Intraosseous mucoepidermoid carcinoma of the maxilla in a teenager: a case report and review of literature.

Central mucoepidermoid carcinoma is a rare central bony lesion in teenagers. We report on an 11-year-old girl with a central pathologic lesion in the right hemimaxilla.     

Negative impact of systemic catecholamine administration on hepatic blood perfusion after porcine liver transplantation.

Catecholamines are often administered during and after liver transplantation (LTx) to support systemic perfusion and to increase organ oxygen supply. Some vasoactive agents can compromise visceral organ perfusion. We followed the hypothesis that the vasculature of transplanted livers presents with a higher sensitivity, which leads to an increased vulnerability for flow derangement after application of epinephrine (Epi) or norepinephrine (NorEpi). Hepatic macroperfusion and microperfusion during systemic Epi or NorEpi infusion were measured by Doppler flow and thermodiffusion probes in porcine native, denervated, and transplanted livers (n = 16 in each group). Epi or NorEpi were infused (n = 8 in each subgroup) in predefined dosages (low dose = 5 microg/kg/minute and high dose = 10 microg/kg/minute) over 240 minutes. Systemic cardiocirculatory parameters were monitored continuously. Hepatic perfusion data were compared between all groups at comparable time points and dosages. In all native, denervated, and transplanted liver groups, Epi and NorEpi induced an inconsistent rise of mean arterial pressure and heart rate shortly after onset of infusion in both dosages compared with baseline. No significant differences of cardiovascular parameters at comparable time points were observed. In native livers, Epi and NorEpi induced only temporary alterations of hepatic macrocirculation and microcirculation, which returned to baseline 2 hours after onset of infusion. No significant alterations of hepatic blood flow were detected after isolated surgical denervation of the liver. By contrast, transplanted livers showed a progressive decline of hepatic macrocirculation (33-75% reduction) and microcirculation (39-58% reduction) during catecholamine infusions in a dose-dependent fashion. Characteristics of liver blood flow impairment were comparable for both vasoactive agents. In conclusion, pronounced disturbances of hepatic macrocirculation and microcirculation were observed during systemic Epi and NorEpi infusion after LTx compared with native and denervated livers. Microcirculation disturbances after LTx might be explained by impairment of hepatic blood flow regulation caused by an increased sensitivity of hepatic vasculature after ischemia-reperfusion and by lengthening of vasopressor effects caused by reduced hepatocyte metabolism. Clinicians should be aware of this potentially hazardous effect. Therefore, application of catecholamines after clinical LTx should be indicated carefully.     

Cost-Effectiveness of Increasing Access to Mammography Through Mobile Mammography for Older Women

OBJECTIVES: To compare the costs of mobile and stationary mammography and examine the incremental cost-effectiveness of using mobile mammography to increase screening rates.
DESIGN: A cost-effectiveness analysis was performed using effectiveness data from a randomized clinical trial and modeling of costs associated with the mobile mammography intervention.
SETTING: The trial involved 60 community-based meal sites, senior centers, and clubs.
PARTICIPANTS: Four hundred ninety-nine individuals were enrolled in the study, of whom 463 had outcome data available for analysis.
MEASUREMENTS: Costs were calculated for stationary and mobile mammography, as well as costs due to differences in technology and film versus digital. Incremental cost-effectiveness (cost per additional screen) was modeled, and sensitivity analysis was performed by altering efficiency (throughput) and effectiveness based on subgroup data from the randomized trial.
RESULTS: The estimated annual costs were $435,162 for a stationary unit, $539,052 for a mobile film unit, and $456, 392 for a mobile digital unit. Assuming mobile units are less efficient (50% annual volume), the cost per screen was $41 for a stationary unit, $86 for a mobile film unit, and $102 for a mobile digital unit. The incremental cost per additional screen were $207 for a mobile film unit and $264 for a mobile digital unit over a stationary unit.
CONCLUSION: Although mobile mammography is a more effective way to screen older women, the absolute cost per screen of mobile units is higher, whereas the reimbursement is no different. Financial barriers may impede the widespread use of this approach.     

Management of mandibular vascular malformation with sclerotherapy. Report of two cases.

