Ml In Adults Research Articles

Bacterial profile and antimicrobial susceptibility patterns in cancer patients.

Bloodstream infections have been the leading complications in cancer patients because they are at high risk for antibiotic-resistant bacterial infections. There is increasing evidence from different parts of the world of the high prevalence of antimicrobial-resistant bacterial strains in cancer patients. The burden of the infection is high in developing countries, especially in Ethiopia. Data on bacterial profile and antimicrobial susceptibility patterns among cancer patients in Ethiopia is limited. Thus, this study aimed to determine the predominant bacterial species causing bacteremia and their antibiotic resistance pattern among cancer patients at University of Gondar comprehensive specialized hospital. A hospital-based, cross-sectional study was conducted on 200 study participants from March to July 2021. All cancer patients who developed a fever at the time of hospital visit were included in this study, and their socio-demographic and clinical data were collected using a structured questionnaire. Blood samples (10 mL for adults and 4 mL for children) were collected from each patient, and the collected blood samples were transferred into sterile tryptic soy broth, then incubated at 37°C for 7 days. Tryptic soy broth which showed signs of growth were Gram-stained and sub-cultured on blood agar, chocolate agar, MacConkey agar, and mannitol salt agar. The inoculated plates were then aerobically incubated at 37°C for 18-24 hours and the isolates obtained were identified using standard microbiological methods. Antimicrobial susceptibility tests were done using a modified Kirby-Bauer disk diffusion technique following CLSI 2021 guidelines. Data were entered using EPI data version 4.6 and analyzed with SPSS version 20. In this study, out of 200 cancer patients included and 67.5% (135/200) of them were males. The majorities of study participants, 56% (113/200) of cancer patients were pediatrics and 26.5% (53/200) of them belong under five years of age. Out of 200 patient samples that had undergone culture, 27% (54/200) samples had bacterial growth. Gram-positive bacterial isolates were predominant, 61.1%, and S. aureus was the predominant Gram-positive isolate, (51.5.6%), followed by coagulase-negative staphylococci (48.5%). Moreover, K. pneumoniae (47%) and P. aeruginosa (29.5%) were the most common Gram-negative bacterial isolates. Among patients who had BSIs, the highest prevalence of BSIs was observed among males (66.7%), and in pediatrics cancer patients (44.2%). Pediatric study participants were more venerable to bloodstream infection (P = 0.000) compared to adult participants. Meropenem (100%), amikacin (100%), piperacillin/tazobactam (72.3%), and ceftazidime (73.5%) were effective against for Gram-negative isolates while cefoxitin (81.2%) and penicillin (70.5%) were effective for Gram-positive isolates. Additionally, most Gram-negative and Gram-positive bacterial isolates were sensitive for gentamycin (75.9%). Multidrug resistance was seen among 17.1% bacterial isolates, and MDR in Gram-negative and Gram-positive bacteria were 83.3% and 16.7%, respectively. Gram-negative bacterial isolates showed a high prevalence of MDR than Gram-positive isolates. BSI's remains an important health problem in cancer patients, and Gram-positive bacteria were more common as etiologic agents of BSIs in cancer patients. S. aureus was the dominant bacteria followed by CoNS, K. pneumoniae, and P. aeruginosa. Multidrug-resistant isolates found in cancer patients and routine bacterial surveillance and study of their resistance patterns may guide successful antimicrobial therapy and improve the quality of care. Therefore, strict regulation of antibiotic stewardship and infection control programs should be considered in the study area.

Prevalence of Salmonella typhi in among febrile patients in a tertiary care hospital of South West Rajasthan.

