Bat coronavirus was detected positive from insectivorous bats in Krau Wildlife Reserve Forest

@#Bats are flying mammals with unique immune systems that allow them to hold many pathogens. Hence, they are recognised as the reservoir of many zoonotic pathogens. In this study, we performed molecular detection to detect coronaviruses, paramyxoviruses, pteropine orthoreoviruses and dengue viruses from samples collected from insectivorous bats in Krau Reserve Forest. One faecal sample from Rhinolophus spp. was detected positive for coronavirus. Based on BLASTN, phylogenetic analysis and pairwise alignment-based sequence identity calculation, the detected bat coronavirus is most likely to be a bat betacoronavirus lineage slightly different from coronavirus from China, Philippines, Thailand and Luxembourg. In summary, continuous surveillance of bat virome should be encouraged, as Krau Reserve Forest reported a wide spectrum of biodiversity of insectivorous and fruit bats. Moreover, the usage of primers for the broad detection of viruses should be reconsidered because geographical variations might possibly affect the sensitivity of primers in a molecular approach.

Redo Coronary Artery Bypass Grafting in the era of Advanced PCI

Abstract Objective: To review the evidence behind the role and relevance of redo coronary artery bypass grafting (CABG) in the current practice of percutaneous coronary intervention (PCI). Methods: A comprehensive electronic literature search was performed to identify articles that discuss the practice of PCI and redo CABG in patients that require coronary revascularization. All relevant studies are summarized in narrative manner to reflect current indications and preference. Results: The advancement in utilization of PCI has reduced the rate of redo CABG in patients with previous CABG that requires revascularization of an already treated coronary disease or a new onset of coronary artery stenosis. Redo CABG is associated with satisfactory perioperative outcomes but higher mortality at immediate postoperative period when compared to PCI. Conclusion: Redo CABG patients are less likely to develop comorbidities associated with revascularisation, but the operative mortality is higher and long-term survival rates are similar in comparison to PCI. There is a need for further research into the role of redo CABG in the current advanced practice of PCI.

Microbial water quality in pangasius and tilapia aquaculture systems in five regions of Bangladesh

Aims@#To determine abundance of potential pathogenic microorganisms in pangasius and tilapia farms in five major fish-producing areas in Bangladesh by PCR approaches.@*Methodology and results@#Important microbial water quality indicators were studied in water of 38 fish farms producing pangasius (Pangasianodon hypophthalmus) and tilapia (Oreochromis niloticus) in five major fish-producing areas of Bangladesh. The parameters included physicochemical data and PCR detection of total coliforms and E. coli, species of potentially pathogenic Vibrio, and cyanobacterial genes encoding the toxins microcystin and saxitoxin. Quantitative PCR showed that coliform bacteria occurred in all fish farms with densities from one to 2.2 × 105 per mL, while E. coli ranged from none to 5.0 × 104 per mL. Numbers of total coliforms and E. coli were higher in pangasius farms than in tilapia farms, and when high abundances occurred, coliform bacteria and E. coli bacteria co-varied. Detection of Vibrio-specific genes indicated presence of Vibrio species in 76% of the farms and included V. vulnificus and V. cholerae. The human pathogen type of V. cholerae (carrying the ctxA gene) and the fish pathogen V. parahaemolyticus were not detected. The microcystin-encoding mcyE gene ranged from undetectable to 2.6 × 105 copies per mL and tended to be highest in pangasius farms. The saxitoxin-encoding gene sxtA was not found in any of the farms. @*Conclusion, significance and impact of study@#Based on the high abundance of especially coliform bacteria and E. coli, we recommend more efficient water quality monitoring systems to improve detection and control of fecal coliforms and to reduce presence of microcystin-producing cyanobacteria in aquaculture farms in Bangladesh

Blowing the whistle: Perceptions of surgical staff and medical students in a public South African hospital

Understanding perspectives on whistleblowing is important in tackling a resistance to speaking out. This study aimed to elicit the views of medical students and doctors in Edendale Hospital, South Africa using a mixed-methods questionnaire study incorporating free text and tick-box answers. Thematic analysis and descriptive statistics were used to interpret the results. Fifty-eight doctors and medical students responded (87% response rate); the majority were surgeons at Edendale hospital. Seventeen percent did not understand the concept of whistleblowing, while 42% felt unable to report an adverse event. Motivation for reporting adverse events was overwhelmingly in the interests of patient safety (91%), but reluctance was mainly due to the potential consequences on workplace relationships (24%). The most common innovation suggested was a reporting structure (54%). These observations indicate workplace relationships are an important barrier to whistleblowing. Further research should expand on these concerns and explore staff knowledge about whistleblowing

Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report

The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed—correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.

