Reduction in Stroke After Transient Ischemic Attack in a Province-Wide Cohort Between 2003 and 2015.

BACKGROUND: Improvements in management of transient ischemic attack (TIA) have decreased stroke and mortality post-TIA. Studies examining trends over time on a provincial level are limited. We analyzed whether efforts to improve management have decreased the rate of stroke and mortality after TIA from 2003 to 2015 across an entire province. METHODS: Using administrative data from the Canadian Institute for Health Information's (CIHI) databases from 2003 to 2015, we identified a cohort of patients with a diagnosis of TIA upon discharge from the emergency department (ED). We examined stroke rates at Day 1, 2, 7, 30, 90, 180, and 365 post-TIA and 1-year mortality rates and compared trends over time between 2003 and 2015. RESULTS: From 2003 to 2015 in Ontario, there were 61,710 patients with an ED diagnosis of TIA. Linear regressions of stroke after the index TIA showed a significant decline between 2003 and 2015, decreasing by 25% at Day 180 and 32% at 1 year (p < 0.01). The 1-year stroke rate decreased from 6.0% in 2003 to 3.4% in 2015. Early (within 48 h) stroke after TIA continued to represent approximately half of the 1-year event rates. The 1-year mortality rate after ED discharge following a TIA decreased from 1.3% in 2003 to 0.3% in 2015 (p < 0.001). INTERPRETATION: At a province-wide level, 1-year rates of stroke and mortality after TIA have declined significantly between 2003 and 2015, suggesting that efforts to improve management may have contributed toward the decline in long-term risk of stroke and mortality. Continued efforts are needed to further reduce the immediate risk of stroke following a TIA.

Call 911: Lower Ambulance Utilization Among Young Adults, Especially Women, with Stroke.

BACKGROUND: Delayed presentation to the emergency department influences acute stroke care and can result in worse outcomes. Despite public health messaging, many young adults consider stroke as a disease of older people. We determined the differences in ambulance utilization and delays to hospital presentation between women and men as well as younger (18-44 years) versus older (≥45 years) patients with stroke. METHODS: We conducted a population-based retrospective study using national administrative health data from the Canadian Institute of Health Information databases and examined data between 2003 and 2016 to compare ambulance utilization and time to hospital presentation across sex and age. RESULTS: Young adults account for 3.9% of 463,310 stroke/transient ischemic attack/hemorrhage admissions. They have a higher proportion of hemorrhage (37% vs. 15%) and fewer ischemic events (50% vs. 68%) compared with older patients. Younger patients are less likely to arrive by ambulance (62% vs. 66%, p < 0.001), with younger women least likely to use ambulance services (61%) and older women most likely (68%). Median stroke onset to hospital arrival times were 7 h for older patients and younger men, but 9 h in younger women. There has been no improvement among young women in ambulance utilization since 2003, whereas ambulance use increased in all other groups. CONCLUSIONS: Younger adults, especially younger women, are less likely to use ambulance services, take longer to get to hospital, and have not improved in utilization of emergency services for stroke over 13 years. Targeted public health messaging is required to ensure younger adults seek emergency stroke care.

Radioiodine-131 Therapy Used for Differentiated Thyroid Cancer Can Impair Titanium Dental Implants: An In Vitro Analysis.

BACKGROUND: The aim was to assess, in vitro, the effects of radioiodine-131 (I-131) on the structure of titanium implants. MATERIAL AND METHODS: A total of 28 titanium implants were divided into 7 groups (n = 4) and irradiated at 0, 6, 12, 24, 48, 192 and 384 hours. At the end of the experiment, each sample was investigated via scanning electron microscopy (SEM) and electrochemical measures. RESULTS: The control sample revealed a smooth and compact surface. The small micro-sized porosity is slightly visible at the macroscopic level, but the precise details cannot be observed. A mild exposure to the radioactive solution for 6 to 24 h showed a good preservation of the macro-structural aspects such as thread details and surface quality. Significant changes occurred after 48 h of exposure. It was noticed that the open-circuit potential (OCP) value of the non-irradiated implants move toward more noble potentials during the first 40 min of exposure to the artificial saliva and then stabilizes at a constant value of -143 mV. A displacement of the OCP values toward more negative values was observed for all irradiated implants; these potential shifts are decreasing, as the irradiation period of the tested implants increased. CONCLUSION: After exposure to I-131, the structure of titanium implants is well preserved up to 12 h. The eroded particles start to appear in the microstructural details after 24 h of exposure and their numbers progressively increase up to 384 h after exposure.

