Power injection of peripherally inserted central catheters

PURPOSETo study the tolerance of peripherally inserted central catheters (PICCs) of varying sizes and materials to power injection of radiographic contrast agents.MATERIALS AND METHODSEight different models of silicone and five different models of polyurethane single-lumen PICCs were injected with increasing rates of iothalamate 60% with use of a power injector. Tolerated and bursting rates and pressures were recorded.RESULTSThere was a wide range of tolerated rates and pressures, depending on the inner and outer diameters of the catheters and on the catheter material. Silicone PICCs tolerated rates between 0.4 and 7.0 mL/sec and polyurethane PICCs tolerated rates between 0.6 and 10.2 mL/sec, depending on the specific catheter. The 5 Fr silicone PICCs and the 4 Fr and 5Fr polyurethane PICCs tested all tolerated rates greater than 4 mL/sec. Silicone catheters tolerated pressures between 107 and 184 psi, and polyurethane catheters tolerated pressures between l60 and 314 psi.CONCLUSIONSLarger single-lumen silicone and polyurethane PICCs may be suitable for power injection of contrast agents.     

Maximum Flow Rates Achievable Through Peripherally Inserted Central Catheters Using Standard Hospital Infusion Pumps

PurposeTo determine maximum flow rates through peripherally inserted central catheters (PICCs) using a standard hospital infusion pump.BackgroundTwo questions asked with the use of PICCs and flow rates are (1) can a PICC be used to give nonemergent fluid boluses, and (2) can standard hospital infusion pumps develop enough pressure to rupture a catheter?MethodsNew PICCs of different brands and gauges were gathered. Six standard hospital infusion pumps and tubing of the same brand and model were used. The pressure sensor was set at 600 mm Hg. The pumps were connected through the access ports of each intravenous tube in a series fashion. The PICC end was submerged under 5 cm of water. All equipment and fluids were at 70°F. PICCs were trimmed to 45 cm. Fluids were run starting with the first pump at 999 mL/hour and then additional pumps were added until the pump's 600 mm Hg limit stopped the infusion or catheter rupture. Tests with the same PICC were repeated and recorded.ResultsFlow rates varied with the type, size, gauge, and brand of PICC catheter. Flows were achieved from 2,100 mL/hour to >6,000 mL/hour. None of the PICCs ruptured.ConclusionsMaximum flow rates through PICCs were limited by the maximum pressure allowed by the standard hospital infusion pump. A standard hospital infusion pump cannot generate enough pressure to rupture a new-out-of-the-package catheter.Implication for PracticeNonemergent fluid boluses can be given through PICCs and standard infusion pumps will not rupture a PICC.     

The Effects of Focused Nursing Education on 3F Groshong™ PICC Occlusion Rates: The Experience of One Tertiary Pediatric Care Facility

ObjectiveThe primary aim of this project is to reduce the incidence of 3 Fr. Groshong? PICC occlusions through focused nursing education.BackgroundThe use of Peripherally Inserted Central Catheters (PICC) has become an essential tool in the care of pediatric patients. The small lumen and long length of PICCs requires specialized skill and knowledge in proper care, maintenance and flushing in order to prevent catheter occlusion and other complications. Occluded catheters compromise patient care and increase costs. Reducing the incidence of catheter occlusion, will have a significant impact on the quality of patient care; patient, family and nursing satisfaction, patient outcomes, and costs.MethodsA pre-test/post-test design using a convenience sample of all the core staff nurses working on the medical/surgical unit at a Southern California Children's Hospital was utilized. Objective measures included a written assessment of nursing knowledge, direct observations of nurses' flushing technique, and retrospective chart review to determine the rate of total catheter occlusion.ResultsMean written test scores improved from 0.78 to 0.93 (p = 0.00) Mean observation scores improved from 0.88 to 0.95, (p = 0.004). The pre-test occlusion rate was 21.11/1000 catheter days. The post test occlusion rate was 15.49/1000 catheter days (p = 0.057).ConclusionFocused nursing education contributed to reducing 3F Groshong? PICC occlusions and the associated costs due to PICC occlusions.     

