[Post-traumatic growth impairment following pediatric distal radius fractures resulting in an ulnar variance : A case report]. / Posttraumatische Wachstumsstörung nach kindlichen distalen Radiusfrakturen mit Entwicklung einer Ulnalängenvarianz : Ein Fallbeispiel.

BACKGROUND: Fractures of the distal forearm are common in children. While we treat adults by trying to anatomically reconstruct the wrist joint, in children, fracture treatment is predominantly conservative due to the high correction potential of the distal growth plate. However, the presentation of young adults with post-traumatic wrist pain is not unusual. OBJECTIVES: Do pediatric distal forearm fractures really heal without consequences despite a large tolerance of axial deviation? MATERIALS AND METHODS: Review of the literature, discussion of results and case report. RESULTS: Positive ulnar variance is the most common sequelae of pediatric distal forearm fractures. A positive variance of as little as >2 mm frequently causes ulnar-sided wrist pain and loss of motion, as is also shown in our case. CONCLUSIONS: Careful follow-up is advisable beyond fracture union following pediatric distal forearm fractures, especially after transphyseal osteosynthesis or growth plate involvement. Reconstructively corrective osteotomy of the ulna should be considered in patients with corresponding clinical symptoms, radiological findings and a positive ulnar variance of >2 mm.

Genetic characterization of measles virus genotype D6 subacute sclerosing panencephalitis case, Alberta, Canada.

Subacute sclerosing panencephalitis (SSPE) is a progressive and eventually fatal neurological disease arising from a persistent infection with measles virus (MV) acquired at a young age. SSPE measles virus strains are defective and unable to produce progeny virions, due to multiple and extensive mutations in a number of key genes. We sequenced the full MV genome from our recently reported SSPE case, which typed as genotype D6, and compared it with other genotype D6 wild type and SSPE sequences. The Alberta D6 strain was significantly different from other reported SSPE D6 sequences. Mutations were observed in all the genes of the Alberta strain, with the greatest sequence divergence noted in the M gene with 17.6% nucleotide and 31% amino acid variation. The L gene showed the least variation with 1.3% nucleotide and 0.7% amino acid differences respectively. The nucleotide variability for 15,672 bases of the complete genome compared to the wild type and other SSPE D6 strains was around 3%.

Interim estimates of 2013/14 vaccine effectiveness against influenza A(H1N1)pdm09 from Canada s sentinel surveillance network, January 2014.

The 2013/14 influenza season to date in Canada has been characterised by predominant (90%) A(H1N1)pdm09 activity. Vaccine effectiveness (VE) was assessed in January 2014 by Canada's sentinel surveillance network using a test-negative case-control design. Interim adjusted-VE against medically-attended laboratory-confirmed influenza A(H1N1)pdm09 infection was 74% (95% CI: 58-83). Relative to vaccine, A(H1N1)pdm09 viruses were antigenically similar and genetically well conserved, with most showing just three mutations across the 50 amino acids comprising antigenic sites of the haemagglutinin protein.

Interim estimates of influenza vaccine effectiveness in 2012/13 from Canada's sentinel surveillance network, January 2013.

The 2012/13 influenza season in Canada has been characterised to date by early and moderately severe activity, dominated (90%) by the A(H3N2) subtype. Vaccine effectiveness (VE) was assessed in January 2013 by Canada's sentinel surveillance network using a test-negative case-control design. Interim adjusted-VE against medically attended laboratory-confirmed influenza A(H3N2) infection was 45% (95% CI: 13-66). Influenza A(H3N2) viruses in Canada are similar to the vaccine, based on haemagglutination inhibition; however, antigenic site mutations are described in the haemagglutinin gene.

A two-ward acute care hospital outbreak of SARS-CoV-2 delta variant including a point-source outbreak associated with the use of a mobile vital signs cart and sub-optimal doffing of personal protective equipment.