Adult binge drinking: rate, frequency and intensity in Buffalo City Metropolitan Municipality, South Africa

Background: Binge drinking (BD) is a significant risk factor for several acute and chronic illnesses, including injuries. This study examines the rate, frequency and intensity of BD in Buffalo City Metropolitan.Municipality (BCMM), South Africa.Methods: This was a cross-sectional survey of 998 adults attending the three largest outpatient clinics in BCMM. Rate, frequency and intensity of BD were assessed using the WHO STEPwise questionnaire. Descriptive and inferential statistics were carried out to determine the rate and determinants of binge drinking.Results: The overall rate of BD was 15.0%. Frequency and intensity of BD were 5.4 episodes per month and 13.4 drinks on one occasion, respectively. The study data showed that BD was commoner in males than females (24.0% vs. 10.8%). Smokers engage more in BD than non-smokers (44.0% vs. 9.9%). In the analysis of socio-demographic variables, BD was commonest among students, age group 18­25 years, those never married and those on incomes between 2001 and 5000 Rand per month. In the multivariate logistic regression, after adjusting for confounders, only age less than 25 years (p < 0.001) and male gender (p < 0.001) were significant predictors of binge drinking. Also, male gender (p = 0.002) was significantly associated with frequency of BD. There was no significant gender variation in the intensity of BD. Only age and smoking were significantly associated with the intensity of BD.Conclusion: The rate of binge drinking was high among the study participants, and those who binge drink tend to do so frequently and at a high intensity. Women who binge drink also do so at a high intensity. There is a need for sensitisation campaigns and health advocacy talks on the dangers associated with binge drinking among young adults in this setting

The Susceptibility Pattern of Salmonella Species to Commonly Used Antibiotics in the Bamenda District Health Area; Cameroon

The susceptibility of Salmonella bacteria to commonly used antibiotics such as ampicillin; chloramphenicol and trimethoprim/sulphamethoxazole is threatened by the emergence of resistance strains of Salmonella. A cross-sectional study was carried out from September 2014 to November 2014 in the Regional Hospital Bamenda on individuals presenting with symptoms of salmonellosis. The Salmonellae were isolated from stool by culturing in Salmonella-Shigella Agar and Kliger Iron Agar; the later in which the isolates produced specific biochemical characteristics which were conclusive. They were assessed for antimicrobial susceptibility by the disc diffusion method using Mueller-Hinton Agar following both CLSI and EUCAST manual instructions. A total of 253 samples were collected and 22 cases were positive for Salmonella species with a prevalence of 8.70%. The susceptibility of the isolated Salmonellae to seven antibiotics was noted with ciprofloxacin having an overall sensitivity of 52.38%; ofloxacin; 47.62%; ceftriaxone; 47.62%; and gentamicin; 38.10%. Chloramphenicol had a low sensitivity percentage of 28.57%; while co-trimoxazole and amoxicilin had a high resistance level of 100.00% (0% sensitivity). The fluoroquinolones were found to be the best drugs for the treatment of typhoid; but there was also a noticeable re-emergence of chloramphenicol susceptible Salmonella

The Hospital Costs Associated with Acute Paediatric Burn Injuries

Background. Ongoing rationing of healthcare threatens services that are well established; and cripples others that desperately require investment. Burn; for one; remains a neglected epidemic in South Africa (SA); despite the magnitude of the problem.Objective. To identify the prominent components contributing to the cost of hospital admission with paediatric burn injury. Determining the true costs of specialist services is important; so that resources can be allocated appropriately to achieve the greatest possible impact.Methods. A retrospective study was undertaken over 1 year to determine patient demographics and injury details of 987 patients admitted with burn injuries to Red Cross War Memorial Children's Hospital; Cape Town; SA. The in-hospital financial records of 80 randomly selected patients were examined. This was followed by a prospective study to determine the financial implications of four cost drivers; i.e. bed cost per day; costs of medications received; costs of dressings for wound care; and costs of surgical intervention. A random selection of 37 dressing changes (in 31 paediatric patients) and 19 surgical interventions was observed; during which all costs were recorded.Results. As expected; severe flame burns are responsible for more prolonged hospital stays and usually require surgical intervention. Scald burns comprise the greatest proportion of burn injuries; and therefore account for a considerable part of the hospital's expenditure towards burn care.Conclusion. While community programmes aiming to prevent burn injuries are important; this study motivates for the implementation of accessible ambulatory services in low-income areas. This strategy would enable the burn unit to reduce its costs by limiting unnecessary admissions; and prioritising its resources for those with more severe burn injuries

Ethical Guidelines for Military-Based Health Research: an Unmet Need in Africa?