Impact of the Positive Pressure Valve on Vascular Access Device Occlusions and Bloodstream Infections

Background/PurposeThe use of needleless positive pressure connector valves (PPVs) on venous access devices (VADs) has been shown to have possible benefits in decreasing VAD occlusion rates. Catheter-related bloodstream infection (CRBSI) rates, however, have been variable. With this potential for improving patient outcomes, decreasing costs, and facilitating nursing care and catheter management, the use of PPV devices becomes both advantageous and desirable.MethodologyThis was a randomized, prospective, parallel clinical study of 160 medical and surgical step-down unit patients requiring parenteral therapies. Patients were equally randomized to two study groups to assess the impact on occlusion and CRBSI rates, using a PPV versus a standard cap without PPV. VADs included both peripherally inserted catheters (PICCs) and midlines.ResultsSeven VAD occlusions occurred; six in the experimental group, one in the control group (p = 0.43). Also, two CRBSIs occurred in the experimental group, with none in the control group (p = 0.497). All incidents occurred in doublelumen PICCs. The lack of statistical difference between the two groups for occlusions and CRBSIs indicates that the use of PPVs had no impact in preventing such outcomes. However, it was observed that the number of double-lumen PICCs and their dwelling time in the experimental group was significantly higher (p = 0.003).ConclusionThere was no difference in the rate of catheter occlusions or CRBSIs when using PPVs or standard caps. We consider that the study outcomes may be due to the study's small sample size, and we speculate that longer dwell time of double lumen catheters may have contributed to these outcomes. These observations deserve further investigation. However, the use of PPVs may still be advantageous from a nursing process perspective.     

Incidence of Nonelective Removal of Single-Lumen Silicone and Dual-Lumen Polyurethane Percutaneously Inserted Central Catheters in Neonates

ObjectiveTo compare the incidence of nonelective removal of single-lumen silicone and dual-lumen polyurethane percutaneously inserted central catheters (PICCs).Study DesignA prospective cohort study was conducted with neonates in whom 247 PICC lines had been successfully inserted. Patients were assigned to either the single-lumen silicone group or the dual-lumen polyurethane group and nonelective removal incidence was compared using a logistic regression model.ResultsIncidence of nonelective removal in dual-lumen polyurethane PICCs (n = 91) was 48.3% versus 34% in single-lumen silicone PICCs (n = 156). Thus, dual-lumen polyurethane catheters had a significantly increased chance of nonelective removal compared with single-lumen silicone PICCs (P = .004). The most usual complication in dual-lumen polyurethane PICCs was suspected catheter-related bloodstream infection; in single-lumen silicone PICCs it was external rupture.ConclusionsDual-lumen polyurethane PICCs are associated with higher rates of nonelective removal and complications such as suspected catheter-related bloodstream infection. Cautious nursing care is necessary to prevent complications.     

Coût par patient répondeur associé au traitement du purpura thrombopénique immunologique primaire par romiplostim et rituximab chez l’adulte en France

Purpose of the studyThis analysis compared the response rates and cost per responder associated with romiplostim and rituximab in adult immune thrombocytopenia from the French National Health System payer perspective.MethodsA decision analytic model was developed to estimate the cost per patient and per responder of treating adult immune thrombocytopenia patients with romiplostim versus rituximab over 6 months. A systematic literature review identified phase 3 randomized controlled trials. Published response rates were extracted (response definition: ≥ 50 × 10⁹ platelets/liter). Resource utilization was based on French and international treatment guidelines, and clinical expert opinion. Unit costs were derived from literature and French reimbursement lists, and included the costs of routine physician visits, treatment administration, and emergency care. Non-responders incurred bleeding-related event costs.ResultsThe literature review identified a phase 3 randomized controlled trial for romiplostim with a response rate of 83%. Due to a lack of phase 3 randomized controlled trials for rituximab, a systematic review of studies was selected as the best source, reporting a response rate of 62.5%. Romiplostim and rituximab were associated with similar treatment costs, with an estimated cost per patient for romiplostim of € 17,456 and € 17,068 for rituximab. Rituximab resulted in a 30% higher cost per responder (€ 27,308 for rituximab versus € 21,031 for romiplostim). Romiplostim use reduced drug administration, intravenous immunoglobulin, and bleeding-related hospitalization costs compared to rituximab.ConclusionsDue to its high efficacy leading to lower bleeding-related costs, romiplostim represents an efficient use of resources for adult immune thrombocytopenia patients in the French healthcare system.     

