Relationship between 25 hydroxyvitamin D and lipid profile in Lebanese school children.

PURPOSE: Limited information is available regarding the association of vitamin D and lipid profile in pediatric populations. The objective of this cross-sectional study is to determine the prevalence of vitamin D deficiency in a large sample of Lebanese schoolchildren and to evaluate the relationship between vitamin D and lipid profile. METHODS: 969 Lebanese schoolchildren (505 boys and 464 girls) aged 8-18 years were recruited from 10 schools of different socioeconomic status (SES). Non-fasting total cholesterol, triglycerides and HDL-Cholesterol (HDL-C) were measured. Non-HDL-C was calculated. RESULTS: The prevalence of 25(OH)D deficiency (level below 20 ng/ml) is 56.6% (48.1% in boys, 65.7% in girls). There is no significant relationship between 25(OH)D levels and age. 25(OH)D is inversely correlated with BMI in the total population, and in boys and girls (p < 0.0001, p = 0.001 and p = 0.001, respectively) and is higher in children from high SES schools and during the summer season (p < 0.0001 in both cases). 25(OH)D is inversely correlated with triglycerides and non-HDL-C in the total population and in boys and girls (p < 0.0001 for all), and positively correlated with HDL-C in the total population and in boys but not in girls (p = 0.001, p < 0.0001 and p = 0.1, respectively). In a multilinear regression analysis, in the overall population, 25(OH)D is independently associated with sex, season, school's SES, BMI, triglycerides and non-HDL-C. In boys, the association with BMI and season is non-significant. CONCLUSION: An independent relationship is observed between 25(OH)D and cardiometabolic risk factors in the pediatric Lebanese population Further studies are needed to evaluate the long-term consequences of this relationship.

Parafilm-assisted microdissection: a sampling method for mass spectrometry-based identification of differentially expressed prostate cancer protein biomarkers.

Mass spectrometry-based methods for prostate cancer biomarker discovery are hampered by their low-throughput capabilities because of extensive sample preparation. We present the parafilm-assisted microdissection technique coupled with label-free quantification and bioinformatics analysis as a means to evaluate directly protein expression changes on benign and tumor regions.

Donor organ shortage crisis: a case study review of a financial incentive-based system.

INTRODUCTION: Current organ supply system depends on altruistic noncoercive donation, which has failed to meet the demand of organ transplantation. Providing financial incentives to donors is one of several approaches to address organ shortage. However, its feasibility is debatable as it relates to medical, ethical, and economic dimensions. An incentive-based procurement system (IBPS) applied by the Mobile Donor Action Team (MDAT) was instituted in Riyadh, Saudi Arabia, resulting in a 3-fold increase in donation rate. The goal of this study was to provide a qualitative review of a 7-year experience with IBPS. MATERIALS AND METHODS: A qualitative approach was used. Documents were reviewed to create a chronological audit and shape interview questions. Sampling was purposeful and inclusive of MDAT members. Semi-structured interviews were conducted, and findings were subjected to thematic analysis. RESULTS: Documents reflected the evolution of MDAT. The essence of MDAT is field work and liberal use of financial incentives, which resulted in a 3-fold increase in the donation rate. MDAT members believed that IBPS is the main reason behind this increase. Moreover, IBPS is viewed as acceptable from a moral, ethical, and religious standpoint, with a high degree of professional satisfaction. CONCLUSIONS: Theoretical assumptions doubted the feasibility of IBPS. This real-life experience with IBPS proved the contrary. The findings may be applicable only to the setting in Riyadh, Saudi Arabia, however; further research is thus needed to explore its transferability to other settings. IBPS may be an alternative to altruistic noncoercive donation and should be piloted in different settings.

Infective endocarditis caused by USA300 methicillin-resistant Staphylococcus aureus (MRSA).

