Does a 5-day course of antibiotics in elderly patients with community-acquired pneumonia achieve the established criteria of clinical stability?

OBJECTIVE: We aimed to determine the proportion of elderly patients hospitalised for community-acquired pneumonia (CAP) in whom a 5-day antibiotic therapy would achieve clinical stability according to American Thoracic Society (ATS) criteria. METHODS: Patients aged≥75 years, hospitalised for CAP between November 2018 and August 2019, were analysed retrospectively. The American Thoracic Society (ATS) clinical stability criteria (temperature≤37°C, heart rate≤100/min, respiratory rate≤24/min, systolic blood pressure≥90mmHg, oxygen saturation≥90% in room air) were assessed after five days of antibiotic therapy. RESULTS: Seventy-five patients (mean age 88 years, 49% requiring oxygen therapy) were included. Six died, and at day 5, 36/69 (52%) fulfilled 4/5 stability criteria. The median duration of treatment was 9 days. In 28 patients (41%), it was ≤7 days. CONCLUSION: In 52% of elderly patients with CAP, a 5-day treatment regimen resulted in clinical stability.

Prevalence of physical activity and sedentary-related behaviors among adolescents: data from the Qatar National School Survey.

OBJECTIVES: To investigate the prevalence of physical activity (PA) and sedentary behaviors among adolescents in Qatar by selected demographic characteristics. STUDY DESIGN: Cross-sectional study. METHODS: A total of 5862 students (2938 boys and 2924 girls) in the age group 12-17 years were included in the analyses. PA and sedentary-related measures were obtained from the self-reported survey questions. RESULTS: Only 35.4% of students were performing 60 min of PA ≥3 days/week. The proportion of students with >2 hr screentime ranged from 43% to 57% (weekdays) and 50% to 62.5% (weekends). Girls had less odds of being physically active than the boys (odds ratio [OR] = 0.61, P < 0.001). Qatari students were less likely to be physically active than non-Qataris (OR = 0.79, P < 0.001). Age was inversely correlated with PA ([r = -0.113, P < 0.001 for participation with sports team] and [r = -0.139, P < 0.001 for school physical education classes]). Participation in sports teams positively correlated with 60 min of PA number of days in a week (r = 0.317, P < 0.001). CONCLUSIONS: The study describes insufficient PA among youth as a public health issue of concern in the State of Qatar that requires multipronged health promotion initiatives.

The Use of Intraoperative Traction in Pediatric Scoliosis Surgery: A Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVE: To study the morbidity and the potential benefits of using intraoperative skeletal traction as an adjunct method for correcting scoliosis. SUMMARY OF BACKGROUND DATA: Cotrel et al., used intraoperative skeletal traction in all patients in their original series of segmental spinal instrumentation for scoliosis correction (Cotrel et al., Clin Orthop Relat Res 1988;227:10-23). However, the use of intraoperative traction may introduce other forms of surgical morbidity, which has not been systematically studied. METHODS: Two independent reviewers searched MEDLINE (1948-current) and EMBASE (1980-current) using the keywords scoliosis, intraoperative, and traction in all fields, combined with AND. Studies were subject to full-text assessment against specific inclusion and exclusion criteria; discrepancies between the reviewers were resolved by a third independent reviewer. Data were extracted into standardized extraction tables and papers were critically appraised papers with regards to their relative strengths and weaknesses, with particular attention to the study objective. RESULTS: Nine papers were included: case report (n = 1), retrospective case series (n = 2), retrospective case-control (n = 6), and studies included both adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis. Seven studies reported positive effects of intraoperative skeletal traction on diverse outcome measures, such as correction of pelvic obliquity, Cobb angle, and axial plane deformity, as well as precluding the need for an anterior release preceding posterior instrumentation for large curves. Overall, there was only one reported postoperative traction-related complication (anterosuperior iliac spine pressure sore). One paper reported that intraoperative traction may evoke neuromonitoring signal changes in a large proportion of patients undergoing AIS surgery. These changes were responded to intraoperatively by decreasing or removing weight and none of the patients had postoperative neurologic deficits. CONCLUSION: Isolated intraoperative skeletal traction may be a low-morbidity adjunct to facilitate scoliosis surgery. Further studies are needed to compare outcomes of scoliosis surgery with or without intraoperative skeletal traction.