A novel technique,dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: A preliminary biomechanical study

BackgroundAnterior cruciate ligament (ACL) rupture is a common lesion. Current treatment emphasizes arthroscopic ACL reconstruction via a graft, although this approach is associated with potential drawbacks. A new method of dynamic intraligamentary stabilization (DIS) was subjected to biomechanical analysis to determine whether it provides the necessary knee stability for optimal ACL healing.MethodsSix human knees from cadavers were harvested. The patellar tendon, joint capsule and all muscular attachments to the tibia and femur were removed, leaving the collateral and the cruciate ligaments intact. The knees were stabilized and the ACL kinematics analyzed. Anterior–posterior (AP) stability measurements evaluated the knees in the following conditions: (i) intact ACL, (ii) ACL rupture, (iii) ACL rupture with primary stabilization, (iv) primary stabilization after 50 motion cycles, (v) ACL rupture with DIS, and (vi) DIS after 50 motion cycles.ResultsAfter primary suture stabilization, average AP laxity was 3.2 mm, which increased to an average of 11.26 mm after 50 movement cycles. With primary ACL stabilization using DIS, however, average laxity values were consistently lower than those of the intact ligament, increasing from an initial AP laxity of 3.00 mm to just 3.2 mm after 50 movement cycles.ConclusionsDynamic intraligamentary stabilization established and maintained close contact between the two ends of the ruptured ACL, thus ensuring optimal conditions for potential healing after primary reconstruction. The present ex vivo findings show that the DIS technique is able to restore AP stability of the knee.     

Arthroscopic BPTB graft reconstruction in ACL ruptures: 15-year results and survival

PurposeThe aim of this study is to investigate the 15-year results and survival of arthroscopic ACL reconstruction using the central-third patellar bone–tendon–bone (BPTB) autograft.MethodsACL BPTB reconstruction was performed in 250 consecutive patients. Of these patients, 88% returned for a follow-up examination at 15 years after reconstruction. Therefore, 220 patients were studied. Mean time from injury to intervention was 3.4 months (range 2 to 16). The parameters for assessment of results were subjective satisfaction, clinical examination (pivot-shift test, Lachman test with KT-1000), recovery of pre-injury activity level, and long-leg standing radiographs. We also evaluated the presence of meniscal and/or chondral injuries during the procedure. Failure rates were also evaluated. We defined a failure as severe instability not compatible with the activities of daily living (ADL) due to graft rupture.Results8.2% of patients required a revision procedure because of graft rupture. In subjective terms, 98.1% of patients said that they were satisfied with the surgical outcomes after 15 years. Pivot shift test was normal in 93.5% at 15 years. Lachman test (KT-1000) was normal in 95.4% at 15 years. Fifteen years after surgery, 90% of patients recovered their pre-injury activity level. In 25.4% of patients symptomatic osteoarthritic changes in the knee were found at 15 years.ConclusionsThe survival prevalence of arthroscopic ACL reconstruction using the central-third patellar bone–tendon–bone (BPTB) autograft at 15 years was 94.8%. Fifteen years after surgery, 90% of patients recovered their pre-injury activity level. In 25.4% of patients symptomatic osteoarthritic changes in the knee were found at 15 years.Level of evidenceLevel IV.     