Nailfold capillary density is importantly associated over time with muscle and skin disease activity in juvenile dermatomyositis.

OBJECTIVES: To investigate the longitudinal association of nailfold capillary density (NCD; as a potential marker of activity) with various other clinical measures of disease activity and to evaluate baseline NCD as a predictor of disease outcome in children with JDM. METHODS: Data from 809 clinic visits from 92 JDM patients were prospectively collected at each clinic visit over a time period of 5.5 years. The number of capillaries per millimetre at the distal nailfold was scored using a stereomicroscope. Disease activity was determined using the Childhood Myositis Assessment Scale (CMAS) and a modification of the validated disease activity score (DAS), which included three skin (SDAS) and three muscle (MDAS) criteria. An inception cohort subgroup (n=28) with a baseline visit at diagnosis was analysed separately. RESULTS: Both DAS subscores, MDAS (ß = -0.04437, P < 0.0001) and SDAS (ß = -0.1589, P < 0.0001), as well as the CMAS (ß = 0.02165, P < 0.0001) were significantly associated with loss of end row nailfold capillary over time (multiple regression mixed-model analysis). All patients in the inception subcohort showed a reduced baseline NCD (diagnostic sensitivity = 100%) that improved as the disease improved, but this did not predict longer term outcome or course of disease. CONCLUSION: NCD is a marker of skin and muscle disease activity, and is an important measure of disease activity changes from visit to visit. Determination of capillary density may be useful when making treatment decisions. A decrease in NCD may be considered for inclusion in the diagnostic criteria due to its high sensitivity.

The Side Effects of Therapeutic Radioiodine-131 on the Structure of Enamel and Dentin in Permanent Human Teeth.

Radioiodine-131 (I-131) is an essential therapy for patients with differentiated thyroid carcinomas (DTC). Generally, I-131 is safe and well tolerated, but patients may present early or late complications in the oral and maxillofacial areas. Thus, the aim of this study was to evaluate in-vitro, the alteration of enamel and dentin after I-131 exposure using histopathological assessment, scanning electron microscopy (SEM) and atomic force microscopy (AFM). For I-131 irradiation, an in-vitro protocol was used that simulates the procedure for irradiation therapy performed for patients with DTCs. A total of 42 teeth were divided into seven groups (n = 6) and irradiated as follows: control, irradiation groups (3, 6, 12, 36, 48 h, 8 days). Histological changes were observed at 48 h (enamel surface with multifocal and irregular areas) and at 8 days (enamel surface with multiple, very deep, delimited cavities). SEM imaging revealed the enamel destruction progresses along with the treatment time increasing. The alterations are extended into the enamel depth and the dislocated hydroxyapatite debris is overwhelming. The enamel-dentine interface shows small gaps after 6 h and a very well developed valley after 12 h; the interface microstructure resulted after 8 days is deeply altered. The AFM imaging shows that I-131 affects the protein bond between hydroxyapatite nano-crystals causing loss of cohesion, which leads to significant increasing of nano-particles diameter after 6 h. In conclusion, both enamel and dentin appear to be altered between 12 and 48 h and after 8 days of treatment are extended in depth.

Different Manifestations in Familial Isolated Left Ventricular Non-compaction: Two Case Reports and Literature Review.

