The prevalence of vesicoureteral reflux in infants with first urinary tract infection following circumcision is similar to infants with UTI not following circumcision

Purpose

Urinary tract infections (UTIs) are common serious bacterial infections in early infancy. Ritual circumcision in neonates may increase the risk of UTI within 2 weeks of the procedure. The aims of this study were to assess the prevalence and risk factors for vesicoureteral reflux (VUR) among young infants with first UTI following circumcision, and compare it with the prevalence of VUR among young infants with first UTI not related to circumcision.

Methods

In this retrospective cohort study, the medical records of all children aged 0–100 days who were diagnosed with UTI at Shaare Zedek Medical Center between 2005 and 2012 were reviewed for demographic, clinical and laboratory data and for the presence of VUR in voiding cystourethrography (VCUG).

Results

Four hundred and sixty eight cases of UTI were included. Infants with post-circumcision UTI in our study were more likely to have associated bacteremia and abnormal renal function tests. VCUG was done for 166 infants (35%). There was no statistically significant difference in the prevalence of abnormal VCUG between infants with UTI following circumcision, in comparison to infants with UTI not following circumcision (30% vs. 36%, p?=?NS).

Conclusions

The decision regarding the need for radiographic evaluation and prophylactic antibiotic treatment following UTI should be made regardless if infection was related to circumcision.

     

Bone bank at University Department of Orthopedics, Zagreb University Hospital Center, Zagreb, Croatia

AIM: Bone bank has to supply patients of our Department as well as patients from other hospitals with necessary bone grafts, but only in a case of appropriate medical indication that is evaluated by the Board of Orthopedic Surgeons. METHODS: The paper describes in detail the modalities of donor selection, explantation technique, transportation and preservation of frozen bone grafts. Also, the harvesting models and expenses of the bone bank are described. RESULTS: During the 1998-2006 period, explantation team retrieved bone grafts from 32 cadaver donors, in 10 of them bilaterally. Retrieving bone grafts from cadavers took 90 minutes and transportation 30 minutes on an average. Contamination rate of cadaveric bone grafts was 21%; all retrieved allografts were destroyed in two patients only. Bone grafts were used for reconstruction of bone defects after tumor resection, for revision hip or knee arthroplasty, spondylodesis, or corrective osteotomy. CONCLUSION: Bone bank is a service that retrieves, stores and distributes bone grafts. Appropriate documentation, control and harvesting for optimal indications provide a safe and relatively inexpensive system supplying surgeons and their patients with necessary bone stock in orthopedic surgery procedures.     

Does experience change anything? Attitudes of paramedic students regarding drinking and driving

Purpose

The current study examined attitudes and behavior of first degree emergency medical technician (paramedic) students at Ben-Gurion University of the Negev in Israel toward DUI (driving under the influence).

Methods

Students were asked to complete an anonymous, self-administered, multiple-choice questionnaire and a demographic questionnaire.

Results

We found that 42% of respondents (n = 59) had driven after drinking, and 56% of them had driven after more than one drink in the past year. Furthermore, 70% of the students had been designated drivers in the past year, 31% of whom had drunk-driven. No significant difference was found between past volunteers at MDA* and those who did not volunteer regarding the number of DUI events or the amount of alcohol consumed, but those who did volunteer drank more when engaging in DUI.

Conclusion

Our findings are worrisome and may reveal the strength of social norms for consumption of alcohol on one hand and the lack of suitable education regarding the dangers of alcohol in the health care department on the other hand.

     

Determination of the ionization constants of 4-iodo-2,6-dimethylphenylcarbamoylmethyl iminodiacetic acid

In order to develop a radiopharmaceutical for hepatobiliary scintigraphy with better hepatobiliary properties new ligand for complexation of ^99mTc, 4-iodo-2,6-dimethylphenylcarbamoylmethyl iminodiacetic acid (METHYLIODIDA), was synthesized. Acid–base equilibria of METHYLIODIDA were studied potentiometrically, because these data are important for determination of complex formation conditions. It was established that METHYLIODIDA undergoes a complex acid–base equilibrium due to its zwitterionic nature and four proton-binding sites. The stoichiometric ionization constants were determined at 25 °C and constant ionic strength 0.1 M (NaClO₄): pK₁=1.7±0.1; pK₂=2.44±0.07; pK₃=6.29±0.02 and pK₄=10.91±0.06, respectively.     