ABSTRACTBackground:Salmonella enterica, serotype typhi, remains the predominant Salmonella species causing enteric fever in India. The mode of Salmonella typhi transmission is considered to be predominantly vehicle-borne through contaminated water or food. In India, the incidence of Salmonella typhi occurs between the months of April and June (dry season) followed by July and September (monsoon season). Typhoid fever may be difficult to distinguish clinically from other febrile illnesses and if left untreated, intestinal, neuropsychiatric, and other complications develop in some patients.Objective:The aim of this study was to determine the prevalence of S. typhi in bloodstream infections and its antimicrobial susceptibility pattern among patients with febrile illness.Methodology:Febrile patients admitted in the hospital who were prescribed blood culture tests and whose samples were sent to microbiology laboratory were included in the study. All blood samples (average 5 mL for adults and 2–3 mL for pediatric age group) were immediately inoculated into Bac-T ALERT aerobic blood culture bottles containing sodium polyethanol sulfonate as an anticoagulant (0.025%). If growth was isolated, isolated colony characteristics of growth and Gram stain were assessed. On Gram staining, typical nonlactose fermenting Gram negative bacilli were further subjected to species identification and detection of antimicrobial susceptibility pattern on the VITEK2.Results:In this study period, a total of 511 blood culture (paired) samples were processed, out of which 47 isolates of Salmonella were obtained. Among these isolates, 33 (70.23%) were from males, and 14 (29.77%) were from females. Amongst these, 35 (74.4%) patients were from rural, 8 (17%) were from subrural, and 4 (8.5%) were from urban areas. Out of the total 47 isolates of Salmonella, 42 (89.36%) were Salmonella typhi, 2 (4.25%) were Salmonella paratyphi A and B each, and 1 (2.12%) was Salmonella enterica. Antimicrobial susceptibility pattern of Salmonella isolates revealed that all the isolates of Salmonella species were highly susceptible (95%–100%) to third generation cephalosporins (ceftazidime, ceftriaxone, cefepime, cefoperazone-sulbactam) and other higher antibiotics such as betalactamase inhibitors – piperacillin tazobactam (95%–100%) and Ticarcillin–clavulanic acid (100%). They were also highly susceptible (100%) to carbapenams (imipenem, merpenem, doripenem, and ertapenem) but showed a fairly decreased susceptibility was towards nalidixic acid with 15% for Salmonella typhi and 50% for other Salmonella isolates.Conclusion:Surging drug-resistant Salmonella enterica cases, the level of resistance was not as high as predicted in our study population. Multidrug-resistant (MDR) trends may vary; therefore, drug susceptibility testing side-by-side to empirical therapy is mandatory, especially in developing countries where there is a practice of self-medication.

Prediction of Belimumab Pharmacokinetics in Chinese Pediatric Patients with Systemic Lupus Erythematosus.

Background and ObjectiveIntravenous (IV) belimumab is the first treatment approved for children ≥5 years of age with active autoantibody-positive systemic lupus erythematosus (SLE) in the USA, Europe, and Japan. Pharmacokinetic data for belimumab were collected from several clinical trials in Chinese and non-Chinese adults and non-Chinese pediatric patients with SLE. This study aimed to predict the belimumab dose-exposure relationship to Chinese pediatric patients with SLE, as part of the belimumab registration process for this population in China, using a population PK modeling approach.MethodsAn initial linear two-compartment population pharmacokinetic model was built using data from adults only, and considering and adjusting for the covariates age, body weight, body mass index, fat-free mass, race, baseline albumin and immunoglobulin G levels. The model was used to study possible ethnic differences between Chinese and non-Chinese adults and to predict pediatric pharmacokinetic data in a study of non-Chinese pediatric patients (PLUTO study; NCT01649765). The predicted data were compared with the observed data from PLUTO. The model was then updated with pediatric data from PLUTO to predict steady-state belimumab exposure in Chinese pediatric patients with SLE receiving belimumab 10 mg/kg IV every 4 weeks.ResultsThe dataset comprised 9650 sampled concentration values from 1783 patients. The pharmacokinetics of belimumab were adequately described by the final model using all adult and pediatric data with the estimated typical clearance of 238 ml/day in adult and pediatric patients and steady-state volume of distribution of 4915 ml in adults. Between-patient variability was modest (coefficients of variation: 26.1% for clearance; 8.9% and 28.5%, respectively, for volumes of distribution of the central and peripheral compartments). Six covariates were identified that influenced pharmacokinetics: age, fat-free mass, an indicator of North East Asian race, baseline albumin, immunoglobulin G, and an early study indicator (two early phase I and phase II belimumab studies: LBSL01 and LBSL02). The analysis showed no apparent difference in steady-state exposure between Chinese and non-Chinese populations and between pediatric and adult populations receiving belimumab 10 mg/kg IV.ConclusionsIn Chinese pediatric patients with SLE, belimumab 10 mg/kg IV every 4 weeks is expected to have exposure similar to that in Chinese adults and non-Chinese pediatric patients with SLE, supporting the use of this regimen in Chinese pediatric patients with SLE.Clinical Trial Registration NumbersNCT01649765, NCT00657007, NCT00071487, NCT01345253, NCT01516450, NCT00410384, NCT00424476, NCT02880852, NCT01583530.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40268-021-00363-2.