BACKGROUND: The arrival of the Delta variant of SARS-CoV-2 was associated with increased transmissibility and illness of greater severity. Reports of nosocomial outbreaks of Delta variant COVID-19 in acute care hospitals have been described but control measures varied widely. AIM: Epidemiological investigation of a linked two-ward COVID-19 Delta variant outbreak was conducted to elucidate its source, risk factors, and control measures. METHODS: Investigations included epidemiologic analysis, detailed case review serial SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) testing of patients and healthcare workers (HCWs), viral culture, environmental swabbing, HCW-unaware personal protective equipment (PPE) audits, ventilation assessments, and the use of whole genome sequencing (WGS). FINDINGS: This linked two-ward outbreak resulted in 17 patient and 12 HCW cases, despite an 83% vaccination rate. In this setting, suboptimal adherence and compliance to PPE protocols, suboptimal hand hygiene, multi-bedded rooms, and a contaminated vital signs cart with potential fomite or spread via the hands of HCWs were identified as significant risk factors for nosocomial COVID-19 infection. Sudden onset of symptoms, within 72 h, was observed in 79% of all Ward 2 patients, and 93% of all cases (patients and HCWs) on Ward 2 occurred within one incubation period, consistent with a point-source outbreak. RT-PCR assays showed low cycle threshold (CT) values, indicating high viral load from environmental swabs including the vital signs cart. WGS results with ≤3 SNP differences between specimens were observed. CONCLUSION: Outbreaks on both wards settled rapidly, within 3 weeks, using a `back-to-basics' approach without extraordinary measures or changes to standard PPE requirements. Strict adherence to recommended PPE, hand hygiene, education, co-operation from HCWs, including testing and interviews, and additional measures such as limiting movement of patients and staff temporarily were all deemed to have contributed to prompt resolution of the outbreak.

[Clinical findings and treatment of perilunar dislocations and dislocation fractures]. / Diagnostik und Therapie von perilunären Luxationen und Luxationsfrakturen.

Perilunate dislocations, dislocation fractures and lunate dislocations are rare injuries predominantly resulting from hyperextension of the wrist during high-energy trauma. Early recognition and treatment of these injuries usually results in good functional outcome despite degenerative changes on radiographs. Immediate reduction and adequate restoration of normal alignment are the key to successful healing. Surgical intervention with open reduction and ligament repair aims at stable reconstruction of the carpus. It requires broad surgical experience and a profound knowledge of normal anatomy.

Fatal influenza B virus pneumonia in a preterm neonate: case report and review of the literature.

Although less common than influenza A, influenza B infections can cause significant mortality and morbidity in children who are immunocomprised and have underlying medical conditions. We report a preterm neonate with fatal influenza B virus pneumonia. This infant presented with signs and symptoms indistinguishable from any other cause of sepsis.

Perspectivas de uso sostenible del grillo doméstico tropical (Gryllodes sigillatus) para la alimentación humana en Colombia / Prospects for the sustainable use of the tropical house cricket (Gryllodes sigillatus) for human consumption in Colombia

RESUMEN Para el año 2050 se espera un aumento del 60% al 70% en el consumo de productos de origen animal. Este aumento en el consumo demandará enormes recursos, siendo las fuentes tradicionales de proteína las más costosas, sobreexplotadas y perjudiciales para el ambiente. Explorar nuevas fuentes de proteína animal se convierte en una necesidad para el sector agropecuario. Es por esta razón que la FAO (2009) incluyó el uso de insectos en la alimentación humana y animal como una fuente alternativa de nutrientes desde el 2003 debido a sus características nutricionales y a su bajo impacto ambiental. Una de las especies más promisorias es el grillo doméstico tropical (Gryllodes sigillatus), cuyo potencial como sistema productivo sostenible ha sido demostrado en varios países asiáticos como europeos. El propósito de este artículo es presentar los aspectos asociados al aprovechamiento y producción de la especie G. sigillatus que pueden hacerla sostenible como alimento en Colombia, dando cuenta de las características generales y nutricionales de la especie y las ventajas socioeconómicas y ambientales de la cría de estos grillos y de los insectos en general. Se establece que, aunque existen emprendimientos en el país, es importante continuar con la investigación sobre esta especie en términos de producción a gran escala, así como en términos nutricionales para potenciar el sector económico y mejorar las condiciones materiales de agricultores en el país.

