Cause Of Consultation Research Articles

Surgical management of cerebellopontine angle epidermoid cysts: an institutional experience of 10 years

Background Cerebellopontine angle (CPA) epidermoids, although of benign nature, are of considerable neurosurgical interest because of their close proximity and adherence to the cranial nerves and brain stem. In this paper, we describe our experience and attempt to correlate the final outcomes with the extent of surgical removal. The main objectives were to study various modes of surgical management of CPA epidermoids with regard to removal and preservation of the cranial nerves and also to evaluate the role of endoscopic assisted microsurgical excision thereby minimizing recurrences. This case series is one of the largest series reported so far worldwide. Materials and methods From 2006 to 2016, 139 patients with CPA epidermoids were operated at Grant Medical College and J. J. Hospital, Mumbai. All patients underwent detailed magnetic resonance imaging (MRI) of brain. Lesions were classified according Rogelio Revuelta-Gutiérrez et al. with respect to their anatomic extent: grade I- within the boundaries of the CPA, grade II- extension to the suprasellar and perimesencephalic cisterns, and grade III-parasellar and temporomesial region involvement. Retrosigmoidal and sub temporal approaches were taken to excise the lesions. Endoscopic assisted microsurgical excision was done in cases with extensions beyond the CPA. Patient follow-up was based on outpatient repeated brain MRI studies. Results The mean duration of symptoms before surgery was 42 months (range, 2 months to 6 years). The mean follow-up period was 27 months (range, 2–60 months). The main presenting sympt om was headache in 69% (96/139) of the cases and trigeminal neuralgia in 30% cases was the second most common cause of consultation. Seventy-five percent of patients had some degree of cranial nerve (CN) involvement. Retrosigmoid approach was taken in 92% patients and 7 patients with supratentorial extension were operated by combined retrosigmoidal and subtemporal approach. Endoscopic assisted microsurgical excision was done in 40% cases. Use of angled views by an endoscope helped to excise residual tumor in 47 (83%) patients. Complete excision was achieved in 67% of cases. In 33% patients, small capsular remnants could not be removed completely because of their adherence to vessels, brainstem and cranial nerves. Compared with their preoperative clinical status, 74% improved and 20% had persistent cranial nerve deficits in the first year of follow up. Conclusions Epidermoid cysts are challenging entities in current neurosurgery practice due to tumor adhesions to neurovascular structures. Meticulous surgical technique with the aid of neurophysiological monitoring is crucial to achieve safe and effective total or subtotal removal of these lesions. A conservative approach is indicated for patients in whom the fragments of capsule is adhered closely to blood vessels, nerves, or the brainstem, in order to avoid risk of serious neurological deficits related to an inadvertent damage of these structures. Use of angled views by endoscope at the conclusion of the surgery may assure the surgeon of total removal of the tumor.

Emergency department frequentation and unscheduled readmissions within the first year after liver transplantation, and their impact on survival.

The aim of this study was to assess emergency room frequentation, visit causes, and unscheduled readmissions within the first year after discharge from hospital following liver transplantation. Their impact on graft and patient survival was also assessed. This was a retrospective study of the medical records of 98 patients (mean age, 55.6 ± 8.59 years, 77.6 % males) who were consecutively discharged from hospital after undergoing a first liver transplant in our institution during 2012-2015. All visits to the emergency room during the first years after transplantation were analyzed, and survival at two years after transplantation was calculated. Fifty-six of the 98 patients (57.15 %) visited the emergency room on 117 occasions within the first year post-transplantation. Fever (n = 34; 29.05 %) and digestive symptoms (n = 32; 27.35 %) were the most common causes of consultation, and resulted in over half of visits. Thirty-five of these 56 patients (62.5 %) required an urgent readmission during 50 of the 117 (42.7 %) visits. This was primarily due to infectious complications (44 %) of diverse causes (bacterial pneumonia, cholangitis, Clostridium difficile colitis) and biliary tract-related issues. The likelihood of readmission increased from 11.22 % at 30 days after discharge to 22.4 % at 90 days after discharge. Patient survival at 1 and 2 years after transplantation was lower for patients who were readmitted (88.4 % and 80.7 %, respectively) when compared to those who were not readmitted (95.56 % and 91.17 %, respectively, p = 0.002).