Mortality and risk factor analysis for Candida blood stream infection: A three-year retrospective study

BackgroundThe aim of this study was to evaluate the possible risk factors for mortality in adult patients with candidemia by investigating the causative agents, underlying conditions and predisposing factors.Material and methodsThe data including causative Candida species, predisposing factors, and underlying conditions of candidemia patients between the years 2015–2017 were collected and the impact of these factors on mortality was evaluated. Patients were divided into two groups as died (died patients within 30 days of the onset of candidemia) and survived and risk factors were evaluated for each group.ResultsWe found 163 adult candidemia cases during the study period. Overall 30-day mortality was 40.5%. Candida parapsilosis was the most frequent causative agent (49.1%). C. parapsilosis candidemia was more common in the survived group compared with the died group (n: 49 (61.3%) vs. n: 31 (38.8%), P = 0.888). Mortality rates were significantly higher in patients with dialysis (n: 27 (69.2%) vs. n: 12 (30.8%), P < 0.00) and concurrent bacteremia (n: 20 (57.1%) vs. n: 15 (42.9%), P = 0.024). Survival rates were significantly higher in patients with follow-up blood cultures (n: 75 (65.8%) vs. n: 39 (34.2%), P = 0.013). The most important source of candidemia was catheter (49.7%), and C. parapsilosis was the most common causative agent (58%). The catheter was removed in 96.3% of these patients and the mortality rate was 38.5%. All of the patients received antifungal therapy and there was no significant difference between the effects of antifungals on mortality (n: 65 (39.9%) vs. 98 (60.1%), P = 0.607).ConclusionsDialysis and concurrent bacteremia are strong predictors of mortality in 30 days within patients with candidemia, whereas follow-up blood cultures have a protective role with lower mortality rates. In our study, the most important source of candidemia was catheter, and C. parapsilosis was the most common causative agent. The catheter was removed in almost all patients and the mortality rate was almost one third among these patients.     

Development of anti-hepatitis B surface (HBs) antibodies after HBs antigen loss in HIV-hepatitis B virus co-infected patients

BackgroundHepatitis B surface antigen (HBsAg)-seroconversion, or loss of HBsAg and acquisition of anti-hepatitis B surface (HBs) antibodies, defines functional cure of chronic hepatitis B virus (HBV) infection. After HBsAg-loss, little is known regarding the development of anti-HBs antibodies and even less so in individuals co-infected with HIV.ObjectivesTo determine anti-HBs antibody kinetics after HBsAg-loss and explore determinants of HBsAg-seroconversion in HIV-HBV co-infected patients.Study designPatients enrolled in the French HIV-HBV cohort were included if they had >1 study visit after HBsAg-loss. Individual patient kinetics of anti-HBs antibody levels were modeled over time using mixed-effect non-linear regression, whereby maximum specific growth rate and maximal level of antibody production were estimated from a Gompertz growth equation.ResultsFourteen (4.6%) of 308 co-infected patients followed in the cohort exhibited HBsAg-loss, all of whom were undergoing antiretroviral therapy. Nine (64.3%) of these patients achieved HBsAg-seroconversion during a median 3.0 years (IQR = 1.1–5.1) after HBsAg-loss. Across individuals with HBsAg-seroconversion, the fastest rates of antibody growth ranged between 0.57–1.93 year⁻¹ (population maximum growth rate = 1.02) and antibody production plateaued between 2.09–3.66 log₁₀ mIU/mL at the end of follow-up (population maximal antibody levels = 2.66). Patients with HBsAg-seroconversion had substantial decreases in HBV DNA viral loads (P = 0.03) and proportion with elevated ALT levels (P = 0.02) and HBeAg-positive serology (P = 0.08). No such differences were observed in those without HBsAg-seroconversion.ConclusionsMost co-infected patients with HBsAg-seroconversion produced and maintained stable antibody levels, yet kinetics of anti-HBs production were much slower compared to those observed post-vaccination or after clearance of acute HBV-infection.     

