Transition of Care: Pediatric Ambulatory Center to Emergency Department.

BACKGROUND: Little is known about the characteristics, clinical course, and the disposition of sick children transferred from pediatricians' offices to the emergency department (ED). OBJECTIVES: The purpose of the study was to determine the clinical profile, ED course, and disposition of children transferred from a hospital-based pediatric clinic to the ED. METHODS: We conducted a retrospective cohort study involving all sick children transferred from a hospital-based clinic to the hospital's ED from January 2012 to December 2013. Data collected included demographics, acuity of illness, ED course, diagnoses, and disposition of all children. RESULTS: A total of 179 patients were transferred to and received care in the ED: boys, 56%; median age, 18 months; mean age, 58 months; 68% were younger than 60 months; African American, 83%; Hispanic, 12%. Sixty-eight percent of the patients were triaged as Emergency Severity Index 3 (urgent) and 13% were Emergency Severity Index 2 (high risk), with the rest categorized as nonurgent. Forty-three percent (78) were discharged home, and 57% were admitted. Age younger than 60 months, need for intravenous antibiotics, inhaled medications, plain x-rays, respiratory viral panel polymerase chain reaction (PCR), supplemental oxygen, and blood work in the ED were associated with being admitted (P < 0.05). The top 3 primary diagnoses were respiratory distress (40%), skin and soft tissue infections (15%), and other infections (10%). CONCLUSIONS: Children transferred from a hospital-based pediatric clinic to the ED at an urban academic medical center had a high level of acuity, and almost 60% were admitted for inpatient care. Improvement in the provision of pretransfer care can potentially decrease transfers to the ED.

Microrna-130a Downregulates HCV Replication through an atg5-Dependent Autophagy Pathway.

We previously identified that miR-130a downregulates HCV replication through two independent pathways: restoration of host immune responses and regulation of pyruvate metabolism. In this study, we further sought to explore host antiviral target genes regulated by miR-130a. We performed a RT² Profiler™ PCR array to identify the host antiviral genes regulated by miR-130a. The putative binding sites between miR-130a and its downregulated genes were predicted by miRanda. miR-130a and predicted target genes were over-expressed or knocked down by siRNA or CRISPR/Cas9 gRNA. Selected gene mRNAs and their proteins, together with HCV replication in JFH1 HCV-infected Huh7.5.1 cells were monitored by qRT-PCR and Western blot. We identified 32 genes that were significantly differentially expressed more than 1.5-fold following miR-130a overexpression, 28 of which were upregulated and 4 downregulated. We found that ATG5, a target gene for miR-130a, significantly upregulated HCV replication and downregulated interferon stimulated gene expression. miR-130a downregulated ATG5 expression and its conjugation complex with ATG12. ATG5 and ATG5-ATG12 complex affected interferon stimulated gene (ISG) such as MX1 and OAS3 expression and subsequently HCV replication. We concluded that miR-130a regulates host antiviral response and HCV replication through targeting ATG5 via the ATG5-dependent autophagy pathway.

Urethral diverticular carcinoma: an overview of current trends in diagnosis and management.

AIMS: To review the management of female urethral diverticular tumours, and rationalize treatment protocols. METHODS: A literature search through Medline, Psychoinfo, EMBASE and the Cochrane library from 1951 was performed for all reports and series of urethral diverticular tumours. RESULTS: A total of one male patient and 75 female patients were reported, with data on demographics, presentation, diagnosis, treatment modalities, recurrence rates and mortality. There is considerable variation in the method of reporting outcomes, and heterogeneity in treatment methods. CONCLUSION: There appears to be no current consensus in the management of these rare tumours. There is an urgent need to establish an international registry of rare tumours to help formulate guidelines on management of such tumours. We propose a management algorithm based on the evidence gathered from review of the published literature.