"Background: Achieving the highest standards of ethics in military health research is a challenging but crucial undertaking. The military environment is complex and African military health professionals struggle to maintain a balance between ethics and military ethos. The objective of this paper is to review ten existing research ethics guidelines for their application to the military context; and describe the need for guidance in military research ethics in sub-Saharan Africa.Method: To achieve this; five prominent international research ethics guidelines and five African guidelines were selected using some inclusion/exclusion criteria. Thereafter; designed topics were used in analyzing them for their strengths and weaknesses in providing protection for military research participants.Results: Out of the five international guidelines reviewed; only the Council for International Organization of Medical Sciences (CIOMS) mentions the ""armed forces"". Similarly; the only African national guideline that specifically mentions the ""armed forces"" is the Ugandan national guideline.Conclusions: We conclude that national and international guidelines for human subject research may be too general and not suitable for research with military populations. There is a need for additional guidance in research ethics for militaries in sub-Saharan Africa."

Concurrent Salmonella mycotic abdominal aneurysm and empyema thoracis: a rare coincidence

To present a case of Salmonella bacteremia with a rare metastatic focus. Clinical Presentation and Intervention: A 61-year-old male presented with a suicide attempt after ingestion of half a bottle of toilet cleaner. He had a medical history of intravenous drug abuse and major depression. Persistent Salmonella enteritidisbacteremia occurred during his hospitalization, and a search for the primary source of infection disclosed a mycotic abdominal aortic aneurysm. A suppurative lesion was also noted over the left pleural space, and Salmonella empyema was confirmed after thoracentesis. He underwent video-assisted thoracoscopic surgery and endovascular repair of the abdominal aortic aneurysm and was placed on long-term antibiotics, without recurrence. S. enteritidis involvement of the cardiovascular system is a rare coincidence and results in significant morbidity and mortality. In addition, the phenomenon of secondary metastatic infective foci involving the pleural space has an even lower frequency than that of cardiovascular involvement. Therefore, a high index of suspicion and prompt treatment from the treating physicians are strongly recommended

Elucidating the role of ApxI in hemolysis and cellular damage by using a novel apxIA mutant of Actinobacillus pleuropneumoniae serotype 10

Exotoxins produced by Actinobacillus (A.) pleuropneumoniae (Apx) play major roles in the pathogenesis of pleuropneumonia in swine. This study investigated the role of ApxI in hemolysis and cellular damage using a novel apxIA mutant, ApxIA336, which was developed from the parental strain A. pleuropneumoniae serotype 10 that produces only ApxI in vitro. The genotype of ApxIA336 was confirmed by PCR, Southern blotting, and gene sequencing. Exotoxin preparation derived from ApxIA336 was analyzed for its bioactivity towards porcine erythrocytes and alveolar macrophages. Analysis results indicated that ApxIA336 contained a kanamycin-resistant cassette inserted immediately after 1005 bp of the apxIA gene. Phenotype analysis of ApxIA336 revealed no difference in the growth rate as compared to the parental strain. Meanwhile, ApxI production was abolished in the bacterial culture supernatant, i.e. exotoxin preparation. The inability of ApxIA336 to produce ApxI corresponded to the loss of hemolytic and cytotoxic bioactivity in exotoxin preparation, as demonstrated by hemolysis, lactate dehydrogenase release, mitochondrial activity, and apoptosis assays. Additionally, the virulence of ApxIA336 appeared to be attenuated by 15-fold in BALB/c mice. Collectively, ApxI, but not other components in the exotoxin preparation of A. pleuropneumoniae serotype 10, was responsible for the hemolytic and cytotoxic effects on porcine erythrocytes and alveolar macrophages.

A low-pH medium in vitro or the environment within a macrophage decreases the transcriptional levels of fimA, fimZ and lrp in Salmonella enterica serovar Typhimurium.

Many Salmonella Typhimurium isolates produce type 1 fimbriae and exhibit fimbrial phase variation in vitro. Static broth culture favours the production of fimbriae, while solid agar medium inhibits the generation of these appendages. Little information is available regarding whether S. Typhimurium continues to produce type 1 fimbriae during in vivo growth. We used a type 1 fimbrial phase-variable strain S. Typhimurium LB5010 and its derivatives to infect RAW 264.7 macrophages. Following entry into macrophages, S. Typhimurium LB5010 gradually decreased the transcript levels of fimbrial subunit gene fimA, positive regulatory gene fimZ, and global regulatory gene lrp. A similar decrease in transcript levels was detected by RT-PCRwhen the pH of static brothmediumwas shifted frompH 7 to amore acidic pH 4. A fimA-deleted strain continued to multiply within macrophages as did the parental strain. An lrp deletion strain was unimpaired for in vitro growth at pH 7 or pH 4, while a strain harboring an lrp-containing plasmid exhibited impaired in vitro growth at pH 4. We propose that acidic medium, which resembles one aspect of the intracellular environment in a macrophage, inhibits type 1 fimbrial production by down-regulation of the expression of lrp, fimZ and fimA.