Immunogenicity,protective efficacy and mechanism of novel CCS adjuvanted influenza vaccine

We optimized the immunogenicity of adjuvanted seasonal influenza vaccine based on commercial split influenza virus as an antigen (hemagglutinin = HA) and on a novel polycationic liposome as a potent adjuvant and efficient antigen carrier (CCS/C-HA vaccine). The vaccine was characterized physicochemically, and the mechanism of action of CCS/C as antigen carrier and adjuvant was studied. The optimized CCS/C-HA split virus vaccine, when administered intramuscularly (i.m.), is significantly more immunogenic in mice, rats and ferrets than split virus HA vaccine alone, and it provides for protective immunity in ferrets and mice against live virus challenge that exceeds the degree of efficacy of the split virus vaccine. Similar adjuvant effects of optimized CCS/C are also observed in mice for H1N1 swine influenza antigen. The CCS/C-HA vaccine enhances immune responses via the Th1 and Th2 pathways, and it increases both the humoral responses and the production of IL-2 and IFN-γ but not of the pro-inflammatory factor TNFα. In mice, levels of CD4⁺ and CD8⁺ T-cells and of MHC II and CD40 co-stimulatory molecules are also elevated. Structure–function relationship studies of the CCS molecule as an adjuvant/carrier show that replacing the saturated palmitoyl acyl chain with the mono-unsaturated oleoyl (C18:1) chain affects neither size distribution and zeta potential nor immune responses in mice. However, replacing the polyalkylamine head group spermine (having two secondary amines) with spermidine (having only one secondary amine) reduces the enhancement of the immune response by ∼50%, while polyalkylamines by themselves are ineffective in improving the immunogenicity over the commercial HA vaccine. This highlights the importance of the particulate nature of the carrier and the polyalkylamine secondary amines in the enhancement of the immune responses against seasonal influenza. Altogether, our results suggest that the CCS/C polycationic liposomes combine the activities of a potent adjuvant and efficient carrier of seasonal and swine flu vaccines and support further development of the CCS/C-HA vaccine.     

Three cases of osteoma cutis occurring in infancy. A brief overview of osteoma cutis and its association with pseudo-pseudohypoparathyroidism

We report three cases of primary osteoma cutis in children, two of whom (siblings) were associated with Albright's hereditary osteodystrophy (AHO), manifesting as short stature with autosomal dominant inheritance from the father, but no dysmorphic features and no parathyroid hormone (PTH) resistance. Osteoma cutis can manifest as an isolated skin disease, a secondary condition to other skin diseases (such as acne), or in association with several syndromes, including AHO, which in turn may be associated with PTH resistance. The management and prognosis of patients diagnosed with osteoma cutis is determined by whether the skin manifestation has occurred in isolation, in association with a syndrome, or as a secondary skin disease. These three paediatric cases highlight the importance of understanding the aetiology and associations of osteoma cutis in order to appropriately investigate and manage patients who present with this rare skin disease.     

Neonatal lupus erythematosus presenting as papules on the feet

We describe a case of neonatal lupus erythematosus in a 4‐week‐old male baby presenting with nodules/papules on the plantar surface of both feet. Skin histology of the right foot papule was consistent with lupus erythematosus. Annular lesions more typical of this condition then appeared later and maternal antibodies were positive for speckled antinuclear antibodies (1:5120), anti‐Ro/SSA and anti‐La/SSB(+), rheumatoid factor 1380.0 IU/mL. The patient had no evidence of cardiac, haematological or hepatobilary involvement. Although the mother was asymptomatic, the maternal grandmother had recently been diagnosed with Sjögren's syndrome.     

Cimetidine for mucosal warts in an HIV positive adult

An HIV-positive adult presented with recalcitrant mucosal warts which failed to respond to therapies including curettage and cautery, cryocautery and oral etretinate. There was an apparent complete resolution of intra- and perioral warts with the histamine H2 antagonist, cimetidine.     

p66ShcA and ageing: modulation by longevity-promoting agent aurintricarboxylic acid

Many mutations that extend the lifespan of the lower organisms such as C. elegans and Drosophila, are associated with signaling or apoptotic pathways. Recently, such a possibility was shown in mammals: p66ShcA-deficient mice were more resistant to oxidative stress and lived longer than the wild-type animals [Migliaccio, E., Giorgio, M., Mele, S., Pelicci, G., Reboldi, P., Randolfi, P.P., Lanfrancone, L., Pelicci, P.G., 1999. The p66Shc adaptor protein controls oxidative stress response and life span in mammals. Nature 402, 309-313]. There is evidence to implicate p66ShcA in age-related degenerative pathology, including atherosclerosis, sarcopenia, and Alzheimer's disease. We hypothesized that a low level expression of p66ShcA could be associated with longevity. Also, we suggested that the level of p66ShcA could be modulated by a putative longevity-promoting agent aurintricarboxylic acid [aurintricarboxylic acid (ATA); Fraifeld, V., Wolfson, M., Sagi, O., Seidman, R., Asraf, H., Utko, N., Muradian, K., 2002. Effects of anti-apoptotic agent aurintricarboxylic acid on longevity and longevity-associated processes. Biogerontology 3, 48]. We have found that: (i) the level of p66ShcA decreases with advanced age. Thirty-six-month-old mice have the lowest, whereas newborns have the highest p66ShcA levels; (ii) ATA significantly decreases the p66ShcA level in mouse lungs. In addition, the lifespan-prolongation effect of ATA in a Drosophila model was further validated. The results support the suggested role for the p66ShcA as one of the lifespan determinants in mammals; p66ShcA therefore represents a potential target for pharmacological longevity-promoting intervention.