ABSTRACT Global agriculture production must increase by about 60-70 percent from the current levels to meet the increased food demand in 2050, which will demand enormous resources, with traditional protein sources being the most expensive, overexploited, and environmentally damaging. New alternative protein sources are a necessity for the agricultural sector. Since 2003, FAO (2009) has included insects as feed and food as an alternative protein source because they are nutritious and environmentally sustainable. One of the most promising species is the tropical house cricket (Gryllodes sigillatus), whose potential as a sustainable production system has been demonstrated in several Asian and European countries. This article presents the aspects associated with using and producing the G. sigillatus that can make it sustainable as food in Colombia, accounting for the general and nutritional features of this species and the socioeconomic and environmental advantages of raising these crickets, and insects in general. It was established that, even though there are entrepreneurships in the country, research on this species needs to continue, both in terms of its large-scale production and of its nutritional qualities, to strengthen the economic sector and to improve the material conditions of farmers.

Prenatal ethanol exposure modifies locomotor activity and induces selective changes in Met-enk expression in adolescent rats.

Several studies suggest that prenatal ethanol exposure (PEE) facilitates ethanol intake. Opioid peptides play a main role in ethanol reinforcement during infancy and adulthood. However, PEE effects upon motor responsiveness elicited by an ethanol challenge and the participation of opioids in these actions remain to be understood. This work assessed the susceptibility of adolescent rats to prenatal and/or postnatal ethanol exposure in terms of behavioral responses, as well as alcohol effects on Met-enk expression in brain areas related to drug reinforcement. Motor parameters (horizontal locomotion, rearings and stereotyped behaviors) in pre- and postnatally ethanol-challenged adolescents were evaluated. Pregnant rats received ethanol (2g/kg) or water during gestational days 17-20. Adolescents at postnatal day 30 (PD30) were tested in a three-trial activity paradigm (habituation, vehicle and drug sessions). Met-enk content was quantitated by radioimmunoassay in several regions: ventral tegmental area [VTA], nucleus accumbens [NAcc], prefrontal cortex [PFC], substantia nigra [SN], caudate-putamen [CP], amygdala, hypothalamus and hippocampus. PEE significantly reduced rearing responses. Ethanol challenge at PD30 decreased horizontal locomotion and showed a tendency to reduce rearings and stereotyped behaviors. PEE increased Met-enk content in the PFC, CP, hypothalamus and hippocampus, but did not alter peptide levels in the amygdala, VTA and NAcc. These findings suggest that PEE selectively modifies behavioral parameters at PD30 and induces specific changes in Met-enk content in regions of the mesocortical and nigrostriatal pathways, the hypothalamus and hippocampus. Prenatal and postnatal ethanol actions on motor activity in adolescents could involve activation of specific neural enkephalinergic pathways.

The role of air pollution in myocardial remodeling.

BACKGROUND: Excessive air pollution in urban environments can impact morbidity and mortality. The authors evaluated the role of particulate matter2.5 (PM2.5) in structural, geometric, and functional remodeling in hearts, using an experimental model of myocardial infarction. METHODS AND FINDINGS: Seventy-five rats were divided into 5 groups: control (CG), CG exposed to PM2.5 pollution (CGP), myocardial infarcted group (MI), infarcted group immediately exposed to pollution (IGP-I), and infarcted group previously exposed to pollution and kept exposed after infarction (IGP-II). Greater deposition of interstitial collagen occurred in the left ventricle in CGP, MI, IGP-I, and IGP-II groups compared with that in controls (p = 0.002 CG vs CGP and p<0.0001 CG vs MI, IGP-I, and IGP-II). In the right ventricle, greater collagen deposition existed in CGP, MI, IGP-I, and IGP-II compared with that in CG (p<0.021 CG vs CGP and p<0.0001 CG vs MI, IGP-I, and IGP-II). At the end of the study, CG had a higher mean shortening fraction than the other groups had (p≤0.03). Left ventricular systolic diameter was lower in CG than in infarcted groups (p≤0.003). The infarcted groups had greater expression of TGF-ß (p≤0.04). PM2.5 increased the expression of TGF-ß in the IGP-II compared with the MI group (p = 0.004). The TNF-α gene was overexpressed in the IGP-II compared with the CGP group (p = 0.012). INF-γ gene expression was greater in IGP-II (p≤0.01). Oxidative stress analysis showed a higher glutathione concentration in CGP (p = 0.03), MI (p = 0.014), and IGP-I (p = 0.008) compared with that in CG. CONCLUSIONS: PM2.5 stimulates the deposition of fibrosis in the myocardium of healthy hearts, but not in infarcted hearts. PM2.5 modulates the inflammatory response, which was greater in the IGP-II group. It also modulates oxidative stress in healthy hearts but not in infarcted hearts.