Medical management of obesity: an update.

Obesity is rapidly growing global epidemic with monumental impact on health and economics. It is associated with multiple adverse health consequences including hypertension, diabetes, dyslipidemia, coronary heart disease, heart failure and stroke to name a few. It is also associated with premature death. The economic impact of obesity is also striking and represents up to 6% of the total healthcare expenditure worldwide. Therefore, effective therapeutic strategies are desperately needed to curb the rising epidemic of obesity. In this review, we present the underlying cause of obesity, together with pathophysologic insights necessary for the practicing physician as basis for the medical therapeutic options available, that are presented in more details. We also discuss promising therapeutic agents that are under different stages of development.

Recognizing and treating social anxiety disorder.

Social anxiety disorder is the third most common psychiatric disorder in the United States. Patients strive to avoid stress-inducing situations, or they may endure them with marked psychological distress and physical reactions, including sweating and tachycardia. Social anxiety disorder can be diagnosed by a careful history and can be treated successfully with medications or psychosocial interventions.

A cluster of pediatric metallic mercury exposure cases treated with meso-2,3-dimercaptosuccinic acid (DMSA)

Nine children and their mother were exposed to vapors of metallic mercury. The source of the exposure appears to have been a 6-oz vial of mercury taken from a neighbor's home. The neighbor reportedly operated a business preparing mercury-filled amulets for practitioners of the Afro-Caribbean religion Santeria. At diagnosis, urinary mercury levels in the children ranged from 61 to 1,213 microg/g creatinine, with a geometric mean of 214.3 microg/m creatinine. All of the children were asymptomatic. To prevent development of neurotoxicity, we treated the children with oral meso-2,3-dimercaptosuccinic acid (DMSA). During chelation, the geometric mean urine level rose initially by 268% to 573.2 microg mercury/g creatinine (p<0.0005). At the 6-week follow-up examination after treatment, the geometric mean urine mercury level had fallen to 102.1 microg/g creatinine, which was 17.8% of the geometric mean level observed during treatment (p<0.0005) and 47.6% of the original baseline level (p<0.001). Thus, oral chelation with DMSA produced a significant mercury diuresis in these children. We observed no adverse side effects of treatment. DMSA appears to be an effective and safe chelating agent for treatment of pediatric overexposure to metallic mercury.

An in vivo model of femtosecond laser intrastromal refractive surgery.

BACKGROUND AND OBJECTIVE: To develop an animal model for evaluation of femtosecond laser intrastromal refractive surgery. METHODS: Intrastromal photodisruption was performed in New Zealand Albino rabbits using a femtosecond laser system. This surgical pattern consisted of a 100 microm-tick pyramid of laser pulses starting 180 microm below the corneal surface. Animals underwent serial slit lamp examinations and corneal thickness measurements at 1,3,7,14, and 28 days, then monthly up to 1 year. RESULTS: Approximately 70 microm of central corneal thinning were seen at 1 week, remaining stable up to 7 months. CONCLUSIONS: Intrastromal photodisruption with femtosecond lasers produced consistent changes in corneal thickness without loss of corneal transparency. These changes were more stable than those produced with excimer laser procedures in a similar animal model.

[Simultaneous traumatic dislocations of the index finger. Apropos of a case with review of the literature]. / Luxation étagée traumatique de l'index. A propos d'un cas avec revue de la littérature.

A new case of simultaneous dislocation of the proximal and distal interphalangeal joints on the same digit is reported. This injury is uncommon in the index. The forces were applied to the finger tip in hyperextension position. Closed treatment provided a good result with full range of motion. Therapeutic options are discussed.

Implementation of early discharges after uncomplicated vaginal deliveries: maternal and infant complications.