Left ventricular non-compaction (LVNC) is a form of cardiomyopathy characterized by prominent trabeculae and deep intertrabecular recesses which form a distinct "non-compacted" layer in the myocardium. It results from intrauterine arrest of the compaction process of the left ventricular myocardium. Clinical manifestations vary from asymptomatic to heart failure (HF), arrhythmias, or thromboembolic events. We present a case of mother and son diagnosed with isolated LVNC (ILVNC). A 4-years-old male patient, diagnosed at 3 months with ILVNC, and NYHA functional class IV HF, was admitted to the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, Romania, for cardiologic reevaluation, and diagnosis confirmation. ILVNC was confirmed using echocardiography, revealing a non-compaction to compaction (NC/C) ratio of > 2.7. His evolution was stationary until the age of 8 years, when severe pneumonia caused hemodynamic decompensation, and he was listed for heart transplantation (HT). The patient underwent HT at the age of 11 years with favorable postoperative outcome. Meanwhile, a 22-years-old female patient, mother of the aforementioned patient, was also admitted to our institute due to severe fatigue, dyspnea, and recurrent palpitations with multiple implantable cardioverter defibrillator (ICD) shock delivery. Extensive medical history revealed that a presumptive ILVNC diagnosis was established when she was 11 years old. She was asymptomatic until 18 years old, when 3 months post-partum, she developed NYHA functional class III HF, and subsequently underwent ICD implantation. Her diagnosis was confirmed using multi-detector computed tomography angiography, which revealed a NC/C ratio of > 3.3. ICD adjustments were carried out with a favorable evolution under chronic drug therapy. The last evaluation, at 27 years old, revealed that she was in NYHA functional class II HF. In conclusion, ILVNC, even when familial, can present different clinical pictures and therefore requires different medical approaches.

Recent Trends in Hospitalizations for Cardiovascular Disease, Stroke, and Vascular Cognitive Impairment in Canada.

BACKGROUND: We analyzed hospitalization rates for a broad set of cardiovascular diseases, stroke, and vascular cognitive impairment (VCI) between 2007 and 2016 in Canada to characterize population-level trends and demographic and provincial/territorial variation in inpatient health care utilization. METHODS: Record-level administrative hospitalization data from April 1, 2007 to March 31, 2017 for individuals aged 0-105 years were obtained from the Canadian Institute for Health Information Discharge Abstract Database. Data were available for all provinces and territories, except Quebec. Using the International Classification of Diseases (10th Revision, Canada) diagnostic coding standards, we identified disease categories related to cardiovascular disease, stroke, or VCI. Hospitalizations, crude and standardized, for age and sex (direct method) were calculated using the 2011 Census as the standard population. RESULTS: Between 2007 and 2016, percent decreases in standardized hospitalization rates were relatively small for heart failure and stroke (-2.4% and -4.7%, respectively), whereas those for coronary artery and vascular disease and heart rhythm disorders were moderate (-27.4% and -16.8%, respectively). Percent increases were relatively small for congenital heart disease (+7.2%) and moderate for acquired valvular heart disease (+31.1%) and VCI (+23.4%). There were notable age- and sex-specific differences along with provincial/territorial variation. CONCLUSIONS: Between 2007 and 2016, there was an overall decrease in standardized hospitalization rates for coronary artery and vascular disease, heart failure, heart rhythm disorders, and stroke, and an increase in hospitalization rates for structural heart disease (congenital heart disease and acquired valvular heart disease) and VCI in Canada.

National trends in hospital admission, case fatality, and sex differences in atrial fibrillation-related strokes.

BACKGROUND AND AIM: Atrial fibrillation is associated with increased risk of ischemic stroke and its global prevalence is increasing. We aimed to describe the contemporary temporal trends in hospital admissions, case fatality rate, as well as sex differences in atrial fibrillation-related stroke in Canada. METHODS: We conducted a retrospective cohort study using Canadian national administrative data to identify admissions to hospital for stroke with comorbid atrial fibrillation between 1 April 2007 and 31 March 2016. We determined temporal trends in the crude and the age- and sex-standardized admission and case fatality rates. We also evaluated for any sex differences in these outcomes. RESULTS: There were 222,100 admissions to hospital for ischemic (n = 182,990) or hemorrhagic (n = 39,110) stroke. Comorbid atrial fibrillation was present in 20.2% of admissions for ischemic strokes and 10.1% for hemorrhagic strokes. Over the study period, the age-sex adjusted proportion of admissions with atrial fibrillation increased from 16.3% to 20.5% (p = 0.02) for ischemic stroke and was stable for hemorrhagic stroke. In-hospital case fatality rate decreased for ischemic stroke with and without comorbid atrial fibrillation. Women aged 65 years and older with ischemic stroke were more likely to have comorbid atrial fibrillation compared to men, while this association was reversed in younger women. There were no sex differences in the case fatality rate for people with atrial fibrillation-related ischemic stroke. CONCLUSION: Atrial fibrillation is present in an increasing proportion of people hospitalized in Canada with ischemic stroke and disproportionately affects older women. Renewed focus is needed on atrial fibrillation-related stroke prevention with particular attention to sex disparities.