Surveillance of Respiratory Syncytial Virus in Children Aged 0-5 years in Côte d'Ivoire

Acute Respiratory Infections (ARI) are, after malaria, the second most common cause of consultation of children in health facilities in Côte d'Ivoire. Viral etiology points to Respiratory Syncytial Virus (RSV) as the primary cause of these acute respiratory infections. In order to better assist health workers in diagnosing the virus, a study on the epidemiology, seasonality and clinical signs associated with RSV acute respiratory infections was conducted over four consecutive years. During these years, nasopharyngeal samples were collected from 5648 children aged 0-5 years, in different geographical areas of the country, following a survey form for analysis by real-time PCR, to detect the virus and describe its epidemiological characteristics. Our results revealed 564 (9.98%) RSV positive children. A number of 181 (32.09%) were positive in inpatients, and 383 (67.91%) in outpatients. The 0-12 month age group was the most affected with 51.95% of positive cases. Cumulative monthly RSV activity for the 4 years of the study was relatively lower during the months of January to March and higher during the months of May to September. This distribution of RSV was superimposed on rainfall during these study years. Our work has also linked RSV positivity to the presence of clinical signs, including fever, cough, diarrhoea and vomiting. These results give scientific tools to health personnel to better orient their diagnosis and also a better rational use in the prescription of medication, notably the stopping of unjustified antibiotic therapy.

Transurethral Resection of the Prostate (TURP): About 146 Cases at Sheikh Zayed Hospital in Nouakchott Mauritania

Introduction: Transurethral resection of the prostate (TURP), entered our service in October 2015, since then it became a part of the service daily activity. The aim of our study is to assess the acceptance of the technic by our patients and by the nursing staff and to analyze the results of our initial experience. Materials and Methods: Retrospective study over 14-month (October 2015 to December 2016); bringing together all the patients who received TURP. The inclusion criteria are to have benefited from a TURP in our service. The exclusion criteria all patients operated by other techniques. It was a monopolar resection of the prostate using a glycocolle loop, the size limit of the prostate was 65 cc or less. A questionnaire on the knowledge of the technique and its acceptance is made. The parameters studied the age of the patient; surgical indications; the course of the operation, the complications and the course. The frequency of TURP compared to other techniques and the demand for this technique by patients. The urinary catheter was left in place for 4 days, the patients were seen again on day 7 after the catheter was removed to assess the urine flow, a question regarding the opinion of the nursing staff was included and analyzed separately. Results: The total number of patients was 146; the mean age was 68.2 years. The main cause of consultation was urine retention 65%. The average duration of the intervention was 56 minutes. The average length of hospital stay was 28 hours. The urinary catheter was removed on day 4. Complications were bleeding in 7% of cases requiring blood transfusions. Failure to remove the indwelling catheter leads to revision via the transurethral route. The TURP syndrome was observed in 2 patients in our early patients but quickly resolved. The outcome was favorable in 75% of cases. Post operating management give satisfaction for nurse and acceptance was a success. Conclusion: TURP is now a routine surgical activity; it seems to have an upright place for BPH in our department; its impact on morbidity was remarkable.

An entomological survey in the Sudanese Guinean environmental transition zone after indoor residual spraying, Chad.

