Right superior vena cava draining into the left atrium in a patient with sinus venosus defect

Right superior vena cava draining into the left atrium is an extremely rare anomaly of systemic venous return. It can be isolated or it can be associated with other congenital heart defects, thus clinical presentation may vary. A case of a 9-year-old asymptomatic patient with sinus venous defect and bilateral superior vena cava with the right-sided draining into the left atrium is described.     

Promotion of Immunizations for Health Professionals in Europe: A Qualitative Study in Seven European Member States

Health Care Workers (HCWs) are a high-risk group for contracting Vaccine-Preventable Diseases who, despite legislation and guidance, remain undervaccinated. In order to understand their barriers and needs, focus groups were formed with 278 physicians, nurses, infection-control personnel, and policy-makers in 7 EU MS. Several implications for the development of promotional initiatives were identified including the need to overcome organizational barriers, to sensitize HCWs about the importance of immunization and to provide specific up-to-date information about vaccinations covering prevalence of diseases, protection years, side effects, administration times, antibody examinations, costs and immunization settings.     

In vitro and in vivo evaluations of oxacillin efficiency against mecA-positive oxacillin-susceptible Staphylococcus aureus

Community-type Staphylococcus aureus strains that are positive for mecA and PBP2a but appear phenotypically susceptible to oxacillin are increasingly reported worldwide. Four S. aureus clinical isolates carrying the mecA gene with oxacillin MICs of <2 μg/ml were tested for oxacillin efficiency by population analyses and experimental thigh infections. These isolates harbored staphylococcal cassette chromosome mec type IV and belonged to two genotypes. Two of the four isolates were found by population analysis to be truly oxacillin susceptible. All four isolates exhibited significant reductions in the numbers of colonies grown after dicloxacillin treatment of experimental thigh infections, as also did a mecA-negative S. aureus control strain. These observations indicate that some of the phenotypically oxacillin susceptible mecA-positive Staphylococcus aureus isolates may be at least partially responsive to oxacillin.     

Comparison of six radionuclidic and non-radionuclidic methods for the assessment of glomerular filtration rate in patients with chronic renal failure

The assessment of renal function in patients with chronic renal failure has a significant impact on both prognosis and treatment. We were unable to find a study, comparing six radionuclidic and non-radionuclidic methods as tested in this study on the same patients for the assessment of renal function in order to evaluate the relative significance of each method. In this study 82 patients were enrolled, 31 females with an age range 18-73 y (mean: 46 y) and 51 males with an age range 20-77 y (mean: 48 y). The level of renal function of these subjects ranged between normal, and mild to severe renal failure with serum creatinine levels: 2.7+/-2.2 mg/dl (mean+/-SD). The methods used for the glomerular filtration rate (GFR) were: (a) the clearance of inulin; (b) the technetium 99m labeled-diethyleno triamine pentacetic acid (99m)Tc-DTPA plasma disappearance curve; (c) the UV/P formula, not corrected for the residual urine volume in the bladder [DTPA(-)]; (d) the UV/P formula corrected for the residual urine volume in the bladder [DTPA(+)]; (e) plasma clearance of creatinine by the Cockcroft-Gault formula; and (f) plasma clearance of creatinine by using a 24-hour urine collection. In a subgroup of 13/82 patients, GFR was assessed by the radionuclidic and non-radionuclidic methods and compared against clearance of inulin, which was considered to be the gold standard. Moreover, we evaluated in our results the impact of age, gender, cause and stage of renal failure and the effect of the residual urine volume in the bladder. Fifteen of our patients were re-evaluated after 19-21 weeks. Spearman's correlation was used for statistical analysis; a two-sided P value < 0.05 was considered as statistically significant. Our results have shown that: the DTPA(+) method displayed the best correlation with the clearance of inulin (r=0.996) and was considered as the reference method in this study. The radionuclidic methods (99m)Tc-DTPA) plasma disappearance curve and DTPA(-) gave similar and comparable results with DTPA(+) (r=0.98, r=0.96), while the non-radionuclidic methods(plasma clearance of creatinine by using a 24-hour urine collection and plasma clearance of creatinine by the Cockcroft-Gault formula) tended to overestimate GFR respectively(r=0.91, r=0.79). Patient's age and gender had no impact on the calculated GFR values. With regards to the chronic renal failure cause, the above-mentioned tendencies were confirmed in primary and secondary glomerulonephritis, in diabetic nephropathy, and in hereditary renal diseases. On the contrary, in patients with renal disease of unknown cause, all methods -- isotopic and non-isotopic -- gave comparable results. The DTPA(-) method is simple to use and reliable, however, due to the fact that it does not consider the residual urine volume in the bladder, it seems to overestimate GFR in elderly men with prostate hypertrophy and increased residual urine volume in the bladder. The DTPA(+) method is reliable in a wide range of renal function levels, from mild to significant renal impairment. The radionuclidic methods DTPA(+), DTPA(-) and the (99m)Tc-DTPA plasma disappearance curves showed a very good reproducibility (r =0.97, r =0.96, r = 0.87) when were reperformed after 19-21 weeks, as compared to creatinine clearance with 24-hour urine collection (r=0.83). In conclusion, the radionuclidic methods in patients with chronic renal failure are reliable and reproducible, closely resembling those of inulin clearance. The among all radionuclidic methods, (99m)Tc-DTPA(+) shows the best results.     

Tumour necrosis factor gene polymorphisms and migraine in Greek children

Introduction

Migraine is considered to be a multifactorial, complex disease. Various genetic and environmental factors contribute to the manifestation of this disease. The aim of this study was to determine whether polymorphisms in the tumour necrosis factor (TNF) region are associated with the risk of migraine. We examined the association between 6 single nucleotide polymorphisms in the coding regions of TNF-α and TNF-β genes and migraine.

Material and methods

The study included two groups of children (group A and group B). Group A consisted of 103 unrelated children with typical migraine without aura 5–14 years of age. Group B (control group) consisted of 178 unrelated healthy children. The diagnosis of migraine was, in all patients, made according to the International Classification of Headache Disorders (ICHD II).

Results

According to our results positive family history was present in 62.2% of patients of group A. No significant differences were found in the frequencies of genotypes or alleles between patients and controls. The non-parametric analyses of variance showed no significant differences in the age at onset between genotype groups of the TNF-α and TNF-β gene polymorphisms. Comparison of genotype frequencies between boys and girls in affected patients and control individuals were not significantly different (p = 0.089, p =0.073 respectively). The distribution of TNF polymorphisms was not associated with the presence of family history of migraine in patients.

Conclusions

Our data indicate that TNF-α and TNF-β gene polymorphisms are not a significant risk factor for migraine without aura in Greek children.