K.Vita: a feasibility study of a blend of medium chain triglycerides to manage drug-resistant epilepsy.

This prospective open-label feasibility study aimed to evaluate acceptability, tolerability and compliance with dietary intervention with K.Vita, a medical food containing a unique ratio of decanoic acid to octanoic acid, in individuals with drug-resistant epilepsy. Adults and children aged 3–18 years with drug-resistant epilepsy took K.Vita daily whilst limiting high-refined sugar food and beverages. K.Vita was introduced incrementally with the aim of achieving ≤35% energy requirements for children or 240 ml for adults. Primary outcome measures were assessed by study completion, participant diary, acceptability questionnaire and K.Vita intake. Reduction in seizures or paroxysmal events was a secondary outcome. 23/35 (66%) children and 18/26 (69%) adults completed the study; completion rates were higher when K.Vita was introduced more gradually. Gastrointestinal disturbances were the primary reason for discontinuation, but symptoms were similar to those reported from ketogenic diets and incidence decreased over time. At least three-quarters of participants/caregivers reported favourably on sensory attributes of K.Vita, such as taste, texture and appearance, and ease of use. Adults achieved a median intake of 240 ml K.Vita, and children 120 ml (19% daily energy). Three children and one adult had ß-hydroxybutyrate >1 mmol/l. There was 50% (95% CI 39–61%) reduction in mean frequency of seizures/events. Reduction in seizures or paroxysmal events correlated significantly with blood concentrations of medium chain fatty acids (C10 and C8) but not ß-hydroxybutyrate. K.Vita was well accepted and tolerated. Side effects were mild and resolved with dietetic support. Individuals who completed the study complied with K.Vita and additional dietary modifications. Dietary intervention had a beneficial effect on frequency of seizures or paroxysmal events, despite absent or very low levels of ketosis. We suggest that K.Vita may be valuable to those with drug-resistant epilepsy, particularly those who cannot tolerate or do not have access to ketogenic diets, and may allow for more liberal dietary intake compared to ketogenic diets, with mechanisms of action perhaps unrelated to ketosis. Further studies of effectiveness of K.Vita are warranted.

Classification, diagnosis of reversibility and severity assessment of patients having respiratory distress based on pulmonary function test

Introduction: Pulmonary function testing is the gold standard for physicians to diagnose and manage respiratory problems. An obstructive defect is indicated by low forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio, defined as less than 0.7 or below the fifth percentile. If an obstructive defect is present, the physician should determine if the disease is reversible based on the increase in FEV1 or FVC after bronchodilator treatment (i.e., increase of more than 12% and 200 ml in adults). An FVC below the fifth percentile indicates a restrictive pattern based on NHANES III data in adults. If both the FEV1/FVC ratio and the FVC are low, the patient has a mixed defect. Method: A total of 60 patients having respiratory distress, who attended chest OPD underwent a pulmonary function test. Results: In this study out of 60 patients, 32 patients had obstructive airway diseases with low FEV1/FVC (53.33%), 8 of them (13.33%) had restrictive lung diseases, ten patients(16.66%) had mixed features and rest ten patients(16.66%) had normal spirometry. Among those 32 patients of obstructive features, 22 (68.75%) had reversible airway diseases. Severity was measured among the other ten non-reversible obstructive patients according to the GOLD criteria. Conclusion: Pulmonary function test is the fundamental first-line investigation to diagnose obstructive and restrictive lung diseases and also to differentiate between reversible and non-reversible obstruction. It is also a vital tool for determining the severity among non-reversible obstructive airway patients.