Introductionmalaria is a major public health issue in Africa. In Chad in 2019, with 955,243 confirmed cases and 2,955 deaths, malaria is the main cause of consultations. A longitudinal entomological study was conducted in Moïssala Health District. Its objective was to assess the impact of indoor residual spraying with 80% bendiocarb wettable powder on malaria transmission.Methodstwo areas were defined for the study: Dembo, located in the sprayed area, Moïssala, in the untreated area. Two sampling methods were used: pyrethrum spray catches and human landing catches.Resultssixteen sessions of human landing catches totalling 32 man-nights were conducted and 160 rooms/site were sprayed. Two anopheles were captured in Dembo and 547 in Moïssala. In Moïssala, An coluzzii, An funestus and An rufipes were captured in the rooms and on human bait. An colluzzii and An funestus were captured in pyrethrum spray catches in Dembo. The anophelian human landing catches density was zero in Dembo while it was 8.38 bites/man/night in outdoor and 10.06 bits/man/night in indoor in Moïssala. Only An coluzziiwas found infected in human landing catches and sporozoite index of was 7.46% (10/134) in outdoor and 7.45% (12/161) in indoor in Moïssala. Malaria transmission was estimated at 0.63 infected bites/man/night in outdoor and 0.75 infected bites/man/night in indoor i.e. 229.95 infected bites/man/year in outdoor and 273.75 infected bites/man/year. In pyrethrum spray catches, An coluzzii and An rufipes were the two species found infected in Moïssala with sporozoite indices of 6.70% (23/343) and 20% (2/10) respectively. However, in Dembo, neither of the two captured mosquitoes was found infected.Conclusionthe indoor residual spraying campaign in the eastern zone of Moïssala has led to the collapse of vectors´ density and aggressiveness. However, its evaluation over a short period of time is not sufficient to assess the impact of malaria transmission in this constant and endemic malaria zone.

Safety and effectiveness of radiofrequency ablation in pediatric patients. Fifteen years experience

Introduction and objectivesHeart rhythm disorders are a frequent cause of consultation for pediatric cardiologists all over the world. Arrhythmias can present congenitally in a structurally normal heart, consequence of a congenital heart defect itself or secondary to surgical or interventional correction. Radiofrequency ablation is a minimally invasive technique with high success rates. The objective was to evaluate short and long-term safety and effectiveness of radiofrequency ablation, as well as outcome-related factors in a single-center cohort of pediatric patients. MethodsA retrospective, observational, longitudinal, historical cohort study was performed with patients who underwent radiofrequency ablation between 2001 and 2016 at our institution. We documented clinical and electrophysiological characteristics, final diagnosis, results, time of recurrence, and complications. ResultsA total of 872 radiofrequency ablation procedures were performed between 2001 and 2016, in 762 patients, 16.9% of which had congenital heart disease. Overall success rate was 90.7%. Recurrence occurred in 16.9% of cases. The most frequent complication was atrioventricular block in 1.26%. The most common indication was accessory pathway in 69.5% of cases. ConclusionsRadiofrequency ablation is a safe and effective treatment for arrhythmias in children because of its high rate of success, safety, and low rate of complications. The presence of congenital heart disease increases the complexity of the procedure and increases the rate of recurrence.

Is Celiac Disease Testing Necessary in Functional Abdominal Disorders? A Study in Predominantly Latino Children.

Functional abdominal pain disorders (FAPDs) are among the most common causes of consultation in general pediatrics and pediatric gastroenterology. The Rome IV criteria recommend testing for celiac disease (CD) in children with irritable bowel syndrome-diarrhea (IBS-D) and leaves testing in cases of other FAPDs to the practitioner's discretion. These recommendations were based on a single study that showed a 4-fold increase of CD among patients with IBS in Italy. It is unclear if these findings can be extrapolated to other populations. Understanding whether those results are reproducible in areas with different racial/ethnic backgrounds can optimize patient care. The aim of the study was to assess the prevalence of CD in a sample of children consulting for FAPDs to a tertiary care center in Miami. The charts of all pediatric patients consulting for FAPDs from January 2016 to November 2019 at the University of Miami were reviewed. Demographics, diagnosis, and CD testing for each child were analyzed. One hundred eighty-one children with FAPDs and celiac testing were seen. Mean age of 12.89 years, girls 61.34%. 84 (46.40%) had a diagnosis of IBS and 97 (53.59%) had a diagnosis of other FAPD. One of 181 children with FAPDs (0/84 with IBS and 1/97 with other FAPDs) had positive CD serological testing and EGD confirmation. Our study suggests that the prevalence of CD among children with FAPDs is similar to the community prevalence. This data questions the benefit of testing all children FAPDS (including IBS) for CD. Studies with larger sample size and various racial/ethnic makeup should be done to confirm our findings.