Acetoacetate protects hippocampal neurons against glutamate-mediated neuronal damage during glycolysis inhibition.

Glucose is the main substrate that fulfills energy brain demands. However, in some circumstances, such as diabetes, starvation, during the suckling period and the ketogenic diet, brain uses the ketone bodies, acetoacetate and beta-hydroxybutyrate, as energy sources. Ketone body utilization in brain depends directly on its blood concentration, which is normally very low, but increases substantially during the conditions mentioned above. Glutamate neurotoxicity has been implicated in neurodegeneration associated with brain ischemia, hypoglycemia and cerebral trauma, conditions related to energy failure, and to elevation of glutamate extracellular levels in brain. In recent years substantial evidence favoring a close relation between glutamate neurotoxic potentiality and cellular energy levels, has been compiled. We have previously demonstrated that accumulation of extracellular glutamate after inhibition of its transporters, induces neuronal death in vivo during energy impairment induced by glycolysis inhibition. In the present study we have assessed the protective potentiality of the ketone body, acetoacetate, against glutamate-mediated neuronal damage in the hippocampus of rats chronically treated with the glycolysis inhibitor, iodoacetate, and in hippocampal cultured neurons exposed to a toxic concentration of iodoacetate. Results show that acetoacetate efficiently protects against glutamate neurotoxicity both in vivo and in vitro probably by a mechanism involving its role as an energy substrate.

Antibody to hepatitis C virus in selected groups of a Canadian urban population.

In an anonymous survey, 433 sera from Canadian individuals of selected categories were tested for the presence of antibody to hepatitis C virus (HCV) using a recombinant antigen-based immunoassay. About 50% of intravenous drug abusers (IVDA), 10% of transfusion recipients and an overall average of 7.9% of male homosexuals were reactive for antibody to HCV. Individuals with jaundice and negative hepatitis B virus (HBV) serology were not reactive for antibody to HCV compared with 26.7% of those with positive HBV serology. Similarly 58% of male Federal prisoners with positive HBV serology were also HCV-antibody reactive compared with 15% of those with negative HBV serology. A prevalence of 1.2% was recorded for individuals not in any of the above groups. Of 433 sera, 92 were reactive and the discrimination in absorbance values between reactive and not reactive samples was good except for 13 sera, eight of which gave values considerably higher than the average negative value and five which were just above the positive threshold.

Value of the minimum bactericidal concentration of antibiotics in the management of a case of recurrent Streptococcus bovis septicaemia.

After prostatectomy a 60-year-old man developed Streptococcus bovis septicaemia. The patient did not respond to treatment with a combination of ampicillin and erythromycin and in vitro antagonism between these antibiotics was demonstrated by minimum bactericidal concentration (MBC). The value of determining the MBC of antibiotics used in the treatment of septicaemia is emphasised.

Septicaemia and meningitis caused by dysgonic fermenter-2 (DF-2).

A patient developed dysgonic fermenter-2 (DF-2) septicaemia and meningitis after having been bitten by a dog. The pathogenic organism was isolated from the oral cavity of the dog, which, it is believed, is the first time that this has been done. The growth characteristics of the organism and the immunological response of the patient were studied. The isolation of the infecting agent from the dog confirms that the oropharyngeal flora of dogs is a reservoir of the organism: the fastidiousness and slow growth of this Gram negative bacillus may account for the small number of reported cases of infection caused by this organism.

