RESUMO
ABSTRACT: The onset of the COVID pandemic impacted various regulatory agencies' ability to safely fulfill their regulatory compliance inspection mandates via on-site inspections. Some agencies shifted to a remote or hybrid inspection process, which necessitates the electronic transmittal of a variety of records that may or may not have been transmitted in this fashion in the past, raising concerns about the records being sent and received securely. Considering this new environment, some basic cyber security diagnostic considerations are described for radiation source permit holders to consider prior to responding to an apparent legitimate regulatory inspection request, both in the current COVID cyber risk environment and the environment likely to exist into the future.
RESUMO
The authors report two healthy young patients with progressive idiopathic scoliosis, both without allergies or histories of gastrointestinal disorders, who received perioperative preventive cephalosporin antibiotics, and developed explosive diarrhea postoperatively, confirmed as Clostridium difficile pseudomembranous colitis by stool toxin assay. Both patients had initially recovered uneventfully after posterior fusion and Cotrel-Dubousset instrumentation. Their youth, health, diagnosis, and lack of nosocomial factors made colitis unexpected. The two cases were sporadic, occurring 2 years apart over a 12-year observation period. Symptoms and signs of colitis for the two patients were markedly varied as to time of onset, order of appearance, and severity. Unexplained fever before onset of diarrhea led to renewed cephalosporin administration, potentially exacerbating the colitis. Initial symptoms and signs were nonspecific; appropriate treatment had to begin before diagnosis could be confirmed by stool toxin asay, which requires 2 days.