BACKGROUND: Short-stay obstetric stays have been the recent focus of many social and medical debates. We did a retrospective study of a large community teaching hospital's experience in making a safe transition to short-stay obstetrics. METHODS: Over a 10-month period, a multidisciplinary committee developed an intrapartum and postpartum education program to allow short hospital stays after uncomplicated vaginal deliveries. Computerized data were then retrieved on all uncomplicated spontaneous vaginal deliveries (DRG 373) from January 1994 to March 1995. RESULTS: During the study period, 554 women were discharged on the first postpartum day, resulting in three maternal readmissions and nine pediatric readmissions (combined readmission rate of 2.2%). This low readmission rate compared favorably with our experience with 2,563 uncomplicated vaginal deliveries from January 1991 to December 1993, immediately before the institution of the short-stay obstetrics program (combined readmission rate of 3.9%). The average hospital cost for a 1-day stay was $1,714 compared with $2,477 for a 2- to 3-day stay, representing a saving of only 31%. CONCLUSIONS: Early obstetric discharges after an uncomplicated spontaneous vaginal delivery can be safe and effective with appropriate patient selection and support.

Hyperactivation of the silencing proteins, Sir2p and Sir3p, causes chromosome loss.

The SIRgene products maintain transcriptional repression at the silent mating type loci and telomeres in Saccharomyces cerevisiae, although no enzymatic or structural activity has been assigned to any of the Sir proteins nor has the role of any of these proteins in transcriptional silencing been clearly defined. We have investigated the functions and interactions of the Sir2, Sir3, and Sir4 proteins by overexpressing them in yeast cells. We find that Sir2p and Sir3p are toxic when overexpressed, while high Sir4p levels have no toxic effect. Epistasis experiments indicate that Sir2p-induced toxicity is diminished in strains lacking the SIR3 gene, while both Sir2p and Sir4p are required for Sir3p to manifest its full toxic effect. In addition, the effects of Sir2 or Sir3 overexpression are exacerbated by specific mutations in the N-terminus of the histone H4 gene. These results are consistent with a model in which Sir2p, Sir3p and Sir4p function as a complex and interact with histones to modify chromatin structure. We find no evidence that toxicity from high levels of the Sir proteins results from widespread repression of transcription. Instead, we find that high levels of Sir2p and/or Sir3p cause a profound decrease in chromosome stability. These results can be appreciated in the context of the effects of Sir2p in histone acetylation and of chromatin structure on chromosome stability.

Laparoscopic cholecystectomy for recurrent gallstone pancreatitis during pregnancy.

A pregnant patient with gallstone-induced pancreatitis initially responded to medical treatment, but the pancreatitis recurred. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy were done at 28 weeks' gestation. The remainder of the pregnancy was unremarkable. Although 20 cases of laparoscopic cholecystectomy have been reported for cholecystitis during pregnancy, this is the first report of laparoscopic management of recurrent gallstone pancreatitis in a pregnant patient.

[Transverse fracture of the body of C2. Apropos of a case]. / Fracture séparation sagittale transcorporéale de C2. A propos d'un cas.

INTRODUCTION: A new fracture of the body of C2 is described. The mechanism is an axial compression producing a body sagittal fracture spreading to the posterior arch with a separation effect. CASE REPORT: A 29 years old female fell from the second floor. Examination showed a head injury and upper neck stiffness. Specific radiological signs was reported on the standard X-ray. The fracture involved the body and the lamina of C2 with a sagittal separation. No neurological abnormality was detected. CT scan provided additional information and allowed the survey of bone healing. Non operative treatment was undertaken by minerva jacket for four months carying complete recovery. DISCUSSION: The mechanism of this fracture seems to be similar to Jefferson's fracture. Review of the literature showed that fractures of the body of C2 are uncommon. Their different types are discussed.

[Atlanto-axial Pott's disease. Apropos of a case with review of the literature]. / Mal de Pott atloïdo-axoidien. A propos d'un cas avec revue de la littérature.

INTRODUCTION: A new case of sub-occipital Potts disease is reported. CASE REPORT: A 26 years old female from Senegal was admitted for cervical pain of three months duration, neck stiffness and left nasal obstruction with Arnold neuralgia. Radiological studies found a C1-C2 rotatory subluxation with an osteolytic erosion of the lateral mass of the atlas and destruction of the left atlanto-axial joint. CT scan and magnetic resonance imaging provided important diagnostic clues. Culture of sinus biopsies showed a mycobacterium tuberculosis. Progressive reduction of the dislocation and immobilization by minerva jacket for six months with prolonged antituberculous chemotherapy provided successful end result. DISCUSSION: A review of the literature found 95 cases reported since the beginning of this century. The mean age was 20-30 years old. A finding of acid resistant bacilli is necessary for diagnosis and requires culture of gastric secretion, expectoration, retro pharyngeal mass puncture and other upper respiratory tract foci. Radiological signs are discussed. Chemotherapy is the mainstay of treatment with immobilization following reduction of the dislocation when present. The removal of abscess is discussed as well as bone grafting by an anterior or more commonly by posterior approach in case of instability.