In vitro characteristics of cryopreserved platelet concentrates reconstituted by fresh frozen or lyophilized plasma

Background and objectivesSix percent dimethyl sulfoxide (DMSO) cryopreservation of platelet concentrates (PCs) allow longer storage of PCs but require time-consuming post-thaw washing. An alternative process based on removing supernatant before freezing has been implemented in several centres worldwide. We assessed the in vitro characteristics of cryopreserved PCs (CPPs) prepared according to this latest process using either French lyophilized plasma (FLyP) or fresh frozen plasma (FFP) for reconstitution. FLyP provides additional benefits to the process due to its logistical constraints and quick availability.Materials and methodsApheresis PCs (n = 16) and buffy coat PCs (n = 16) were cryopreserved in 6% DMSO. After storage at ?80 °C, PCs were thawed and reconstituted with FFP or FLyP. Volume, residual leukocytes, total platelet counts (TPCs), post-thaw recovery, biochemical parameters, and DMSO concentration were assessed. Platelet functions were analysed by swirling index, viscoelastometric assay and CD62P quantification.ResultsAfter reconstitution, TPC was above 2.10¹¹/CPs; recovery was 78 ± 14% with no significant difference between FFP and FLyP. Glucose and lactate levels were not different between plasmas, whereas FLyP-CPPs exhibited a significant increase in LDH and significantly lower pH. Residual DMSO was 8 ± 4 G/L. Functional analysis revealed significant differences between FFP and FLyP-CPPs, with lower clot firmness and increased clot initiation. Activation of platelets was not higher in FLyP-CPPs.ConclusionPreparing CPPs according to this “new” process fulfilled the French legal criteria regardless of the type of plasma. Differences highlighted between FFP-CPPs and FLyP-CPPs were unlikely to be of clinical relevance.     

Contrôle de qualité des greffons de sang placentaire décongelés : résultats d’une étude multicentrique

PurposeToday, haematopoietic stem cell graft from placental blood concerns more than 15 % of allogeneic grafts. An inter-laboratory study of the quality control of defrosted cord blood units has been coordinated by the French society for cell and tissue bioengineering (SFBCT), with the cord blood bank of Bourgogne Franche-Comté and controlled by the French health products safety agency (Afssaps). The aim of this study is to ensure the inter-laboratory reproducibility of the quality controls practised by the banks during defrosting. The cellular outputs were analyzed according to the defrosting techniques, according to the method used in flow cytometry: single-platform (SP) versus double-platform (DP), or the product nature, i.e. in total blood or miniaturized.MethodsForty-two units of placental blood (USP), which were out of range were provided for defrosting to 14 participating sites. USP were defrosted and controlled according to the procedures of each bank. Once the USP is defrosted, a part of the product was controlled by the site and the other part by Afssaps. Following controls were carried out: numeration of the total nucleated cells (TNC) and of CD34+ cells (made by a SP method in Afssaps) and functional assay.ResultsConcerning TNC, the defrosting sites obtained a cellular output of 94 % ± 28 in day 0 compared with an output of 72 % ± 24 in Afssaps showing a rather good stability of the USP transmitted with an average deviation of 23 % ± 22. The freezing process with or without reduction of volume does not affect this variation. Concerning the numeration of CD34+ cells, the average deviation between the participating sites and Afssaps was 29 % ± 23 compared with 21 % ± 16 for the sites using a SP method against 47 % ± 25 for those using a DP method. The CD34+ outputs are equal to 82 % ± 60 in day 0 for the participating sites against 52 % ± 20 for Afssaps. For the sites using a DP method, it is stressed that this output is particularly high with a rate of 126 % ± 90 (n = 15) whereas it is 62 % ± 20 (n = 32) for the sites using a SP method.ConclusionThese results underline a good stability of viable CD34+ cells and a greater reliability of the SP methods for the CD34+ cell numeration for these defrosted USP. Lastly, the results of the functional assay regarding the average clonogenicities (equal to 15 %) reinforce the conclusions on the quality of the defrosted products.     