Lipocalin-type prostaglandin D synthase levels increase in patients with narcolepsy and idiopathic hypersomnia.

Excessive daytime sleepiness (EDS) is a frequent cause for consultation and a defining symptom of narcolepsy and idiopathic hypersomnia (IH). The associated mechanisms remain unclear. Lipocalin-type prostaglandin D synthase (LPGDS) is a plausible sleep-inducing candidate. This study is to compare cerebral spinal fluid (CSF) and serum LPGDS levels in patients group with hypersomnia of central origin, including those with narcolepsy type 1 (NT1) and type 2 (NT2) and IH, to those in healthy controls (Con). Serum LPGDS, CSF LPGDS, and CSF hypocretin-1(Hcrt-1) levels were measured by ELISA in 122 narcolepsy patients (106 NT1 and 16 NT2), 27 IH, and 51Con. LPGDS levels in CSF (p = 0.02) and serum (p < 0.001) were 22%-25% lower in control subjects than in patients with EDS complaints, including NT1, NT2, and IH. In contrast to significant differences in CSF Hcrt-1 levels, CSF L-PGDS levels and serum L-PGDS were comparable among NT1, NT2, and IH (p > 0.05), except for slightly lower serum LPGDS in IH than in NT1 (p = 0.01). Serum L-PGDS correlated modestly and negatively to sleep latency on MSLT (r = -0.227, p = 0.007) in hypersomnia subjects. As a somnogen-producing enzyme, CSF/serum LPGDS may serve as a new biomarker for EDS of central origin and imply a common pathogenetic association, but would complement rather than replaces orexin markers.

Anemias carenciales y anemia de los trastornos crónicos

Nutritional anemias, especially iron deficiency anemias, are a global health problem and one of the most frequent causes for consultation in daily clinical practice. Iron, vitamin B12, and folic acid intervene in many physiological processes and as such, a deficiency in them entails other complications in addition to anemia. It is important to know the tools we have available for diagnosis as well as the etiology in order to establish optimal treatment. However, anemia of chronic disease is the most frequent anemia found in hospitalized patients or those with chronic pathologies. Its etiology is more complex, as it tends to occur in elderly patients in which, in addition to possible nutritional deficits, we also have to take into account chronic kidney disease, inflammatory or infectious processes, and neoplasms. Its management is sometimes multidisciplinary and depends on the magnitude and possible causes of the anemia and the patient's comorbidities.

Protocolo diagnóstico y terapéutico de los estados ferropénicos

Iron deficiency anemia (IDA) is the most frequent nutritional disorder and can be found in 2–28% of the population in developing countries. It is one of the most frequent causes for consultation in clinical practice. In Spain, its prevalence is greater in women under 50 years of age (14.8%) and in those under 3 years of age (4.3–5.7%). In the evaluation of a patient with iron deficiency, the most important aspect is to identify and treat the underlying cause. Treatment options include oral compounds, which are a safe, economical, and effective option. Intravenous formulas are indicated for treatment of IDA when oral preparations are not adequate or when rapid supplementation is clinically necessary.

Estudio sobre el subtriaje del Sistema de Triaje de Manchester en pacientes que acuden a Urgencias por cefalea

IntroductionHeadache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the Emergency Department due to headache. Material and methodsWe studied a series of consecutive patients who came to the Emergency Department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. ResultsWe registered a total of 1,120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, two patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and five as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. ConclusionDuring the study period, at least one in 10 patients attending the Emergency Department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.

Unraveling the Mysteries of Restless Leg Syndrome.

