far and wide with their cattle, goats, horses, dogs, cats and pigs in tow. We would start our morning in a schoolyard-turned-hospital at 8 AM to the cacophonous sounds of mooing, bleating, barking and whinnying. We opened our gate to a long line of conscientious villagers who understood the importance of the health of their animals and wanted to learn how they could improve their own farming and veterinary techniques. We provided full physical exams, vaccinations, treatment for internal and external parasites, and assessed pregnancies. We dispensed advice with the help of a phenomenal translator, conducted interviews about farming practices, and chatted and laughed with the farmers and their children.

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Life Lessons from a Spider Monkey

Kate Connell, UPenn

Foot In Mouth Disease, Winner

I’m sure that by this point in your life you’ve been told that our primate relatives down the phylogenetic tree are pretty damn smart. They use tools, work together to work out puzzles, and have demonstrated the ability to innovate. I’ll bet you can also figure out that smart animals in captivity are a pain in the ass to keep captive. They reckon that if you’re dumb enough to try to keep them in a cage (even if your intentions are noble, as mine were while I was working at a wildlife rehabilitation center), they will try to make your life a living hell.

            So let me set the scene for you: this is ARCAS, a wildlife rescue and rehabilitation center buried in the steamy jungle of Guatemala. Most animals are brought in by the police in efforts to quell the illegal pet trade. The air is full of mosquitos, biting yellow flies, and the incessant screeching of scarlet macaws and roars of howler monkeys. You sleep in a screened in guest house, enjoy a drizzle of cold water for your afternoon shower, and eat a diet based around rice, beans, and tortillas. The other volunteers range from backpacking Europeans and vacationing Israelis to high school dropouts and PhD candidates. The permanent staff members are sturdy Guatemalan men who are quick to joke and constantly impress volunteers with their ability to lift really, really heavy stuff. Everyone is working their butt off from dawn until past the heat of the day to keep cages clean and feed the three hundred plus animals in the facility.

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Entry, Creative Corner
Jess Nord, University of Pennsylvania

"Balboa on Canvas," acrylic on canvas, 24''x36''

"Balboa in Bag""Lion Cub, South Africa"

Transmyocardial therapeutic-delivery using real-time MRI guidance

Entry, Abstracts
Jeremy Maurer, Penn

Fig.1 (a) Needle catheter showing microcoils and extended nitinol injection needle. (b) Portions of the heart segmented on cine stack (TR/TE=3.4/1.54ms, voxel=1.3x1.3x5 mm3, FA 43o) are used to build 3d model of the left, right ventricle and infarcted region. (c) 3D model overlaid into real-time MR images is used to (d) navigate the catheter to pre- defined injection targets. Catheter model is built from MR images of active tracking coils. (e) Injection of iron-oxide laden therapeutic into myocardium (yellow arrow) monitored under real-time MRI. TR/TE=2.8/1.19 ms, voxel=1.9x1.9x5mm3, FA/tracking FA =50o/15o, 1.5-4 frames/s. (f, g) Pre- and post- injection MRI confirms injection of microbeads. TR /TE = 6.8/3.25ms, FA=30o, voxel =1.0×1.0×5.0mm3.Hegde S, Shea S, Pan L, Karmakar P, Barbot J, Kirchberg K, Vadakkumpadan F, Maurer J, Cook J, Trayanova N, Solaiyappan M, Johnston P, Kraitchman D. Transmyocardial Therapuetic-Delivery Using Real-Time MRI Guidance. SCMR 16th Annual Scientific Sessions, San Francisco, CA, January 31 - February 3, 2013. Poster.

Background: Catheter-based transmyocardial injection offers a minimally invasive method to deliver therapeutics to the heart. It is typically performed under X-ray fluoroscopic guidance, which suffers from poor demarcation of myocardial boundaries and an inability to assess myocardial viability. MRI-guided intramyocardial delivery of therapeutics at 3T offers the potential for more precise targeting of these therapies with superior tissue contrast.

Our group has been actively involved with microencapsulated stem cell therapy to improve cell retention and prevent stem cell rejection. However, most microencapsulated stem cell products are too large to be administered transmyocardially. We demonstrate here intramyocardial injection of a prototype single stem cell therapeutic into the myocardium of a normal swine using real-time MR guidance and a custom active injection catheter.

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