Demographic, socioeconomic and lifestyle factors associated with sugar-sweetened beverage intake: a population-based study

The intake of sugar-sweetened beverages (SSB) varies according to the characteristics of the population. To investigate the SSB intake and demographic, socioeconomic and lifestyle factors associated with its consumption in adolescents, adults, and older adults in São Paulo. Data were drawn from the Health Survey of São Paulo, a cross-sectional population-based study including 1,662 individuals aged 12 years or more. SSB were classified into six groups: sugar-sweetened sodas, sweetened coffee and tea, sweetened milk and dairy products, sweetened fruit juice, sweetened fruit drink, and total SSB. The association of each group with demographic, socioeconomic and lifestyle variables was assessed using linear regression models. The mean SSB intake was 668.4 mL in adolescents, 502.6 mL in adults, and 358.2 mL in elderly adults. Sodas and sweetened coffee and tea represented had the greatest contribution to energy intake. SSB consumption was lower among female sex and higher among overweight adolescents, among sufficiently active adults, and among lower household per capita income older adults. Consumption of SSB was high, particularly among adolescents. Public policies are required in order to decrease the consumption of these beverages. Age group, sex, household per capita income, and body mass index status were associated with SSB intake.

Local Anesthetic Systemic Toxicity: A Narrative Literature Review and Clinical Update on Prevention, Diagnosis, and Management.

The objective of this narrative review of local anesthetic systemic toxicity is to provide an update on its prevention, diagnosis, and management. The authors used a MEDLINE search of human studies, animal studies, and case reports and summarize findings following the American Society of Regional Anesthesia and Pain Medicine practice advisories on local anesthetic systemic toxicity. Between March of 2014 and November of 2016, there were 47 cases of systemic toxicity described. Twenty-two patients (47 percent) were treated with intravenous lipid emulsion and two patients (4.3 percent) died. Seizures were the most common presentation. The spectrum of presenting neurologic and cardiovascular symptoms and signs are broad and can be obscured by perioperative processes. Local anesthetic type, dosage, and volume; site of injection; and patient comorbidities influence the rate of absorption from the site of injection and biodegradation of local anesthetics. Consider discussing appropriate dosages as a component of the surgical "time-out." A large-volume depot of dilute local anesthetic can take hours before reaching peak plasma levels. Oxygenation, ventilation, and advanced cardiac life support are the first priorities in treatment. Lipid emulsion therapy should be given at the first sign of serious systemic toxicity with an initial bolus dose of 100 ml for adults weighing greater than 70 kg and 1.5 ml/kg for adults weighing less than 70 kg or for children. All physicians who administer local anesthetics should be educated regarding the nature of systemic toxicity and contemporary management algorithms that include lipid emulsion therapy.

Safety of outpatient unilateral medialization laryngoplasty across two academic institutions.

Unilateral ML is a commonly performed surgery for dysphonia secondary to glottic insufficiency. The safety of this procedure performed in the outpatient setting has not been extensively examined. The purpose of the study was to assess the safety of outpatient unilateral ML in adults and determine the incidence and timing of postoperative complications across two tertiary-care academic medical centers. Retrospective chart review, METHODS: A review of patients undergoing unilateral ML at two tertiary-care academic centers from 2011 to 2017 was performed. Patients undergoing bilateral medialization laryngoplasty, revision surgery, or those undergoing additional laryngeal framework procedures including arytenoid adduction were excluded. Patient demographics, operative details, and perioperative and postoperative complications were recorded. Comparisons were made between those individuals who underwent inpatient versus outpatient ML. One hundred three total procedures met inclusion criteria. Fifty-seven were performed as outpatient procedures, and 46 individuals were observed for at least 23 hours following surgery. Silastic or Gore-Tex implants were used in all but two surgeries. There were no postoperative complications in either setting, including hematoma, dyspnea, wound infections or seromas. The incidence of adverse events during and immediately following unilateral ML is very low. Patients can be discharged safely the day of surgery without geographic restrictions. 4 Laryngoscope, 129:1647-1649, 2019.

Acquisition and Retention of Resuscitation Knowledge and Skills: What's Practice Have to Do With It?

Acquisition and Retention of Resuscitation Knowledge and Skills: What's Practice Have to Do With It?