Incidence of speech recognition errors in the emergency department

BackgroundPhysician use of computerized speech recognition (SR) technology has risen in recent years due to its ease of use and efficiency at the point of care. However, error rates between 10 and 23% have been observed, raising concern about the number of errors being entered into the permanent medical record, their impact on quality of care and medical liability that may arise. Our aim was to determine the incidence and types of SR errors introduced by this technology in the emergency department (ED).SettingLevel 1 emergency department with 42,000 visits/year in a tertiary academic teaching hospital.MethodsA random sample of 100 notes dictated by attending emergency physicians (EPs) using SR software was collected from the ED electronic health record between January and June 2012. Two board-certified EPs annotated the notes and conducted error analysis independently. An existing classification schema was adopted to classify errors into eight errors types. Critical errors deemed to potentially impact patient care were identified.ResultsThere were 128 errors in total or 1.3 errors per note, and 14.8% (n = 19) errors were judged to be critical. 71% of notes contained errors, and 15% contained one or more critical errors. Annunciation errors were the highest at 53.9% (n = 69), followed by deletions at 18.0% (n = 23) and added words at 11.7% (n = 15). Nonsense errors, homonyms and spelling errors were present in 10.9% (n = 14), 4.7% (n = 6), and 0.8% (n = 1) of notes, respectively. There were no suffix or dictionary errors. Inter-annotator agreement was 97.8%.ConclusionsThis is the first estimate at classifying speech recognition errors in dictated emergency department notes. Speech recognition errors occur commonly with annunciation errors being the most frequent. Error rates were comparable if not lower than previous studies. 15% of errors were deemed critical, potentially leading to miscommunication that could affect patient care.     

No effect of obesity on limb and component alignment after computer-assisted total knee arthroplasty

PurposeThis retrospective study aimed to determine if computer navigation provides consistent accuracy for limb and component alignment during TKA irrespective of body mass index (BMI) by comparing limb and component alignment and the outlier rates in obese versus non-obese individuals undergoing computer-assisted TKA.MethodsSix hundred and thirty-five computer assisted total knee arthroplasties (TKAs) performed in non-obese individuals (BMI < 30 kg/m²) were compared with 520 computer-assisted TKAs in obese individuals (BMI ≥ 30 kg/m²) for postoperative limb and component alignment using full length standing hip-to-ankle radiographs.ResultsNo significant difference in postoperative limb alignment (179.7° ± 1.7° vs 179.6° ± 1.8°), coronal femoral (90.2° ± 1.6° vs 89.8° ± 1.9°) and tibial component (90.2° ± 1.6° vs 90.3° ± 1.7°) alignment and outlier rates (6.2% vs 7.5%) was found between non-obese and obese individuals. Similarly, alignment and the outlier rates were similar when non-obese individuals and a subgroup of morbidly obese individuals (BMI > 40 kg/m²) were compared.ConclusionsComputer navigation can achieve excellent limb and component alignment irrespective of a patient's BMI. Although obesity may not be an indication per se for using computer navigation during TKA, it will help achieve consistently accurate limb and component alignment in obese patients.Level of EvidenceLevel II     

Incidence des gastroentérites à rotavirus chez les enfants de moins de cinq ans consultant un pédiatre ou un médecin généraliste en France