Restless leg syndrome (RLS) or Willis-Ekbom disease (WED) is an under-diagnosed, chronic, and progressive primary sensory-motor disorder. It is characterized by an uncontrollable urge to move the legs due to uncomfortable and sometimes painful sensations, with a diurnal variation. RLS can lead to severe sleep disturbances, a usual cause of consultation. The pathophysiology is known partially, and it is believed that there is an association between the different variants of genetic mutations combined with dopaminergic and brain iron dysregulation, which plays an important role. The data used for this study were extracted from the articles found in the PubMed database that discuss different gene variants, pathophysiology, and various methods of treatment. They also highlight the role of iron in the pathogenesis of RLS as it is required for the synthesis of tyrosine hydroxylase, which is the rate-limiting step for dopamine synthesis. This review article provides a clinically useful overview of RLS in terms of pathophysiological findings, its genetic associations, and therapeutic options by using the currently available literature. Because RLS presents with vague symptoms and shares similarities with many other diseases, it might be overlooked by many physicians resulting in underdiagnosis and under-treatment. While these discoveries provide a breakthrough in understanding the details of RLS, further studies are recommended as these studies are limited to animal models and provide a limited representation of the general population.

Physico-chemical and Bacteriological Characteristics of the Drinking Water of the Aguégués Lake District in the Lower Ouémé Valley - Benin

Water is an essential resource for life on earth and is the source of several microbiological and toxicological diseases. The Aguégués one of the communes of the lower valley of Ouémé-Benin are very exposed to these type of diseases. Pathogens swarm in a highly polluted environment because of the peculiarity of this predominantly aquatic area. This is what justifies this research, which aims to assess the quality of drinking water for the populations of the Commune des Aguégués. The research technique focused on the field survey which made it possible to identify the different sources of water supply used by the population. Likewise, the physico-chemical and bacteriological quality of these water sources has been determined. These research techniques have made it possible to discover that the population of Aguégués uses several sources of water. Apart from the recommended sources (National Water Company of Benin and Village Water Supply) the populations use other sources of water. These are rainwater consumed in the rainy season by 97% of the households surveyed, surface water used by 78.26% of the population, especially during flood periods for various uses. Physico-chemical and bacteriological analyzes have shown that apart from SONEB waters only available in the districts of Zoungamey and Houédomey, the other sources of water have parameters which do not comply with WHO standards. This justifies the prevalence of diarrheal diseases in the study environment, which represents the second cause of consultation in health centers.

Medulloepithelioma of the Ciliary Body Revealing by a Leukocoria

Leukocoria is a cause of consultation in pediatric ophthalmology, congenital catarct as well as retinoblastoma constitute the most frequent causes, nevertheless, a rarer cause can be at the origin of this white glow of the pupil: the Medullo epithelium of the ciliary body.&#x0D; We report the case of a 5-year-old girl in whom a medullo epithelium of the ciliary body was suspected, revealed by a simple leukocoria, confirmed histologically after enucleation.

Pediatric Ocular Toxocariasis in Costa Rica: 1998-2018 Experience

ABSTRACT Purpose To report the epidemiology, clinical characteristics, treatment and outcomes of patients with ocular toxocariasis. Methods Retrospective review of patients diagnosed with ocular toxocariasis at a pediatric referral center from 1998 until 2018 in Costa Rica. Results 157 patients were diagnosed with ocular toxocariasis with a mean follow-up of 3.1 years. The mean age at presentation was 6.7 years old. The most common causes of consultation included decreased vision (29.9%), strabismus (26.7%), and leukocoria (19.7%). The most common findings included peripheral granuloma, posterior pole granuloma, and chronic endophthalmitis. Sixty-nine (43.9%) eyes had retinal detachment. Patients were managed with a variety of treatments including pars plana vitrectomy, systemic corticosteroids, anti-helminthic drugs or a combination of these. Most eyes did not exhibit functional improvement despite treatment. Conclusions Most patients with pediatric ocular toxocariasis in Costa Rica often present late and despite treatment, most remain with poor vision in the affected eye.

RightPath: a model of community-based musculoskeletal care for children.