Disorders of Dental Hard Tissues Induced by Radioiodine-131 (I-131) Therapy Used in Differentiated Thyroid Cancer: An In Vitro Study.

This study aimed to evaluate, in vitro, the effects of I-131 on enamel and dentin in healthy human incisive permanent maxillary teeth. Our in vitro model analogue with the in vivo conditions of differentiated thyroid carcinoma patients treated with I-131, consisted in a solution of I-131 dissolved in artificial saliva. A total of 48 teeth were divided into eight groups (n = 6): control, irradiation groups at 3, 6, 12, 24, 36, 48, and 192 h, respectively. At the end of radiation exposure, radioiodine activity of specimens was assessed. Fine microstructure, nanostructure, surface roughness, and hidroxyapatite (HAP) crystallite diameter were investigated by atomic force microscopy (AFM) to both enamel and dentin structures. There is a constant increase of radioactivity in dental structures at 3, 6, 12, 24 h, due to progressive retention and I-131 migration, with a maximum at 36 h. Enamel showed notable alterations, which was correlated with the increase of the treatment time. A relevant visible distance between the HAP prisms was observed after 24 h. The surface suffered a loss in its compact structure. I-131 acts in the same way on HAP crystallites in dentin as in those in enamel. It was noticed that their morpho-dimensional changes occurred only after 12 h of treatment. Radioiodine-131 determines degradation of enamel and dentin by starting from the alteration of the crystalline network of HAP prisms, transforming them from compact materials into an agglomeration of rocky submicron structures.

COVID-19 Pandemic: Global Impact and Potential Implications for Cardiovascular Disease in Canada.

BACKGROUND: The literature indicates that cardiovascular disease (CVD; including stroke), older age, and availability of health care resources affect COVID-19 case fatality rates (CFRs). The cumulative effect of COVID-19 CFRs in global CVD populations and the extrapolated effect on access to health care services in the CVD population in Canada are not fully known. In this study we explored the relationships of factors that might affect COVID-19 CFRs and estimated the potential indirect effects of COVID-19 on Canadian health care resources. METHODS: Country-level epidemiological data were analyzed to study the correlation, main effect, and interaction between COVID-19 CFRs and: (1) the proportion of the population with CVD; (2) the proportion of the population 65 years of age or older; and (3) the availability of essential health services as defined by the World Health Organization Universal Health Coverage index. For indirect implications on health care resources, estimates of the volume of postponed coronary artery bypass grafting, percutaneous coronary intervention, and valve surgeries in Ontario were calculated. RESULTS: Positive correlations were found between COVID-19 CFRs and: (1) the proportion of the population with CVD (ρ = 0.40; P = 0.001); (2) the proportion of the population 65 years of age or older (ρ = 0.43; P = 0.0005); and (3) Universal Health Coverage index (ρ = 0.27; P = 0.03). For every 1% increase in the proportion of the population 65 years of age or older or proportion of the population with CVD, the COVID-19 CFR was 9% and 19% higher, respectively. Approximately 1252 procedures would be postponed monthly in Ontario because of current public health measures. CONCLUSIONS: Countries with more prevalent CVD reported higher COVID-19 CFRs. Strain on health care resources is likely in Canada.