Seropersistence of TBE virus antibodies 10 years after first booster vaccination and response to a second booster vaccination with FSME-IMMUN 0.5 mL in adults

Tick-borne encephalitis (TBE) is a viral disease that can have a severe acute clinical course and considerable long-term morbidity. As there is no causal treatment currently available for TBE, vaccination is the only way to combat the disease in endemic areas. The studies presented here were conducted to obtain prospective long-term TBE serum antibody persistence data of subjects up to 10years after the first booster with FSME-IMMUN.This report presents the results of 2 follow-up studies in the same study population of 315 healthy adults. Blood was drawn to assess the seropersistence of TBE virus antibodies yearly, from 2–5 and 7–10years after the first booster vaccination with FSME-IMMUN administered during a previous study. The timing of the second booster vaccination was dependent on the level of serum TBE antibodies observed during yearly follow-up serology observations.The current follow up showed that adult recipients were 84.9% seropositive 10years after a 3 dose primary series and the first booster vaccination of FSME-IMMUN. Seropositivity rates were even higher (88.6%) in subjects below 50years of age.ClinicalTrials.gov Identifier: NCT00503529.ClinicalTrials.gov Identifier: NCT01582698.

Prevention of anthrax epidemic in sheep and goats with Anthracinum 200

Objective: To study the effect of Anthracinum CH 200 to prevent anthrax in sheep and goats in less and highly endemic villages of Kadapa district, Andhra Pradesh, India was studied. Materials and Methods: This study was conducted in 159,250 sheep and goats, in anthrax-endemic Kadapa district in India, from 2003 to 2008, consecutively covering 1 endemic and 17 less endemic villages. Fifteen millilitres of Anthracinum 200 dilution was mixed thoroughly with 1 L of 2.5% albendazole suspension and drenched orally either with a drenching gun or with a 10-ml syringe, in a single bolus of 10 ml for adults and 5 ml for young ones. Results: All the sheep and goats were protected from Anthrax with a single dose of Anthracinum CH 200 both in non\endemic villages. The ratio of cost of vaccine to cost of Homoeopathic Prophylatic was worked out to be 5.47:1. Conclusions: Homoeopathy is very effective in preventing the anthrax in sheep and goats at a very cheap price and is very safe and has a rapid response.

Survey of informal milk retailers in Nairobi, Kenya and prevalence of aflatoxin M1 in marketed milk

Aflatoxins are toxic by-products of fungi contaminating maize and other crops; they can be carried over into milk, meat and eggs when livestock eat aflatoxin-contaminated feed or fodder. People who consume such animal products are exposed to the toxins. To assess the aflatoxin contamination status in marketed raw milk and associated risk factors in peri-urban Nairobi, we conducted a census of raw milk retailers in Dagoretti Division, Nairobi, Kenya. Structured questionnaires were filled in by face-to-face interviews with all retailers who agreed to participate in this study. Small portions of milk were purchased from each respondent and tested for aflatoxin M1 (AFM1) using competitive enzyme-linked immunosorbent assay (cELISA) tests. Geographic coordinates of each eligible retailer were recorded. A total of 350 milk retailers were visited and 344 were plotted on a map. Of these, 250 retailers answered the questionnaire and a milk sample from each of 200 retailers underwent cELISA analysis for AFM1. Four types of businesses were found: kiosks (71%), dairy shops (21%), street or mobile vendors (3%) and grocery stands (1%); for 4% the business type was not identified. Milk was mainly sourced directly from dairy farms (59%) or from intermediate distributors (35%). Most retailers sold less than 20 litres per day of raw milk. The mean daily milk consumption of the milk retailers’ households was 940 ml for adults and 729 ml for children. Although 58% of retailers had heard about aflatoxins and the majority of them agreed that aflatoxins could be present in milk, only 29% believed that “milk safety cannot be solely judged by sight or taste” and only 6% that “milk is not completely safe even after boiling”. The cELISA test found the mean concentration of AFM1 was 128.7 parts per trillion (ppt) (median=49.9; 95% confidence interval=3.0–822.8) with a maximum of 1675 ppt. Overall, 55% of samples exceeded the European Union maximum level of 50 ppt and 6% exceeded the recommended maximum level of the United States Food and Drug Administration of 500 ppt. Compared to milk from street vendors, a significantly higher amount of AFM1 was detected in milk from kiosks and dairy shops, especially when the milk was sourced from farms without an intermediate distributor. Our findings indicate the need to better understand and manage aflatoxin in milk in Nairobi. Keywords: Aflatoxin M1, Kenya, milk, dairy value chain, milk retailers, Dagoretti, mycotoxin, informal milk marketing