Detection of Chlamydia trachomatis antigen by enzyme immunoassay: importance of confirmatory testing.

AIM--To determine when a fluorescence assay for Chlamydia trachomatis elementary bodies in the specimen buffer is of most value as a verification test for genital specimens reactive on screening enzyme immunoassay (EIA). METHOD--Genital swabs from high and medium prevalence populations were tested using EIA. Samples with absorbance values greater than the positive threshold and those within the range of 30% below this value were verified by the MicroTrak direct fluorescence assay (DFA) test. Quotients derived from the threshold value and specimen absorbances were used to establish confidence limits for the EIA. RESULTS--Of 13,283 swabs tested, 474 from the high risk group and 236 from the medium risk group were reactive on EIA and confirmed by DFA. Thirty six (5.9%) patients with confirmed reactive samples would have been missed if the kit criteria alone were followed. When confidence limits were applied to the calculated quotients, only those samples with an EIA quotient of > or = 4.0 were universally confirmed by the DFA. CONCLUSION--A scheme of testing which uses the DFA to verify EIA reactive specimens over a specified range was found to improve the sensitivity and specificity of the EIA screening test.

Inhibition of Pseudomonas aeruginosa from cystic fibrosis by selective media.

Pseudomonas Isolation Agar (selective agent, Irgasan, 25 mg/1) and Pseudomonas Selective Agar (selective agents, cetrimide 200mg/1 and nalidixic acid 15 mg/1) inhibited some strains of P aeruginosa from cystic fibrosis sputum but did not inhibit isolates from other sources. Of 200 cystic fibrosis isolates, 22 were inhibited by 16 mg/1 Irgasan, 45 by 8 mg/1 nalidixic acid, and 15 by 128 mg/1 cetrimide. We recommend that cystic fibrosis sputum should be cultured on selective and non-selective media to maximise the isolation of P aeruginosa.

Screening for antibody to Chlamydia pneumoniae by the complement fixation test.

We performed a retrospective survey for antibody to Chlamydia pneumoniae, by the microimmunofluorescence (MIF) test, on 120 sera that were previously determined to be positive for antibody to ornithosis antigen by the complement fixation (CF) test. The panel of sera comprised 40 paired acute and convalescent sera, and 40 single samples, from 80 patients. Of these patients, 60% were considered to be serologically positive for C. pneumoniae, based on the antibody titers of IgG, IgM, or both. There was no association between the CF titer to ornithosis antigen and the respective IgG or IgM MIF antibody titers. We propose that, in those laboratories routinely using the CF test, sera found to be positive for ornithosis antigen should be further tested by the MIF in order to clarify, both from an epidemiologic and clinical perspective, whether these patients are also serologically positive for C. pneumoniae.

Pasteurella ureae meningitis and septicaemia.

A 55-year-old male diabetic admitted with deafness, nystagmus, headache and vomiting was found to have meningitis due to Pasteurella ureae and responded to treatment with ampicillin. The P. ureae was unusual in showing X dependency. The family's dogs had had ear infections but no P. ureae were recovered from them when cultured three months later.

Fatal hepatic decompensation in a patient with hepatitis B cirrhosis following famciclovir withdrawal.

Hepatitis B virus (HBV) infection is a major cause of chronic liver disease worldwide. Famciclovir is a nucleoside analogue with potent antiviral activity that appears promising in the management of patients with HBV infection. No data exist regarding the safety of nucleoside analogue withdrawal in patients treated for HBV cirrhosis. The authors describe a 41-year-old man with compensated HBV cirrhosis who developed fatal hepatic decompensation due to a rebound in viral replication within six weeks of discontinuing famciclovir therapy. Although several mutations in the HBV DNA polymerase gene have been documented, none has been associated with famciclovir resistance or adverse clinical outcomes. Clinicians should consider the risk of inducing serious flares in hepatic inflammation as a result of abrupt nucleoside analogue withdrawal. Until further data are available regarding the safety of withdrawal of these agents, indefinite treatment may be required in patients with established cirrhosis.