We report seven cases of infective endocarditis caused by USA300 methicillin-resistant Staphylococcus aureus (MRSA) at an urban, tertiary care, academic institution. Five strains were community associated and two were healthcare associated. All patients were injection drug users. Staphylococcus aureus isolates were characterised as USA300-type MRSA using pulsed-field gel electrophoresis. Five cases were right-sided endocarditis and two cases were left-sided. The mean length of in-hospital antimicrobial therapy was 23 days and the mean length of total antibiotic therapy was 55 days. Complications included heart failure resulting in valve replacement in one patient as well as death in that patient. As USA300 strains of MRSA continue to increase in prevalence, clinicians must be aware of the increasing spectrum of illness in considering management and prevention strategies.

Results of flexor-to-extensor and extensor brevis tendon transfer for correction of the crossover second toe deformity.

Between 1990 and 1995, 38 patients (42 feet) underwent repair for crossover toe deformity, 31 (35 feet) of whom returned for final examination at an average of 51.6 months (range, 24-81 months). Causes included trauma, iatrogenic, and unknown. Presenting complaints included dorsal pain with either metatarsalgia or joint pain, isolated metatarsophalangeal (MP) joint pain, metatarsalgia, painful plantar callus, metatarsalgia and joint pain, and painful dorsal callus. All patients were treated with one of two operative techniques, either the flexor-to-extensor tendon transfer or the extensor brevis tendon transfer. Choice of procedure depended on the stage of preoperative deformity. Twenty-four patients were completely satisfied with the surgical correction, 6 were satisfied with reservations, and 1 was dissatisfied. The average postoperative AOFAS score for all patients was 85 points (range, 54-100 points), which correlated strongly with patient satisfaction. Twenty-two patients stated that they had no postoperative pain, 8 reported some pain, and 1 had frequent pain at the corrected toe. In 30 feet, there was no recurrence; three patients had mild residual crossover toe deformity, and two patients had recurrent deformity, although all MP joints were stable. Follow-up radiographs demonstrated substantial reduction in MP joint angles in both the AP (from 7 degrees to -1 degree) and lateral (from 45 degrees to 25 degrees) projections. This article reviews the surgical technique of both procedures, proposes specific indications for each, and presents outcomes. Based on our findings, the extensor brevis tendon transfer is appropriate for stage 1, stage 2, and flexible stage 3 deformities. Flexor-to-extensor tendon transfer is appropriate for rigid stage 3 and stage 4 deformities and for all patients with a symptomatic neuroma of the second web space (where the extensor brevis transfer is not possible). Stiffness of the MP joint is a potential problem with the flexor-to-extensor tendon transfer.

Determination of fixation strength of large-diameter interference screws.

Small-diameter interference screws are a widely used method of securing bone-tendon grafts during anterior cruciate ligament reconstructive procedures. Recent reports document tunnel widening and subsequent loss of fixation, leading to a need for alternative fixation methods. In cadaver tissue, the fixation strength of large-diameter (11-, 13-, and 15-mm) interference screws was tested and compared with that of clinically used 9-mm diameter screws. Patellar-tendon sections were fashioned into three grafts, each with bone plugs measuring 10 x 20 x 7.5 mm. Tunnels were created in the epiphyseal bone of the femurs and tibias, resulting in gap sizes of 4.5-, 6.5-, 8.5-, and 10.5-mm for the 9-, 11-, 13-, and 15-mm diameter screws, respectively. Grafts were pulled from the tunnel at a rate of 51 cm/min. Average fixation strengths were 276, 302, 328, and 328 N for the 9-, 11-, 13-, and 15-mm screws, respectively. No significant difference existed between the fixation strengths (ANOVA, P < or = .05).

An overview of thyroid carcinoma.

Approximately, 12,000 cases of thyroid carcinoma are diagnosed each year. This disease entity accounts for 1.5 percent of all malignancies and is clinically evident in four percent to seven percent of the United States population. This paper provides an overview of thyroid carcinoma, including types, incidence, predisposing factors, evaluation, and treatment.

[Medical treatment of venous priapism apropos of 46 cases: puncture, pharmacologic detumescence or penile cooling?]. / Traitement médical du priapisme veineux à propos de 46 cas: ponction, détumescence pharmacologique ou réfrigération pénienne?