CONTEXTE: La littérature indique que les maladies cardiovasculaires (MCV, incluant les accidents vasculaires cérébraux), l'âge avancé et la facilité d'accès aux ressources de soins de santé ont une incidence sur les taux de létalité (TL) des cas de COVID-19. L'effet cumulatif du TL de la COVID-19 dans l'ensemble de la population atteinte de MCV et l'impact anticipé sur l'accès aux services de santé dans la population atteinte de MCV au Canada ne sont pas entièrement connus. Cette étude a exploré les liens entre les facteurs pouvant influencer le TL des cas de COVID-19 et a estimé le potentiel impact indirect de la COVID-19 sur les ressources de soins de santé au Canada. MÉTHODES: Les données épidémiologiques à l'échelle du pays ont été analysées pour étudier la corrélation, l'effet principal et l'interaction entre le TL de laCOVID-19 et : 1) la proportion de la population souffrant de MCV, 2) la proportion de la population ≥ 65 ans, et 3) l'accessibilité des services de santé essentiels tels que définis par l'indice de couverture sanitaire universelle (CSU) de l'Organisation Mondiale de la Santé. Pour les implications indirectes concernant les ressources de santé, des estimations du volume d'opération de pontages coronariens, d'interventions coronariennes percutanées et de chirurgies valvulaires reportées en Ontario ont été calculées. RÉSULTATS: Des corrélations positives ont été trouvées entre le TL de la COVID-19 et 1) la proportion de la population souffrant de MCV (ρ= 0,40, P = 0,001), 2) la proportion de la population ≥ 65 ans (ρ= 0,43, P = 0,0005), et 3) l'indice CSU (ρ= 0,27, P = 0,03). Pour chaque augmentation de 1 % de la proportion de la population ≥ 65 ans ou de la proportion de la population souffrant de MCV, le TL de la COVID-19 était respectivement supérieur de 9 % et 19 %. Environ 1 252 interventions seraient reportées chaque mois en Ontario en raison des mesures de santé publique actuelles. CONCLUSIONS: Les pays où les MCV sont plus répandues ont signalé un TL de la COVID-19 plus élevé. Il est probable que les ressources de soins de santé soient soumises à de fortes contraintes au Canada.

The value of sequential dialysis, mannitol and midodrine in managing children prone to dialysis failure.

The uremic state impairs compensatory responses to ultrafiltration (UF). Intradialytic symptoms and hypotension can result and lead to premature discontinuation of treatment and sub-optimal dialysis. We report the benefits of mannitol, sequential dialysis and midodrine in reducing dialysis failures in those children prone to intradialytic hypotension. Prophylactic mannitol halved the odds of intradialytic symptoms and hypotension and increased UF volumes. Sequential dialysis halved the odds of symptoms but hypotension persisted. In one patient with refractory hypotension, only intradialytic midodrine consistently maintained acceptable intradialytic blood pressures, reduced intradialytic symptoms and increased the UF potential.

The prevalence of some bacterial markers in female patients undergoing an initial infertility evaluation in north-east Romania.

SCOPE: Genital infections represent one of the most important causes of infertility, affecting: fallopian tubes, endometrial mucosa, sperm parameters. The aim of this study is to evaluate the involvement of four sexually transmitted infections (STD) in the achievement of infertility and to establish the prevalence of each infectious agent in our patients. METHODS: We analyzed the presence of Chlamydia trachomatis (CT) antigen, Ureaplasma urealyticum (UU), Mycoplasma hominis (MH) and Neisseria gonorrhoeae (NG) in the endocervical secretions and Chlamydia trachomatis antibodies IgA, IgG, IgM in the serum of 125 infertile women as well as in 30 pregnant women in the 3rd trimester of pregnancy, as a control group. RESULTS. In infertile women, the prevalence rate of the four bacterial markers was: CT antigen 1/125 (0.80%), CT IgG antibodies 19/125 (15.20%), MH 6/125 (4.80%), UU 51/125 (40.80%) and NG 1/125 (0.8%). From the control group, none was positive for CT antigen, but 1/30 (3.33% of patients) was positive for CT IgA while the prevalence rate for MH and UU were 16.66% and 43.33% respectively. CONCLUSIONS: We couldn't prove any association between genital MH/UU and infertility as the prevalence was higher in the control group than in the cases, but the correlation of the CT infection with the infertility was clearly shown. However, it is necessary to perform routine tests to screen for CT, NG, UU and MH among infertile patients. The positivity for CT IgG is a marker better correlated with fallopian tube obstruction than the CT antigen.