ObjectivesMusculoskeletal (MSK) presentations are common (reported prevalence of one in eight children) and a frequent cause of consultations (6% of 7-year-olds in a cohort study from the UK). Many causes are self-limiting or raised as concerns about normal development (so-called normal variants). We aimed to describe a new model of care to identify children who might be managed in the community by paediatric physiotherapists and/or podiatrists rather than referral to hospital specialist services.MethodsUsing mixed methods, we tested the feasibility, acceptability and transferability of the model in two UK sites. Evaluation included patient flow, referral times, diagnosis and feedback (using questionnaires, focus groups and interviews).ResultsAll general practitioner referrals for MSK presentations (in individuals <16 years of age) were triaged by nurses or allied health professionals using a triage guide; ∼25% of all MSK referrals were triaged to be managed by community-based paediatric physiotherapists/podiatrists, and most (67%) had a diagnosis of normal variants. Families reported high satisfaction, with no complaints or requests for onward specialist referral. No children re-presented to the triage service or with serious MSK pathology to hospital specialist services in the subsequent 6 months after triage. Triagers reported paediatric experience to be important in triage decision-making and case-based learning to be the preferred training format.ConclusionThe triage model is acceptable, feasible and transferable to enable appropriate care in the community for a proportion of children with MSK complaints. This is a multi-professional model of better working together between primary community and specialist providers.

Evaluation of ankle conventional x-ray as a gold standard on diagnosis and treatment decisions for ankle weber B fractures. Self-controlled multi-centric experiment

Ankle fractures are one of the main causes of consultation with emergency services around the world, with an incidence of 187 / 100,000 inhabitants per year. The most common is type B in the Weber-Dannis classification, with a long-term evolution towards osteoarthritis of 14%. Although the diagnosis of distal fibular fracture on an ankle radiograph is very simple, its usefulness has probably been overestimated to provide the necessary insights to decide the appropriate treatment method for the fracture. The objective of the study is to evaluate the diagnostic utility of ankle radiographs and their inter-observer agreement for a treatment decision making in Weber B fractures.

Evaluación Objetiva de las Radiografías de Tobillo como Patrón de Oro en el Diagnóstico y Tratamiento de las Fracturas Webber B. Experimento autocontrolado multicéntrico

BackgroundAnkle fractures are one of the main causes of consultation with emergency services around the world, with an incidence of 187 / 100,000 inhabitants per year. The most common is type B in the Weber classification, with a long-term evolution towards osteoarthritis of 14%. Although the diagnosis of distal fibular fracture on an ankle radiograph is very simple, its usefulness has probably been overestimated to provide the necessary insights to decide the appropriate treatment method for the fracture. The objective of the study is to evaluate the diagnostic utility of ankle radiographs and their inter-observer agreement for the treatment decision making in Weber B fractures. MethodsA prospective, randomized, double-blind, multicenter trial using three-country surveys of orthopedic surgeons was conducted; orthopedic surgeons and foot and ankle surgeons, were exposed to four Weber B ankle fractures x-ray series where surgery was actually required as the only treatment option. Unilateral and comparative projections, where presented in different time and order to each surgeon, measuring the variability of surgical decisions. ResultsFifty-one orthopedic surgeons (72.37%), 24 foot and ankle surgeons (15.79%), 4 surgeons of other orthopedic subspecialties (2.63%) and 14 orthopedic surgery residents (9.21%) were surveyed. An inter-observer agreement of 70.83% (p <0.05) was found in the comparative projections series and 55.31% (p <0.05) in the unilateral ones. When performing linear regression between the training degree, years of experience and the provenance country of the surgeons, no causality was found (power of β <95%). Nevertheless, 100% of the respondents diagnosed the fracture of the distal fibula as a Weber B fracture. DiscussionThe unilateral and comparative radiographic series are not recommended for making an adequate surgical decision in Weber B ankle fractures, given their very low inter-observer agreement. For decision making in Weber B ankle fractures it is necessary to take other complementary examinations such as Computed Axial Tomography.Evidence Level: II

