The use of UV-C radiation for terminal disinfection of pathogenic Gram-negative rods: a pilot study.

In this controlled study, we found that exposure to ultraviolet-C (UV-C) radiation was able to arrest the growth of selected pathogenic enteric and nonfermenting Gram-negative rods. Further studies are needed to confirm the clinical efficacy and determine optimal implementation strategies for utilizing UV-C terminal disinfection.

Dermatoses among returned Canadian travellers and immigrants: surveillance report based on CanTravNet data, 2009-2012.

BACKGROUND: There is a lack of multicentre analyses of the spectrum of dermatologic illnesses acquired by Canadian travellers and immigrants. Our objective for this study was to provide a comprehensive, Canada-specific surveillance summary of travel-related dermatologic conditions in a cohort of returned Canadian travellers and immigrants. METHODS: Data for Canadian travellers and immigrants with a primary dermatologic diagnosis presenting to CanTravNet sites between September 2009 and September 2012 were extracted and analyzed. Data were collected using the GeoSentinel data platform. This network comprises 56 specialized travel and tropical medicine clinics, including 6 Canadian sites (Vancouver, Calgary, Toronto, Ottawa and Montréal), that contribute anonymous, de-linked, clinician- and questionnaire-based travel surveillance data on all ill travellers examined to a centralized Structure Query Language database. Results were analyzed according to reason for most recent ravel: immigration (including refugee); tourism; business; missionary/volunteer/research and aid work; visiting friends and relatives; and other, which included students, military personnel and medical tourists. RESULTS: During the study period, 6639 patients presented to CanTravNet sites across Canada and 1076 (16.2%) received a travel-related primary dermatologic diagnosis. Arthropod bites (n = 162, 21.5%), rash (n = 141, 18.7%), cutaneous larva migrans (n = 98, 13.0%), and skin and soft tissue infection (n = 92, 12.2%) were the most common dermatologic diagnoses or diagnostic bundles issued to returning Canadian tourists (n = 754, 70.1% of total sample). Patients travelling for the purpose of immigration (n = 63, 5.9%) were significantly more likely to require inpatient management of their dermatologic diagnoses (p < 0.001) than those travelling for other purposes. INTERPRETATION: This analysis of surveillance data details the spectrum of travel-related dermatological conditions among returning Canadian travellers in this cohort, and provides an epidemiologic framework for Canadian physicians encountering these patients.

The evidence for hip arthroscopy: grading the current indications.

PURPOSE: The purpose of this systematic review is to provide a comprehensive analysis of the Level of Evidence and the Grade of Recommendation for hip arthroscopy. METHODS: A literature review was performed (in June 2010) using the PubMed and Cochrane databases. Studies that focused on the efficacy of hip arthroscopy for all therapeutic indications were reviewed to determine their Level of Evidence. The studies were grouped based on indication, and the literature supporting each indication was analyzed and assigned a Grade of Recommendation. A subscale proposed by us was used to further describe the evidence base for indications receiving a Grade of Recommendation indicating poor-quality evidence. RESULTS: Fair evidence (grade B) exists to support the surgical technique of hip arthroscopy for the treatment of femoroacetabular impingement. Poor-quality evidence (grade C(f)) exists to support a recommendation for the use of hip arthroscopy in the treatment of acetabular labral tears, extra-articular lesions, septic arthritis, and loose bodies. There is poor-quality conflicting evidence (C(c)) regarding the use of hip arthroscopy for the treatment of mild to moderate osteoarthritis of the hip. CONCLUSIONS: Although fair evidence (grade B) exists to support the use of hip arthroscopy for the treatment of femoroacetabular impingement, a majority of recognized indications for this surgical technique currently lack adequate evidence-based support in the literature (grade C or grade I). Higher-quality trials (Level I and Level II) are needed to provide support for the increasing application of this surgical technique. We also applied a new subscale to the grades of recommendation for summaries or reviews of orthopaedic surgical studies proposed by Wright et al. to provide a description of the direction in which outcomes are trending in Level IV studies. LEVEL OF EVIDENCE: Level IV, systematic review.

Acute splenic sequestration and hypersplenism in the first five years in homozygous sickle cell disease

A cord blood screening programme initiated in June 1973 had screened 68 000 normal deliveries by February 1979 with the detection of 216 cases of homozygous sickle cell disease. Regular review of these children in the Medical Research Council paediatric clinic has identified acute splenic sequestration as a major cause of morbidity and mortality in the first 5 years of life. In addition to classical episodes characterised by peripheral circulatory failure, minor episodes of increasing anaemia associated with an enlargening spleen and an active marrow were also common. These minor episodes appeared to have predictive value in children who later developed severe life-threatening episodes ofacute splenic sequestration. Sustained hypersplenism was also appreciably more common in children developing minor or major episodes of acute splenic sequestration compared with those without such a history. It is proposed that the classification of acute splenic sequetration be expanded to include these minor episodes, and that consideration be given to prevention of recurrences by splenectomy particularly in patients who also develop sustained hypersplenism (Summary)