A randomized clinical trial in adults and newborns in South Africa to compare the safety and immunogenicity of bacille Calmette-Guérin (BCG) vaccine administration via a disposable-syringe jet injector to conventional technique with needle and syringe

IntroductionIntradermal bacille Calmette-Guérin (BCG) vaccination by needle-free, disposable-syringe jet injectors (DSJI) is an alternative to the Mantoux method using needle and syringe (NS). We compared the safety and immunogenicity of BCG administration via the DSJI and NS techniques in adults and newborn infants at the South African Tuberculosis Vaccine Initiative (SATVI) research site in South Africa. MethodThirty adults and 66 newborn infants were randomized 1:1 to receive intradermal BCG vaccine (0.1mL in adults; 0.05mL in infants) via DSJI or NS. Wheal diameter (mm) and skin fluid deposition at the site of injection (SOI) were measured immediately post-vaccination. Adverse events and SOI reactogenicity data were collected 30min and 1, 2, 4, and 12 weeks after vaccination for adults and at 30min and 4, 10, and 14 weeks for infants. Blood was collected in infants at 10 and 14 weeks to assess BCG-specific T-cell immune responses. ResultsMore infant BCG vaccinations by DSJI deposited >5μL fluid on the skin surface, compared to NS (49% versus 9%, p=0.001). However, all 12 infant vaccinations that did not produce any SOI wheal occurred in the NS group (36%, p<0.001). Median wheal diameter, in participants for which an SOI wheal formed, did not differ significantly between groups in infants (combined 3.0mm IQR 2.0 to 4.0, p=0.59) or in adults (combined 9.0mm IQR 7.0 to 10.0, p=0.13). Adverse events were similar between study arms. Proportion of participants with BCG scars after three months did not differ in adults (combined 97%, p=0.67) or infants (combined 62%, p=0.13). Frequencies of BCG-specific clusters of differentiation 4 (CD4) and clusters of differentiation 8 (CD8) T-cells co-expressing IFN-γ, TNF-α, IL-2, and/or IL-17 were not different in the DSJI and NS groups. ConclusionBCG vaccination of newborn infants via DSJI was more likely to deliver an appropriate intradermal wheal at the SOI as compared to NS, despite leaving more fluid on the surface of the skin. Safety, reactogenicity, and antigen-specific T-cell immune responses did not differ between DSJI and NS techniques.

Serum Neuron-specific Enolase Levels in Preterm and Term Newborns and in Infants 1–3 Months of Age

Elevated serum levels of neuron-specific enolase (NSE) was initially assumed to be specific to neuronal tumors (particularly neuroblastoma), but is now known to accompany nontumoral conditions and tumors other than neuroblastomas. There is a need to establish normal ranges for NSE, especially in early infancy. The aims of this study were to determine reference values for NSE in newborns and young infants and to assess whether NSE levels in early infancy (i.e., preterm infants and term infants) differ from the adult reference range for this enzyme. We enrolled 140 healthy babies, which included 40 preterm newborns (3-15 days old and born at 28-42 weeks gestation), 40 term newborns (< 1 month old and born at term), and 60 young infants 1-3 months old (n=20 per subgroup of 1-, 2-, and 3-month-old infants). The determination of NSE levels was performed by the electrochemiluminescence immunoassay (ECLIA) method using the Elecysys 2010 device (Roche Diagnostics, Mannheim, Germany). The mean serum NSE levels for the preterm newborns was 21.83±15.06ng/mL [95% confidence interval (95%CI), 16.95-26.71ng/mL]; term newborns, 18.06±12.83ng/mL (95%CI, 13.94-22.19ng/mL); and young infants, 9.09±4.38ng/mL (95%CI, 7.96-10.23ng/mL). The mean serum NSE level for infants 1-3 months old was within the ECLIA kit's normal range (4.7-18ng/mL for adults), whereas the corresponding means for the preterm and term newborns were higher (p<0.001, for both). Our findings suggest that adult reference values should not be applied to the preterm and term age groups.

Envenomation by caterpillars (erucism): proposal for simple pain relief treatment.