BACKGROUND: Management of vascular anomalies is extremely challenging and varies according to the nature of the lesion. Traditionally, embolization with the resection of the lesion and autologous immediate reconstruction has been used. The purpose of this report is to present cases successfully using sclerosing solution injections alone. METHODS: This paper describes the management of two cases of the mandibular vascular malformations using trans-osseous injection of the sodium tetradecyl sulfate to the periphery of the lesion. The procedure was performed four or five times at two weeks intervals respectively. Imaging was performed using subtraction arteriography and sequential panoramic dental radiographs. RESULTS: Radiological and histological evaluation of the cases showed resolution of the lesions following sclerotherapy alone. CONCLUSIONS: Conservative interventional management using trans-osseous injection of sclerosing solution was successful in treating mandibular vascular anomalies.     

An Urban Population Health Observatory System to Support COVID-19 Pandemic Preparedness,Response, and Management: Design and Development Study

BackgroundCOVID-19 is impacting people worldwide and is currently a leading cause of death in many countries. Underlying factors, including Social Determinants of Health (SDoH), could contribute to these statistics. Our prior work has explored associations between SDoH and several adverse health outcomes (eg, asthma and obesity). Our findings reinforce the emerging consensus that SDoH factors should be considered when implementing intelligent public health surveillance solutions to inform public health policies and interventions.ObjectiveThis study sought to redefine the Healthy People 2030’s SDoH taxonomy to accommodate the COVID-19 pandemic. Furthermore, we aim to provide a blueprint and implement a prototype for the Urban Population Health Observatory (UPHO), a web-based platform that integrates classified group-level SDoH indicators to individual- and aggregate-level population health data.MethodsThe process of building the UPHO involves collecting and integrating data from several sources, classifying the collected data into drivers and outcomes, incorporating data science techniques for calculating measurable indicators from the raw variables, and studying the extent to which interventions are identified or developed to mitigate drivers that lead to the undesired outcomes.ResultsWe generated and classified the indicators of social determinants of health, which are linked to COVID-19. To display the functionalities of the UPHO platform, we presented a prototype design to demonstrate its features. We provided a use case scenario for 4 different users.ConclusionsUPHO serves as an apparatus for implementing effective interventions and can be adopted as a global platform for chronic and infectious diseases. The UPHO surveillance platform provides a novel approach and novel insights into immediate and long-term health policy responses to the COVID-19 pandemic and other future public health crises. The UPHO assists public health organizations and policymakers in their efforts in reducing health disparities, achieving health equity, and improving urban population health.     

Implementation of a new undergraduate radiology curriculum: experience at the University of British Columbia.

OBJECTIVES: The purpose of this study was to review and revise the undergraduate radiology curriculum at the University of British Columbia to improve radiology education to medical students and to meet the needs of a medical program with province-wide distribution. METHODS: We identified the radiology content of the curriculum from the Curriculum Management and Information Tool online database, from personal interviews with curriculum heads, and from published information. Undergraduates' and recent graduates' opinions were solicited by means of surveys. Information on radiology curricula at medical schools across Canada was gathered from email surveys and personal contacts with members of the Canadian Heads of Academic Radiology (CHAR). RESULTS: Review of our curriculum indicated that lack of a unified syllabus resulted in redundant content, gaps in knowledge, and lack of continuity in the curriculum. Results from the survey of programs across Canada indicated that most schools also lacked a formal radiology curriculum for medical students. By adapting the guidelines from the Association of Medical Student Education in Radiology, we revised our undergraduate radiology curriculum to emphasize integration and self-learning. The modified curriculum includes a combination of instructional technology, focused lectures in preclinical years, and in-context seminars in clerkship rotations. CONCLUSION: Most medical schools in Canada do not have a formal radiology curriculum for medical students. A structured curriculum is required to improve the quality of radiology teaching for medical students.     

Cutaneous adverse reactions to hydroxyurea in patients with intermediate thalassemia

Although the cutaneous effects of hydroxyurea have been described for patients with sickle cell anemia, myeloproliferative disorders, and psoriasis, there are no reports of cutaneous adverse effects from hydroxyurea when used for patients with intermediate thalassemia. Therefore 43 patients with intermediate thalassemia treated with hydroxyurea were examined by a dermatologist, and pertinent cutaneous findings were recorded. These patients had received hydroxyurea for a mean of 15.5 months. Nineteen had cutaneous hyperpigmentation, eight had xerosis, and three were found to have one cafe au lait macule each. Eleven patients had nail abnormalities, including nail ridging, partial leukonychia, and longitudinal melanonychia. There were no cases of leg ulceration. It was concluded that the risk of developing leg ulcers and pigmentary disorders appears to be related to the underlying disease being treated, as well as to a patient's age, gender, and pigmentation.