A middle-aged lady with a pyogenic liver abscess caused by Clostridium perfringens

The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens ) is a rare, but rapidly fatal infection. It is usually associated with malignancy and immunosuppression. We report the case of 50-year-old lady with the secondary liver metastases from rectal cancer presented with fever and epigastric pain. The identification of Grampositive bacilli septicaemia, the presence of gas-forming liver abscess and massive intravascular hemolysis should lead to the suspicion of C. perfringens infection. Here we review twenty cases published since 1990 and their clinical features are discussed. The importance of "an aggressive treatment policy" with multidisciplinary team approach is emphasized.     

Psychometric Evaluation of the Young Children's Participation and Environment Measure (YC-PEM) for use in Singapore

Aims: To estimate the psychometric properties of a culturally adapted version of the Young Children's Participation and Environment Measure (YC-PEM) for use among Singaporean families. Methods: This is a prospective cohort study. Caregivers of 151 Singaporean children with (n = 83) and without (n = 68) developmental disabilities, between 0 and 7 years, completed the YC-PEM (Singapore) questionnaire with 3 participation scales (frequency, involvement, and change desired) and 1 environment scale for three settings: home, childcare/preschool, and community. Setting-specific estimates of internal consistency, test-retest reliability, and construct validity were obtained. Results: Internal consistency estimates varied from .59 to .92 for the participation scales and .73 to .79 for the environment scale. Test-retest reliability estimates from the YC-PEM conducted on two occasions, 2–3 weeks apart, varied from .39 to .89 for the participation scales and from .65 to .80 for the environment scale. Moderate to large differences were found in participation and perceived environmental support between children with and without a disability. Conclusions: YC-PEM (Singapore) scales have adequate psychometric properties except for low internal consistency for the childcare/preschool participation frequency scale and low test-retest reliability for home participation frequency scale. The YC-PEM (Singapore) may be used for population-level studies involving young children with and without developmental disabilities.     

Outcome of antibody‐mediated rejection compared to acute cellular rejection after pediatric heart transplantation

Outcomes of ACR after pediatric HTx have been well described, but less has been reported on outcomes of AMR. We compared the clinical characteristics and cardiovascular outcomes (composite end‐point of death, retransplantation, or allograft vasculopathy) of pediatric HTx recipients with AMR, ACR, and no rejection in a retrospective single‐center study of 104 recipients. Twenty were treated for AMR; 15 were treated for ACR. Recipients with AMR had an increased frequency of congenital heart disease (90% vs ACR 67% vs no rejection 59%, P = .03), homograft (68% vs 7% vs 18%, P < .001), HLA sensitization (45% vs 13% vs 13%, P = .008), and positive cross‐match (30% vs 7% vs 9%, P = .046). AMR caused hemodynamic compromise more often than ACR (39% vs 4%, P = .02). AMR recipients had worse cardiovascular outcome than recipients with ACR or no rejection (40% vs 20% vs 8.6%, P = .003). In bivariate Cox analysis, AMR (HR 4.1, CI 1.4‐12.0, P = .009) and ischemic time (HR 1.6, CI 1.1‐2.3, P = .02) were associated with worse cardiovascular outcome; ACR was not. In summary, pediatric HTx recipients who develop AMR have worse cardiovascular outcome than recipients who develop only ACR or experience no rejection at all.     

Diastolic pressure indices offer a novel approach to predicting risk of graft loss after pediatric heart transplant

PH is a risk factor for GL after HTx. However, traditional parameters are not reliable predictors of risk in children. We hypothesized that DPI (dPAP and DPG) are predictive of GL in pediatric HTx recipients. The UNOS/SRTR database was reviewed to identify pediatric HTx recipients (age <18 years) between 1994 and 2013. Recipients with pretransplant hemodynamic data were grouped by diagnosis (CMP or CHD), and the groups were analyzed separately. Bivariate Cox regression analysis examined the association between hemodynamic variables and GL. DPI showed the strongest association with early GL in recipients with CMP (dPAP: HR = 1.25 [1.09‐1.42]; DPG: 1.24 [1.11‐1.38]). Among CHD recipients, DPI were associated with early GL in those with preexisting PH (dPAP: HR = 1.16 [1.01‐1.33]; DPG: HR = 1.10 [1.00‐1.21]). No cutoff values for “high‐risk” DPI were identified, but a continuous relationship between higher DPI and risk of early GL was observed. DPI are associated with early GL in select pediatric HTx recipients. Our findings suggest that DPI should be considered as part of routine hemodynamic assessment for pediatric HTx candidates.     

Binocular switch suppression: a new method for persistently rendering the visible 'invisible'

Rendering the usually visible 'invisible' has long been a popular experimental manipulation. With one notable exception, 'continuous flash suppression' [Tsuchiya, N., & Koch, C. (2005). Continuous flash suppression reduces negative afterimages. Nature Neuroscience, 8, 1096-1101], existing methods of achieving this goal suffer from being either unable to suppress stimuli from awareness for prolonged periods, from being unable to reliably suppress stimuli at specific epochs, or from a combination of both of these limitations. Here we report a new method, binocular switch suppression (BSS), which overcomes these restrictions. We establish that BSS is novel as it taps a different causal mechanism to the only similar pre-existing method. We also establish that BSS is superior to pre-existing methods both in terms of the depth and duration of perceptual suppression achieved. BSS should therefore prove to be a useful tool for the large number of researchers interested in exploring the neural correlates and functional consequences of conscious visual awareness.     