K-ras expression--marker of dysplasia and cancer.

Molecular and epidemiological data indicated that the presence of HPV virus is not sufficient to induce transformation, suggesting the implication of other several cellular factors. Constitutive activation of the Ras signaling pathway is an important component of malignant progression for a number of different cancers. In this context, the objectives of our study were: the quantitative assessment of the K-ras gene expression changes in the development of the HPV positive cervical cancers. We observed that the K-ras mRNA expression levels did not gradually increase with the severity of injury. The mRNA expression in the ASCUS increased 2.02 times as compared with the control group, while in LSIL group only 1.76 times. However ras expression was increased in the HSIL/cancer group by 2.27 times when was reported to the control group. The presence of low risk HPV infection (IrHPV) does not lead to increased ras expression, remaining at baseline, but K-ras expression was increased in the presence of high risk HPV infection (hrHPV). In addition, we noted that in hrHPV single infections ras expression is increased (0.96 +/- 0.48) comparing with hrHPV co-infections. Our findings indicate that high expression of ras among hrHPV infection can be a marker of cervical cancer development.

The relationship between HPV16 and HPV18 viral load and cervical lesions progression.

UNLABELLED: Cervical cancer remains one of the most important mortality causes worldwide. It is already known that high risk HPV (HR-HPV) has the main role in the development of pre- or cancerous lesions. Despite the fact that many studies focused on the HR-HPV viral loads as possible biomarkers, the viral load quantification utility for all HR-HPV genotypes is still a controversy. The purpose of our study was to determine if HPV16 and 18 viral load values might be a potential marker for HPV infection clearance versus of pre- and cancerous lesions development. MATERIALS AND METHODS: 80 women who tested positive for HPV16 and 18 were selected from a cohort of 250 patients. The samples, consisting in cervical smears, were collected in transport media ESwab (Copan). The patient's average age was 36.26 years. HPV DNA detection, genotyping and viral load determination were performed twice for each patient (within one year follow-up). RESULTS: HPV 16 viral load was significantly higher in normal cytology samples and in HGSIL patients than in ASCUS/LGSIL (p value < 0.0312). HPV 18 viral load was also significantly higher in HGSIL cases than in ASCUS/LGSIL (p = 0,038). Independently of cervical cytology, HPV 18 viral load was lower (7.93 x 10(4) copies/microL) than HPV 16 viral load (5 x 10(13)) copies/microL). CONCLUSIONS: For HPV types 16 or 18 positive patients with LGSIL cytology the viral load might have predictive value. Our study suggested that patients with elevated viral loads are at disease risk progression and should be carefully evaluated.

P16INK4A--A possible marker in HPV persistence screening.

UNLABELLED: The aim of this study was to investigate the correlation of p161NK4a expression levels with the cytological group of cervical carcinogenesis (NILM, ASCUS, LSIL, HSIL, cancer groups), in order to establish its value as potential diagnostic marker. METHODS: The smears obtained from 50 women with/without suggestive HPV infection pathology were subjected to cytological investigations. The viral testing was based on the detection of HPV DNA using the INNOLIPA kit, while the semiquantitative expression levels of p16INK4a were estimated by RT-PCR. RESULTS: p16INK4a expression level was correlated with the cytological degree of cervical lesions. In LSIL patients, p16INK4a values were 1.36 times greater than in NILM subjects (p = 0.07). In HSIL/cancer patients, p16INK4a values were 2.38 times greater than in NILM patients (p = 0.002). We also noticed significant differences between ASCUS: HSIL group (p = 0.02) and LSIL: HSIL (p = 0.07) group. The p16INK4a expression level was dependent of HPV genotype, p16INK4a mRNA presence being correlated with the presence of hrHPV in low and high risk lesions.

Retrospective review of unintentional female genital trauma at a pediatric referral center.