Ultrasonic prediction of discordant growth in twin pregnancies.

In this prospective study conducted from 1984 through 1987, the ability to correctly predict growth discordancy in twin gestations by ultrasonic estimated fetal weights is examined. Discordancy was defined as an intertwin birth weight difference of 25% or greater. This method resulted in a sensitivity rate of 77% and a specificity rate of 92%. The positive predictive value of an abnormal test (i.e. discordant growth) was 67% and the negative predictive value of a normal test (i.e. concordant growth) was 95%. The perinatal mortality rate of 217/1,000 in discordant twin fetuses was significantly higher than 29/1,000 in the concordant twins in this study population (p < 0.01) and even more of a contrast to the rate of 10/1,000 in our singleton population. Accurate prediction of discordant twin pregnancies which are at high risk for poor outcome opens the opportunity for potential in utero treatment modalities.

[Bipolar luxation of the 5th metacarpal bone]. / Luxation bipolaire du cinquième métacarpien.

A case of post-traumatic double dislocation of the fifth metacarpal is reported. No reference has been found in the literature. Both were dorsal dislocations, mechanism appears as an axial compression on the metacarpal distal extremity, as first phalanx is hyperextended. Only the carpo-metacarpal-joint was reduced by close technic with percutaneous fixation; the metacarpo-phalangeal dislocation required surgery using a palmar approach. Normal function of the joint was recovered three months later.

The interstitial deletion of bands q33-35 of long arm of chromosome 7: a review with a new case report.

Interstitial or terminal deletion resulting in partial monosomy of various segments of the long arm of chromosome 7 was first recorded over two decades ago. Since then, a number of reports have correlated the severity of clinical manifestations with the length of the deletion involved. However, difficulty remains in defining a so-called "distinct syndrome". We present a new case with the shortest interstitial deletion of the long arm of chromosome 7 bands q33-35, i.e. 46,XX,del(7)(pter----q33::q35----qter). A 4-year-old black female was referred for cytogenetic evaluation due to neurodevelopmental delay. Pertinent physical examination at birth was cleft lip and cleft palate which required corrective surgery. At 2 years of age, a myringotomy tube was inserted for repeated ear infection and a hearing aid was required for conductive deafness. Neurological examination revealed poor eye contact, and severe mental and motor retardation. We reviewed 21 cases of a partial interstitial deletion of varied segments of the long arm of chromosome 7, but we were unable to establish a definite relationship with the deletion of various 7q segments with any specific clinical manifestations.

An apparent balanced translocation [t(9;11)(p21.2;p14.2)] in a neonate with dysmorphic features.

The role of so called balanced translocations in human morphogenesis remains puzzling. An eleven month old hispanic female was referred for neurological evaluation. The major dysmorphic features include: epicanthal folds, flat nasal bridge, small mouth, micrognathia, low set ears and cleft-palate. The cytogenetic findings by multiple banding techniques revealed an apparent balanced translocation involving chromosomes 9p and 11p i.e. 46,XX,t(9;11)(p21.2;p14.2) which, according to the authors, has not been previously reported.

Lower limb movements and urologic function in fetuses with neural tube and other central nervous system defects.

Lower limb movements and urologic systems were evaluated by prenatal ultrasound in 120 fetuses with either neural tube defects or intracranial anomalies. Despite anticipated major lower extremity and bladder dysfunction, lower limb movements were seen in 100% of the fetuses with anencephaly and encephaloceles, 93% with isolated spina bifida, 60% with complex spina bifida and 90% with abnormal intracranial findings. In all the cases except those with cloacal exstrophy, fetal bladder and collecting systems appeared normal. Therefore, fetal lower limb movements and urinary tract integrity appear to have no diagnostic or prognostic value in fetuses with neural tube defects or other central nervous system anomalies. These diagnoses can only be made by direct ultrasound observation of the lesion itself.