Self-Perceived Musculoskeletal Complaints: Relationship to Time Use in Women Homemakers in Hong Kong

OBJECTIVE: To examine patterns of time use and self-perceived musculoskeletal symptoms for women homemakers in Hong Kong using a cross-sectional survey. METHODS: A total of 216 women were selected from a women's center and a selected district by trained volunteers for a single interview using convenience sampling; 63 respondents had paid work and 153 were full-time homemakers. The study included a surveillance of self-reported musculoskeletal symptoms for the past 12 months and a time use log to report respondents' daily activities retrospectively during a 24-h reference day. RESULTS: Significant differences were found in the mean hours spent in paid work, outdoor activities, and passive leisure between respondents with paid and those with unpaid work (P = 0.000-0.021). Although the reported musculoskeletal problems were mostly mild to moderate, more than 60% of homemakers experienced at least one musculoskeletal symptom over the spine or upper or lower extremities in the 12 months prior to the survey. Homemakers were more likely to report discomfort in their upper back (OR = 2.70, 95% CI 1.27-5.71) and shoulder (OR = 3.50, 95% CI 1.21-10.19) while shopping; in their lower back (OR = 1.90, 95% CI 1.03-3.50), wrist (OR = 2.02, 95% CI 1.06-3.84), and hip (OR = 2.35, 95% CI 1.07-5.13) while washing utensils; and in their finger (OR = 1.45, 95% CI 1.03-2.03) and knee (OR = 1.84, 95% CI 1.19-2.82) during cleaning tasks. CONCLUSION: The results showed a high degree of musculoskeletal discomfort among women homemakers in Hong Kong. Modifying current participation in household chores like cleaning, washing utensils, and shopping is needed to reduce the risk of developing musculoskeletal problems in this population.     

Detection of early glaucoma with optical coherence tomography (StratusOCT)

PURPOSE: To evaluate the performance of optical coherence tomography (StratusOCT) for discriminating eyes with early glaucoma from normal eyes. METHODS: Thirty eyes with established early glaucomatous visual field defects (EGVF group), 30 eyes with evidence of early glaucomatous optic neuropathy with normal standard achromatic perimetry [early glaucoma by disc (EGD)], and 33 age-matched normal eyes with good quality StratusOCT nerve fiber layer (NFL) images were enrolled. Average NFL thickness and NFL thickness at quadrants and sectors, areas under receiver operator characteristic curves, and sensitivities at 80% and 90% specificity were evaluated. RESULTS: The average (+/-SD) mean deviation in the EGVF group was -3.4 (+/-1.7) dB. Receiver operator characteristic curves showed areas under the curve (AUC) for NFL thickness in the superior quadrant (AUC=0.75+/-0.07) and in the inferior quadrant (AUC=0.94+/-0.03) to be the best StratusOCT parameters for discrimination of normal controls from EGD and EGVF eyes, respectively. The best parameter for detection of EGD eyes at 80% and 90% specificities was NFL thickness at superior quadrant (51% and 36% sensitivities, respectively). The best parameter for detection of EGVF eyes at 80% and 90% specificities was NFL thickness in the inferior quadrant (90% and 87% sensitivities, respectively). CONCLUSIONS: Optical coherence tomography (StratusOCT) showed good sensitivity and specificity in a group of glaucoma patients with early visual field loss. In patients with normal visual fields in whom the optic disc appeared glaucomatous to glaucoma specialists, half were confirmed to have StratusOCT findings consistent with damage from glaucoma.     

An evaluation of UK secondary data sources for the study of childhood obesity, physical activity and diet

Background This study assesses the potential of secondary datasets for measuring recent and future trends in childhood obesity, physical activity and diet in the UK, at national, regional and sub‐regional levels, and in relation to inequalities. Methods Relevant datasets were identified using online searches; they were excluded if they had low sample sizes, were assembled prior to 1990 or on only one occasion, were not potentially accessible, or were limited to a specific population. Remaining datasets were assessed according to content, sampling frame and size, timing and ability to be used to assess inequalities and regional trends. Results A total of 96 datasets were identified, but only 11 had the potential to be used to assess trends. Eight of these contained data on physical activity, 8 on diet and 3 on obesity. The period over which trends might be assessed varied from 2 years to over 10, with over half of the datasets expected to continue data collection into the future. Most had the potential to be used to assess inequalities and also regional and sub‐regional level trends, albeit with relatively small sample sizes. There were some limitations to the datasets, such as non‐objective measures of diet and physical activity and, in some, low response rates, which would require further consideration when utilizing individual datasets. Conclusions Awareness of the potential of secondary datasets for monitoring trends in childhood obesity should be raised, alongside the financial and intellectual capacity to enhance and exploit them.     

Does population mixing measure infectious exposure in children at the community level?

Epidemiological studies focusing on the etiology of childhood chronic diseases have used population mixing as a proxy for the level of infection circulating in a community. We compared different measures of population mixing (based on residential migration and commuting) and other demographic variables, derived from the United Kingdom Census, with hospital inpatient data on infections from two Government Office Regions in England (Eastern and the West Midlands) to inform the development of an infectious disease proxy for future epidemiological studies. The association between rates of infection and the population mixing measures was assessed, using incidence rate ratios across census areas, from negative binomial regression. Commuting distance demonstrated the most consistent association with admissions for infections across the two regions; areas with a higher median distance travelled by commuters leaving the area having a lower rate of hospital admissions for infections. Deprived areas and densely populated areas had a raised rate of admissions for infections. Assuming hospital admissions are a reliable indicator of common infection rates, the results from this study suggest that commuting distance is a consistent measure of population mixing in relation to infectious disease and deprivation and population density are reliable demographic proxies for infectious exposure. Areas that exhibit high levels of population mixing do not necessarily possess raised rates of hospital admissions for infectious disease.