UNLABELLED: Unintentional female genital trauma is a complaint commonly seen and managed through the emergency department. The purpose of this study was to review all unintentional female genital trauma evaluated at The Hospital for Sick Children for 3.5 years to determine the factors associated with gynecologic consultation and need for operative repair. METHODS: One hundred five patients were identified by health record coding. Data were extracted to study factors associated with gynecologic consultation and operative repair. Statistical analyses were performed to evaluate the significance of these associations. Surgical choices were also evaluated. RESULTS: Mean age was 5.60 years. Mean time to presentation was 7.05 hours. Straddle injury was the most common mechanism (81.90%), and only 4.76% injuries were penetrating. Of the 105 patients, 48.57% consulted the gynecology section, 19.05% were taken to the operating room, and 6.66% were treated under conscious sedation. Overall, 20.95% required surgical repair. The most common complication was dysuria. Six patients had other injuries, the most common of which were pelvic fractures related to trauma.Factors significantly associated with gynecologic consultation and operative management included older age, transfer to our institution, shorter time to presentation, laceration-type injury, hymenal injury, and larger size of injury. Straddle injuries were significantly less likely to be taken to the operating room. When cases were stratified by a surgeon, there were no significant differences in management. CONCLUSIONS: Unintentional female pediatric genital traumas most commonly result from straddle injuries. Most injuries are minor, and in this cohort, only 48.57% received gynecologic consultation and 19.05% required operative management. Future prospective studies would be useful to better evaluate the efficacy of surgical choices.

An outbreak of vancomycin-resistant Enterococcus faecium in an acute care pediatric hospital: Lessons from environmental screening and a case-control study.

BACKGROUND: The present study describes a vancomycin-resistant enterococci (VRE) outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital. OBJECTIVE: To report an outbreak investigation and a case-control study to identify risk factors for VRE colonization or infection in hospitalized children. METHODS: Screening for VRE cases was performed by culture or polymerase chain reaction. A case-control study of VRE-colonized patients was undertaken. Environmental screening was performed using standard culture and susceptibility methods, with pulsed-field gel electrophoresis to determine relationships between VRE isolates. Statistical analysis was performed using SAS version 9.0 (SAS Institute Inc, USA). RESULTS: Thirty-four VRE-positive cases were identified on 10 wards between February 28, 2005, and May 27, 2005. Pulsed-field gel electrophoresis analysis confirmed a single outbreak strain that was also isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization. CONCLUSIONS: In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, particularly in pediatric institutions.

Sentinel lymph node scintigraphy in cutaneous melanoma using a planar calibration phantom filled with Tc-99m pertechnetate solution for body contouring.