To the editorErucism is the name given to injuries caused by mothlarvae in humans. The lesions are provoked by caterpillarbristles filled with toxins that penetrate the skin [1-4]. Thebristles are hollow and when they enter the skin and break,toxins that contain thermolabile proteins, proteolytic en-zymes and histamine are released [2]. The shape of bristlesindicates the families of caterpillars mainly associated withinjuries: Megalopygidae (fine setae throughout the body)and Saturniidae (setae in smallpinetreeformat,seeFigure 1) [3]. The toxins cause immediate severe pain,erythema, edema and immediate lymphangitis (Figure 1).In later stages, there may be vesicles, bullae, erosions, pe-techiae, superficial skin necrosis, and ulcerations [4]. Somegenera (Lonomia, Periga) can cause severe hemorrhagicsyndromes, but most manifestations are limited to excruci-ating pain and mild to moderate local inflammation [1-4].Treatment for such injuries is based on cold watercompresses and oral analgesics (dipyrone is the rule, butthe use of potent analgesics, such as tramadol hydro-chloride may be required). When painkillers do notcontrol the pain, nerve anesthetic blockade (lidocaine4.0 mL for adults) may be employed [1-4]. Based on ourpast experience, we suggest using serial application oftopical commercial anesthetics with 0.25% lidocaine and0.25% prilocaine in order to greatly decrease or eliminatethe pain, these drugs take effect in about half an hourand last for several hours [1,4]. They are easy to apply,does not interfere with the approach adopted for thiskind of accident, and it is especially useful for childrenand patients whose lesion sites do not allow blockades.

First Berlin Heart EXCOR Pediatric VAD Interhospital Transports of Nonambulatory Patients with the Ikus Stationary Driver

Ventricular assist devices (VADs) are increasingly being used in pediatric patients to support cardiac failure. As more centers adopt this technology, there may be a need to transport these patients over long distances to facilitate patient care and organ transplantation. Food and Drug Administration indications for use state only that the patient must be a candidate for transplantation and does not place restrictions on the transplant capabilities of the implanting medical center. Nontransplanting institutions are able to use this technology with a predetermined agreement to transfer the patient to a partnering transplant center. We report the first two cases of interhospital air and ground transport of nonambulatory or intubated pediatric (<13 kg) patients supported by Berlin Heart EXCOR pediatric VADs and Ikus stationary drivers. We present our protocol for transporting this delicate patient population. In addition, we discuss important challenges encountered on these operations regarding vehicle transfers and the management of vehicle power supply. These two cases demonstrate that the transportation of pediatric patients on Berlin Heart VADs is feasible and safe and should be considered a treatment option in certain situations.

Testicular Failure and Male Infertility in the Monogenic Mulibrey Nanism Disorder

Few monogenic mutations causing human male infertility have been identified to date. We studied pubertal development and fecundity in males with Mulibrey nanism (MUL) caused by mutations in the TRIM37 gene. Twenty-eight male MUL patients of the Finnish national cohort aged 8.7 to 50.0 yr (median age, 28.8) at the end of observation were followed for 10 yr beginning from 2000-2001. Clinical characteristics, reproductive hormone levels, semen quality, and testicular histology were assessed. The external genital phenotype was normal. In childhood and prepuberty, serum levels of FSH, LH, testosterone (T), and inhibin B were normal. Puberty started spontaneously at a median age of 12.6 yr (range, 11.1-15.0), and FSH, LH, T, and inhibin B levels increased adequately until midpuberty. Thereafter, testicular growth and virilization proceeded slowly. Concomitantly, FSH, and to a lesser extent LH, showed a progressive increase to hypergonadotropic levels in all patients, whereas inhibin B decreased and T leveled off. Testicular size was small (median volume, 8.7 ml; range, 3.5-18.3 ml in adults). All semen samples showed severe oligoasthenozoospermia or azoospermia. None of the patients had a history of spontaneous fertility, but four men had undergone infertility treatment, which in one case was successful. All histological MUL samples showed varying degrees of degeneration. All adult MUL males have a unique disorder of testicular function with small testes, elevated FSH and LH, and low inhibin B. In MUL, mutations in TRIM37 lead to disturbance of sexual maturation, and fertility is severely compromised. Thus, TRIM37 is a novel gene causing male infertility.