OBJECTIVE: To analyse the efficacy of three nonspecific medical approaches to the first-line treatment of priapism : a) intracavernous injection (ICI) of alpha-adrenergic agonists, b) cavernous puncture, c) penile cutaneous cooling. METHODS: 46 cases of venous priapism, due to various aetiologies, were initially treated by ICI of alpha-adrenergic agonists (23 cases), puncture (14 cases) or cooling (9 cases). These 3 methods were combined only in the case of failure and not uniformly, based on our experience. The results were analysed in terms of successful detumescence and preservation of erectile function. RESULTS: Detumescence was obtained and erectile function was preserved in almost 80% of cases, with conservative treatment alone. ICI (83%) and cooling (78%) were more effective as first-line treatment than puncture (57%). The delay to treatment was a more important parameter than the aetiology. Cooling was no longer effective after the 8th hour, puncture was no longer effective after the 9th hour and ICI was no longer effective after the 34th hour. Failures of conservative treatment and erectile sequelae were only observed in cases of priapism treated after the 24th hour. CONCLUSION: The 3 methods have a similar degree of efficacy, provided they are performed early. Their indication depends on : 1) the duration of priapism, 2) the presence or absence of cavernosal anoxia. Schematically (and in parallel with aetiological treatment when possible) : a) in the case of painless priapism < 12 hours, cooling can be tried first, b) in the case of failure or painless priapism > 12, but < 24 hours, ICI of alpha-adrenergic agonists associated with puncture is indicated (except in the case of contraindications to ICI), c) in the case of painful priapism or > 24 hours, puncture must be the first treatment. In the case of failure, cavernosal blood gases should be performed to evaluate cavernosal anoxia and to guide management.

Evaluation of short-chain fatty acid enemas: treatment of radiation proctitis.

BACKGROUND: Radiation proctitis is a common complication of abdominal and pelvic radiotherapy; unfortunately, there is no established effective therapy for radiation proctitis. Short-chain fatty acids (SCFA) have been effectively used to treat a variety of colitides. We sought to determine whether SCFA enemas have a role in the treatment of radiation proctitis. METHODS: Seven patients completed an open-labeled, pilot study to evaluate the effect of SCFA on clinical, endoscopic, and pathological parameters of radiation proctitis. RESULTS: Four weeks of treatment with SCFA enemas resulted in clinical improvement in all patients. There were modest, but not significant, changes in endoscopic and pathological parameters. CONCLUSION: SCFA are a promising therapeutic option in radiation proctitis.

Increased prolactin level and pituitary adenoma as a cause of headache in two patients with sickle cell disease.

In two patients with sickle cell disease who presented with headache pituitary adenoma and high levels of serum prolactin were found. Treatment with bromocriptine has controlled the headache. We believe that prolactin level determination should be part of the work-up of patients with sickle cell disease who complain of headache.

Current national trends in the posttreatment follow-up of patients with squamous cell carcinoma of the head and neck.

INTRODUCTION: Follow-up of individuals treated for a primary squamous carcinoma of the upper aerodigestive tract is critical because of the high risk of development of either recurrent disease or a new primary tumor. A mail survey of physicians actively practicing head and neck surgery was undertaken. MATERIALS AND METHODS: A multiple-choice survey was distributed to 400 members of the American Society for Head and Neck Surgery. Respondents indicated approach to post-treatment follow up. RESULTS: Surveys were returned from 290 members (73%). Routine monthly follow up is advocated by 73% of respondents during the first postoperative year. Patients are followed every 2 to 3 months in the second postoperative year by 90% of respondents. During postoperative years, 3 to 5 patients are seen every 4 to 6 months by 97% of respondents. All respondents see patients either semiannually or annually for the remainder of their lives. Sixty percent of respondents advocate annual screening chest radiographs, whereas 14% do not order routine chest radiographs. The overwhelming majority of respondents reserve barium swallow and computed tomographic (CT) scans for evaluation of symptomatic patients. Similarly, nuclear imaging is reserved for patients with specific symptoms or abnormal laboratory tests. Blood tests most frequently monitored include complete blood cell count (CBC) (43%), thyroid function test (22%), and liver function test (20%). Follow-up endoscopic evaluation under anesthesia is reserved for symptomatic patients by over 95% of respondents. CONCLUSION: These data demonstrate that head and neck surgeons rarely use supplemental studies other than chest radiograph during routine follow up. The authors speculate that routine chest radiograph may be valuable in screening for a second primary carcinoma. Techniques to screen for esophageal tumors remain contentious.