BackgroundRotavirus (RV) is the main infectious agent of severe acute gastroenteritis (AGE) in infants and children under 5 years. Given the recent availability of new vaccines, it is important to accurately assess the incidence of rotavirus gastroenteritis (GERV) and their medical and epidemiological consequences.MethodsThis work is the French part of study program called SPRIK, a multicenter, prospective, observational study conducted from October 2005 to May 2007 to estimate the annual incidence of GERV within children under 5 years visiting a general practitioner or pediatrician. It presents data collected by 41 general practitioners and 36 paediatricians located throughout the French metropolitan territory. A stool sample was taken for every child. Rotavirus presence was sought by the physician using a rapid immunochromatographic test. French results are presented in this article.ResultsA total of 1648 GEA episodes corresponding to 1463 eligible patients were included in the study mainly from December to May (peak in February–March). The incidence rate of GERV leading to consultations in general practice was 1357 cases per 100,000 patient-years (PY) (1.36%), with a 95% confidence interval of [1345–1368]. The peak incidence occurs before 2 years. GERV accounted for 21% of all GEA cases seen by paediatricians and general practitioners. Patients with GERV were younger (14.1 ± 10.8 versus 18.4 ± 13.9 months for other GEA, P < 0.0001) and had more severe clinical symptoms: presence of fever (32.6% versus 20.0%, P < 0.0001), behavioural symptoms (45.6% versus 20.8%, P < 0.0001) and dehydration (48.7% versus 21.2%, P < 0.0001). GERV episodes were considered severe in 79.7% of cases, using the Vesikari scale. More than 86% patients received oral rehydration during the episode and 13 patients (5.8%) were hospitalized. Nearly 80% GERV episodes were considered severe using the Vesikari scale. Main genotypes were G1P[8] rotavirus (44%) and G9P[8] rotavirus (35%) types.ConclusionThe incidence rate reported in this study is close to results of previous studies done in Europe. The frequency and severity relative to GERV support vaccination in very young children to reduce the burden associated with this pathology.     

Outcomes of passive-active immunoprophylaxis given to infants of mothers infected with hepatitis B virus in Babol,Iran

BackgroundInfants born to chronic hepatitis B virus (HBV) infected mothers may be infected in spite of receiving passive-active immunoprophylaxis.ObjectivesThe purpose of this study was to assess the outcome of infants born to women actively infected by HBV.Study designFrom April 2004 to September 2009, infants born to women actively infected by HBV received hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine at birth. The second and third doses of HBV vaccine were administered at 1 and 6 months of age. Post-vaccination tests to detect HBsAg and anti-HBs were assessed between 12 and 15 months of age. Those who had anti-HBs titers < 10 mIU/ml received the second series of HBV vaccine.ResultsThirty-four and 201 infants were born to HBeAg-seropositive and anti-HBe-seropositive mothers, respectively. HBsAg was detected in 6 (17.6%) infants born to HBeAg-seropositive mothers and in 3 (1.5%) to anti-HBe-seropositive mothers (p = 0.0001). Anti-HBs ≥ 10 mIU/ml were achieved in 26 (76.5%) and 178 (88.6%) infants of HBeAg-seropositive and anti-HBe-seropositive mothers, respectively (p > 0.05). Twenty-two (9.4%) infants were non-responders and 11(50%) of them responded to the second series of HBV vaccine.ConclusionsThe results show that infants of HBeAg-seropositive mothers have higher risk of developing of HBV infection. Some HBsAg-seronegative infants may not respond to passive-active immunoprophylaxis and may remain at risk of HBV infection.     

Low mother-to-child-transmission rate of Hepatitis C virus in cART treated HIV-1 infected mothers

BackgroundMaternal transmission is the most common cause of HCV infection in children. HIV co-infection and high levels of plasma HCV-RNA have been associated with increased HCV transmission rates.ObjectivesWe assessed the vertical HCV transmission rate in the HIV–HCV co-infected group of pregnant women on cART.Study designWe conducted a retrospective study in a Dutch cohort of HIV-positive pregnant women and their children. We identified co-infected mothers. Results of the HCV tests of the children were obtained.ResultsAll 21 women were on cART at the time of delivery. We analyzed data of the 24 live-born children at risk for mother-to-child transmission (MTCT) of HCV between 1996 and 2009. HIV-RNA was <500 copies/ml during 18/24 [75%] deliveries, the median CD4⁺ cell count was 419 cells/μl (290–768). There was no transmission of HIV. The median plasma HCV-RNA in our cohort of 23 non-transmitting deliveries in 21 women was 3.5 × 10E5 viral eq/ml (IQR 9.6 × 104–1.5 × 106 veq/mL). One of 24 live-born children was found to be infected with HCV genotype 1. At the time of delivery the maternal plasma HIV-RNA was <50 copies/ml, the CD4⁺ cell count was 160 cells/μl and maternal plasma HCV-RNA was 4.6 × 10E6 veq/ml. This amounted to a prevalence of HCV-MTCT of 4%.ConclusionIn this well-defined cohort of HIV–HCV co-infected pregnant women, all treated with cART during pregnancy, a modest rate of vertical HCV transmission was observed.     