P0836ROLE OF THE NEPHROLOGIST AS A CONSULTANT FOR VASCULAR SURGERY SERVICE IN A UNIVERSITY HOSPITAL

Abstract Background and Aims The clinical profile and complexity of hospitalised patients from Vascular Surgery are similar to those from Nephrology. Also, the majority of patients with peripheral vascular disease has some degree of chronic kidney disease. Therefore, the collaboration of nephrologist as consultants could have a significant impact on the adequate attention of these patients. Our aim was to analyze the epidemiological and clinical characteristics of the vascular surgery patients admitted in a public university hospital of 1000 beds that were attended by a nephrologist during their hospitalization. Method Observational study of a retrospective cohort of 138 patients in a 1 year period (January 1st to December 31st 2018). The following data were considered: nature of the consultation (“Urgent” LESS THAN 24 H TO BE ATTENDER OR “Standar”), reason for consultation/nephrological diagnosis, cause of admission, follow-up period, age, sex, presence of : Diabetes Mellitus (DM), Hypertension (HT) and/or Chronic Kidney Disease (CKD) presence. Results 138 patients, Mean age was 67,8 y (range 35-92 y). 76,81% were men and 23,19% were women. Most frequent cause for consultations were: 1. Patients on Hemodialysis treatment (66 = 47,83%); 2. Exhacerbations of CKD (29 = 21,01%); 3. Acute Kidney Failure (18 = 13,04%); 4. Kidney transplantation (11 = 7,97%); 5. Ionic alterations (7 = 5,07%); 6. Advanced CKD (6=4,35%). Cause of admission: 1. Chronic lower limb ischemia (68=49,27%); 2. Problems related to arteriovenous fistula (Creation of vascular access: 10=7,25% and complications of vascular access: 16=11,59%); 3. Aneurysmatic complications (14=10,14%); 4. Diabetic foot (11=7,97%); 5. Infections (7=5,07%); 6. Deep venous thrombosis (6=4,35%). About 75.35% had DM, 91.30% were hypertensive and 62.32% had both clinical conditions. The average follow-up time was 72 days (range 1-223 days) and 92,03 % need to be follow-up more than 24 hours. About 49,27% of the consultation were urgent. Conclusion The number of patients admitted to vascular surgery department requiring nephrology attention are high and represents an important percentage of the clinical activities and resources demanding to the nephrology service. Exhacerbations of CKD, Diabetes Mellitus and Hypertension are constant clinical conditions in patients admitted to vascular surgery requiring nephrology assessment. Based on these data is important to improve the coordination between both departments and to stablish a specific training program for nephrologist and vascular surgeons in order to optimize the management of this patients.

Type I Interferon in Children with Viral or Bacterial Infections.

Fever is one of the leading causes of consultation in the pediatric emergency department for patients under the age of 3 years. Distinguishing between bacterial and viral infections etiologies in febrile patients remains challenging. We hypothesized that specific host biomarkers for viral infections, such as type I-interferon (IFN), could help clinicians' decisions and limit antibiotic overuse. Paxgene tubes and serum were collected from febrile children (n = 101), age from 7 days to 36 months, with proven viral or bacterial infections, being treated at pediatric emergency departments in France. We assessed the performance of an IFN signature, which was based on quantification of expression of IFN-stimulated genes using the Nanostring® technology and plasma IFN-α quantified by digital ELISA technology. Serum concentrations of IFN-α were below the quantification threshold (30 fg/mL) for 2% (1/46) of children with proven viral infections and for 71% (39/55) of children with bacterial infections (P < 0.001). IFN-α concentrations and IFN score were significantly higher in viral compared to bacterial infection (P < 0.001). There was a strong correlation between serum IFN-α concentrations and IFN score (p-pearson = 0.83). Both serum IFN-α concentration and IFN score robustly discriminated (Area Under the Curve >0.91 for both) between viral and bacterial infection in febrile children, compared to C-reactive protein (0.83). IFN-α is increased in blood of febrile infants with viral infections. The discriminative performance of IFN-α femtomolar concentrations as well as blood transcriptional signatures could show a diagnostic benefit and potentially limit antibiotic overuse. clinicaltrials.gov (NCT03163628).