Comprehensive Analysis of Blood Culture Performed at Nine University Hospitals in Korea

BackgroundOptimal blood culture performance is critical for successful diagnosis and treatment of sepsis. To understand the status of blood culture, we investigated several aspects of the procedure at 9 university hospitals.MethodsThe process of ordering blood culture sets and sampling volume for adults and children was investigated from January 2010 to April 2010, while the positive rate of detection and growth of skin contaminants were compared in 2009. Microbial growth in aerobic and anaerobic bottles was investigated prospectively.ResultsA majority of the hospitals used 2 sets of bottles for adults and 1 bottle for children. The average blood volume in each set was 7.7 mL for adults and 2.1 mL for children. The positive rate of microorganisms was 8.0%, and the isolation rate of the normal flora of the skin was 2.1%. Bacterial growth rates in aerobic and anaerobic bottles only were 31.8% and 24.5% respectively.ConclusionsOrdering blood culture sets and sampling volumes did not comply with CLSI guidelines. However, the rate of positive cultures and skin contamination rates were acceptable. Anaerobic bottles are useful in enhancing the yield of microorganisms.

Last Resort in Devastated Bladder Outlet: Bladder Neck Closure and Continent Vesicostomy—Long-term Results and Comparison of Different Techniques

To compare surgical techniques and long-term outcomes in patients undergoing bladder neck closure (BNC) and continent vesicostomy for devastated bladder outlet. A total of 17 patients who underwent BNC, omental interposition, and continent vesicostomy between 1994 and 2008 were analyzed. Indication for surgery was recurrent anastomotic stricture combined with postradical prostatectomy incontinence (n = 10), postvulvectomy (n = 1), and neurogenic bladder dysfunction (n = 6). Diversion was performed in 8 patients with normal bladder capacity (>300 mL in adults) through a Mitrofanoff appendicovesicostomy (n = 4) or ileal intussusception valve (n = 4). Simultaneous ileocecal bladder augmentation was performed in 9 patients with primarily reduced bladder capacity, and either the in situ embedded appendix (n = 4) or an ileal intussusception valve (n = 5) served as the continent outlet. The stoma was placed in the lower abdomen using the "butterfly technique" (n = 8) or in the umbilicus (n = 9). Medium follow-up was 68 months (range: 12-129). Primary BNC was successful in all patients and primary continence rate was 82%. Three patients (18%) suffered from continence failure, caused by reduced bladder capacity in 2 cases. The third patient presented with an iatrogenic destruction of his Mitrofanoff appendicovesicostomy. These patients were successfully reconstructed by ileocecal bladder augmentation with an ileal intussusception valve as the continent outlet. Four patients (23%) developed stomal stenosis (3/8 with an abdominal stoma and 1/9 with an umbilical stoma). Patients with simultaneous bladder augmentation had higher bladder capacity. No patients developed ureteral obstruction. This technique is an effective, last resort treatment for patients with nonreconstructible bladder outlet.

Assessment of inflammatory activity in Crohn’s disease by means of dynamic contrast-enhanced MRI

Our aim was to perform a dynamic study of contrast enhancement of the intestinal wall in patients with Crohn's disease to quantitatively assess local inflammatory activity. We studied a population of 50 patients with histologically proven Crohn's disease. Magnetic resonance imaging (MRI) was performed using a 1.5-T magnet with a phased-array coil and acquisition of T2-weighted single-shot fast spin echo (SSFSE) half Fourier sequences before intravenous administration of gadolinium, and T1-weighted fast spoiled gradient (FSPGR) fat-saturated sequences before and after contrast administration. Before the examination, patents received oral polyethylene glycol (PEG) (1,000 ml for adults; 10 ml/Kg of body weight for children). Regions of interest (ROI) were placed on the normal and diseased intestinal wall to assess signal intensity and rate of increase in contrast enhancement over time. Data were compared with the Crohn's Disease Activity Index (CDAI). The diseased bowel wall showed early and intense uptake of contrast that increases over time until a plateau is reached. In patients in the remission phase after treatment, signal intensity was only slightly higher in diseased bowel loops than in healthy loops. There was a significant correlation between the peak of contrast uptake and CDAI. Dynamic MRI is a good technique for quantifying local inflammatory activity of bowel wall in patients with Crohn's disease.