Mid-term results of transphyseal anterior cruciate ligament reconstruction in children and adolescents

BackgroundOptimal therapy for anterior cruciate ligament (ACL) rupture in the paediatric population still provokes controversy. Although conservative and operative treatments are both applied, operative therapy is slightly favored. Among available surgical techniques are physeal-sparing reconstruction and transphyseal graft fixation. The aim of this study was to present our mid-term results after transphyseal ACL reconstruction.MethodsFifteen young patients (mean age = 12.8 ± 2.6, range = 6.2–15.8 years, Tanner stage = 2–4) with open physis and traumatic anterior cruciate rupture who had undergone transphyseal ACL reconstruction with unilateral quadriceps tendon graft were prospectively analyzed. All children were submitted to radiological evaluation to determine the presence of clearly open growth plates in both the distal femur and proximal tibia. Postoperatively, all patients were treated according to a standardized rehabilitation protocol and evaluated by radiographic analysis and the Lysholm–Gillquist and IKDC 2000 scores. Their health-related quality of life was measured using the SF-12 PCS (physical component summary) and MCS (mental component summary) questionnaires.ResultsMean postoperative follow-up was 4.1 years. Mean Lysholm–Gillquist score was 94.0. Thirteen of the 15 knees were considered nearly normal on the IKDC 2000 score. The mean SF-12 questionnaire score was 54.0 ± 4.8 for SF-12 PCS and 59.1 ± 3.7 for SF-12 MCS. No reruptures were observed. Radiological analysis detected one knee with valgus deformity. All patients had a normal gait pattern without restrictions.ConclusionTransphyseal reconstruction of the anterior cruciate ligament shows satisfactory mid-term results in the immature patient.     

Incomplete response to colchicine in M694V homozygote FMF patients

BackgroundPrevious studies have shown that with prophylactic colchicine 65% of the patients suffering from Familial Mediterranean fever (FMF) will show a complete response, 30% a partial response and about 5% will show minimum or no response. These studies were performed before the isolation of the disease gene. Genotyping enables us to study the response rates according to specific mutations. We have witnessed a large number of M694V homozygotes who do not respond well to colchicine despite being treated with maximal sustained doses.AimTo assess the response rates to colchicine in M694V homozygote FMF patients in comparison to other prevalent genotypes.MethodsWe conducted a telephonic survey which included 112 FMF patients: 40 M694V homozygotes, and 2 comparison groups of 41 M694V/V726A compound heterozygotes and 31 V726A homozygotes. The questionnaire included demographic, social and clinical features, colchicine dose, response rates and reported side effects.ResultsM694 homozygotes showed a more severe disease, and were treated with higher doses of colchicine (average dose 1.98 ± 0.56 compared to 1.47 ± 0.58, p = 0.0001 and 1.13 ± 0.41, p < 0.001 in the M694V/V726A compound heterozygotes and the V726A homozygotes, respectively); Colchicine related side effects were noted in 40% of the M694V homozygotes. The average rate of attacks in treated M694V homozygotes (0.70 ± 1.06) was higher compared to the two other groups (0.14 ± 0.26, p = 0.002 and 0.08 ± 0.20, p = 0.0009, respectively) and only 25% of them reported no attacks in the last year. None of the patients who took part in this study had amyloidosis. Side effects limiting the dose of colchicine were noted in 40% of the M694V homozygotes.ConclusionsDespite receiving higher doses of colchicine the prevalence of complete responders among M694V homozygotes is much lower than previously appreciated. The results highlight the need for additional treatment modalities for these patients.