Characterization of Staphylococcus aureus isolates with decreased susceptibility to vancomycin and teicoplanin: isolation and purification of a constitutively produced protein associated with decreased susceptibility.

"Derivative isolates" with 4- to 8-fold and 8- to 16-fold increases in MICs of vancomycin and teicoplanin, respectively, were selected from 2 susceptible clinical isolates of Staphylococcus aureus by serial incubation in low-level vancomycin. A protein of approximately 39 kDa was demonstrable in the cytoplasmic fraction and occasionally in the membrane fraction by SDS-PAGE of both derivatives. This protein was purified by DEAE chromatography, preparative SDS-PAGE, and electroelution. Derivative bacteria were larger on transmission electron microscopy, had thicker cell walls, and had changes in colony morphology on solid media. Further evidence for cell wall reorganization included loss of phage and capsular typing, decreased susceptibility to lysostaphin/lysozyme killing, and changes in condition for detection of optimal coagulase activity. The mechanism of decreased susceptibility to glycopeptide antibiotics among S. aureus derivative isolates is uncertain. The production of the approximately 39-kDa cytoplasmic protein and cell wall reorganization may mediate changed affinity of glycopeptide-peptidoglycan binding or impairment of glycopeptide access to its cell wall target.

Colostomy plug devices: a possible new approach to the problem of incontinence.

The authors report their experience in the use of the Conseal (Coloplast S.p.A., Bologna, Italy) Colostomy Plug, a new device for the regulation of continence in patients with colostomies. The devices were tested on 57 patients divided into two groups: Group A (36 patients) fit with a two-piece Conseal system and Group B (21 patients) fit with a one-piece Conseal system. All patients had the same colostomy type, and all were trained for self-irrigation. The objectives of this randomized, prospective study were to determine compliance with the different systems, to identify the advantages, and to verify the possible different applications among the population of irrigated patients. The following results were obtained. Regarding compliance: Group A's results were excellent in 22.2 percent and good in 52.7 percent of patients. Group B had better compliance than Group A (excellent in 66.6 percent and good in 19 percent of patients). Regarding controlled evacuation, continence time, and silent gas emission: in Group A, the device permitted controlled evacuations (23.8 percent of patients practicing daily washouts) with silent and odorless gas emission (100 percent of cases). In Group B, the results concerning improvement in continence were good (33.3 percent of patients) and excellent concerning the emission of flatus. Regarding the potential use of both systems in different groups of self-irrigated patients: the study has revealed the Conseal Uni-system as being ideal for patients with a well-constructed stoma, slight gas distention, and a better psychologic adaptability to larger-sized systems. In all other cases, the alternative two-piece system is more suitable, owing to the better safety it offers.

Uveal melanoma in teenagers and children. A report of 40 cases.

A review of 3706 consecutive patients with uveal melanoma revealed that 40 patients (1.1%) were age 20 years or younger at the time of diagnosis. The youngest patient was age 6 years but the majority of patients (78%) were between 15 and 20 years old. The tumor occurred in the iris in 5 cases (12%) and in the posterior uvea in 35 cases (88%). The mean largest tumor dimension and thickness was 10 mm and 5 mm, respectively. In all cases, the diagnosis of uveal melanoma was suspected before referral, and misdirected treatment was avoided. The tumor was initially treated by enucleation in 24 cases (60%), local resection in 7 (18%), plaque radiotherapy in 3 (8%), and observation in 6 (15%). Secondary treatment was required in 7 cases in the form of enucleation (4 cases), ablative laser (1 case), plaque radiotherapy (1 case), and exenteration (1 case). The mean follow-up period was 68 months (median, 48 months) from the time of treatment, and only one patient died of metastases (from a massive ciliochoroidal melanoma 33 months after treatment). The remainder of the group of young patients are alive and healthy. Cumulative survival rates show that 96% of young patients with uveal melanoma survive at the 5-year period.