BACKGROUND AND AIMS: Melanoma is a disease that has an increasing incidence worldwide. Sentinel lymph node scintigraphy is a diagnostic tool that offers important information regarding the localization of the sentinel lymph nodes offering important input data to establish a pertinent and personalized therapeutic strategy. The golden standard in body contouring for sentinel lymph node scintigraphy is to use a planar flood source of Cobalt-57 (Co-57) placed behind the patients, against the gamma camera. The purpose of the study was to determine the performance of the procedure using a flood calibration planar phantom filled with aqueous solution of Technetion-99m (Tc-99m) in comparison with the published data in literature where the gold standard was used. METHODS: The study was conducted in the Department of Nuclear Medicine of Oncology Institute "Prof. Dr. Ion Chiricuta" Cluj-Napoca in 95 patients, 31 males and 64 females. The localization of the lesions was grouped by anatomical regions as follows: 23 on lower limbs, 17 on upper limbs, 45 on thorax and 10 on abdomen. The calibration flood phantom containing aqueous solution of Tc-99m pertechnetate was used as planar source to visualize the body contour of the patients for a proper anatomic localization of detected sentinel lymph nodes. The radiopharmaceutical uptake in sentinel lymph nodes has been recorded in serial images following peritumoral injection of 1 ml solution of Tc-99m albumin nanocolloids with an activity of 1 mCi (37 MBq). The used protocol consisted in early acquired planar images within 15 minutes post-injection and delayed images at 2-3 hours and when necessary, additional images at 6-7 hours. The acquisition matrix used was 128×128 pixels for an acquisition time of 5 - 7 minutes. The skin projection of the sentinel lymph nodes was marked on the skin and surgical removal of detected sentinel lymph nodes was performed the next day using a gamma probe for detection and measurements. RESULTS: The sentinel lymph nodes were detected in 92 cases and confirmed with the gamma probe during the surgical procedure. The localization of the lymph nodes was as follows: for the tumors localized on lower limb 23 lymph nodes were localized in inguinal region, for the tumors localized on upper limb, 17 lymph nodes were localized in axilla, for the tumors localized on the thorax, 40 lymph nodes were localized in axilla and 3 were localized in the inguinal region; for the tumors localized on the abdomen, 1 lymph node was localized in axilla and 8 lymph nodes was localized in inguinal region. Regarding the negative sentinel lymph node cases, 2 cases were registered for primarily lesions localized on thorax and 1 for a lesion localized on abdomen. According to histology, 26 cases revealed lymphatic metastatic invasion. Dose rates measured at 1m from the calibrator phantom had an average value of 3.46 µSv/h (SD 0.19) and at 1.4m, the value was 2.57 µSv/h (SD 0.22). Dose rates measured at the same distances from the Co-57 planar flood source had a average values of 32.5µSv/h (SD 0.11) respectively 24.1 µSv/h (SD 0.14). CONCLUSION: The planar calibration flood phantom is an effective tool for body contouring in sentinel lymph node scintigraphy and offers accurate anatomical information to efficiently localize the detected sentinel lymph nodes in melanoma, being for the first time used and mentioned as a pertinent alternative in our department.

Type-specific human papillomavirus detection in cervical smears in Romania.

Although Romania has one of the highest incidence of cervical cancer in Europe (30 new cases/100 000 women), little is known about the distribution of the human papillomaviruses (HPV) genotypes in this population. We seek to determine the distribution of HPV genotypes in women with normal and abnormal cervical cytology. We analyzed 460 cervical cytology specimens from women who self-referred to the gynecologic clinic. HPV was detected and genotyped using the commercially available INNOLiPA (INNOGENETICS NV) kit based on the reverse hybridization principle. HPV DNA was detected in 279 cases (60.7%) with a median age of 32.9 years. In HGSIL (High Grade Squamous Intraepithelial Lesion) cytology, the presence of HPV DNA was confirmed in 82.7% of cases. The most frequent high-risk genotype was HPV16, found in 32.6% of HPV-positive samples. The next common high-risk genotypes were HPV18, HPV31 and HPV51. Our findings on the distribution and frequency of the HPV genotypes in Romanian population confirmed the utility of the current available HPV vaccines, HPV16 and 18 being detected in 28.7% of cases in the investigated area.

Evaluating methods for improving ultrafiltration in pediatric hemodialysis.

Adequate ultrafiltration (UF) is necessary for good health, but it can be hindered by the development of intradialytic symptoms and hypotension. To determine whether sodium ramping, UF profiles and mannitol could improve UF in children, we instituted a standardized prescription for chronic hemodialysis in our unit. We prospectively analyzed 506 treatments from ten patients. Ultrafiltration volumes up to 9.7% of dry weight were obtained with an overall mean of 5.4%. Mannitol reduced the risk of intradialytic symptoms by 64% (p < 0.05) with a mean UF volume of 6.2%. Step sodium ramping from 148-138 mmol/l reduced the odds of intradialytic symptoms (p = 0.1) and hypotension (p < 0.05) with no difference in the mean UF compared with linear profiles. All UF profiles were associated with an increased risk of intradialytic symptoms, but the effect was only statistically significant with profile 2 (stepwise UF reduction). Overall intradialytic morbidity occurred in 10% of the treatments. Notwithstanding the study limitations, UF volumes higher than traditional recommendations of 5% of the dry weight were achieved with the use of mannitol and 148-138 mmol/l sodium ramping. Despite this, the desired dry weight was not achieved in 66% of our treatments. No clear benefit was seen with UF profiles.