Perception of susceptibility to the negative outcomes associated with unprotected sex among University of Venda students

The purpose of this study was to determine the perception of University of Venda students on their susceptibility to the negative outcomes associated with unprotected sex. This cross sectional study involved 408 [206 females and 202 males] University of Venda students residing within the university campus. Simple and systematic sampling methods were used to select participants. A 4-likert scaled self-administered questionnaire was used for data collection and a cut-off point of 75% of the total scores was used as criteria for assessing perception. Majority [90.90%] of the participants understood the magnitude and problems posed by HIV and other sexually transmitted infection in the society, 94.60% believe that anyone can be infected with HIV or fall pregnant when exposed to unprotected sex. Majority [87.30%] believed that alcohol consumption while engaging in sexual activities increases the chances of being infected with HIV, other STI or falling pregnant, 92.40% believed that having multiple sexual partnerships increases the risk of being infected with HIV and other sexually transmitted infections. Eighty six percent of participants agreed or strongly agreed that pregnancy could occur with one sexual intercourse in a month and only 68.45% of the participants believed that practising oral sex could expose them to HIV infection [with no significant difference between male and female]. Majority of the students showed high perception regarding their susceptibility to the negative outcomes associated with unprotected sex, especially when they consume alcohol while engaging in sexual activities and when having multiple sexual partnerships. Contrastingly, the students demonstrated low perception regarding susceptibility to HIV transmission through the practice of oral sex. There is a need to create awareness on the dangers posed by the practise of oral sex

Perception on the severity of unwanted pregnancy among university students

The purpose of this study was to examine the perception of University students regarding the severity of unwanted pregnancy. This cross sectional study involved 408 [206 females and 202 males] students residing within the university campus. Simple and systematic sampling methods were used to select participants. A 4-likert scaled self-administered questionnaire was used for data collection. Majority [87.70%] of participants perceived unwanted pregnancy as leading to impaired mental health; 86.30% perceived it as a cause of many other health problems; 86.60% believed it could result to shame and withdrawal from society or even suicidal attempts; and child neglect and abandonment [84.80%]. Using the cut-off points of 75% of the total scores as a criteria for assessing perception, fewer [60.30%] participants perceived unwanted pregnancy as preventing a girl from continuing with her education; insufficient money to provide for both mother and child [74.50%] and leading to higher risk of substance abuse and problem behaviour among children born from unwanted pregnancies [51.20%]. Females students strongly agreed that unwanted pregnancy could lead to shame and withdrawal from the society compared to their male counterparts [Chi-square = 10.788, p = 0.013]. Few students at the University of Venda perceived unwanted pregnancy as being severe enough and associated with truncated education, poverty for the young mother, and increased risk of problem behaviours. Thus, intervention strategies should be instituted to prevent unwanted pregnancies among the students

Fatness and fat patterning as independent anatomical characteristics of body composition: a study of urban South African children

The purpose of this study was to examine the relationship between fat patterning, age and body composition, among urban South African children in Pretoria, Central. Samples for the study comprised 1136 participants [548 boys and 588 girls] and 581 black and 555 white drawn from 12 primary schools in Pretoria Central. Anthropometrical measurements include stature, body mass and eight skinfolds: triceps, subscapular, biceps, supraspinal, abdomen, front thigh, iliac crest and medial calf. Principal components analysis technique was applied to examine the components loadings. An eigenvalue of >1.0 was retained for analysis. Pearson's correlation coefficient was used to determine the relationship of fat patterning scores, age and body composition measures. Three principal components emerged. The first principal component was a size component [fatness], accounting for 62.3% variance. The second component [central-peripheral patterning] accounted for the total variance of 14.1%. The third component [lower trunk-upper extremity] of relative subcutaneous fat distribution, explained about 10.2% of the total residual variance. Overall, the three components account approximately for 87.0% of the total variance. The correlation coefficients indicating probabilities demonstrated that the overall body fatness [PC1], but not PC2 or PC3 was significantly correlated with body mass index [r=0.745, P<0.01], FM [r=0.672, P<0.01], fat-free mass [r=0.583, P<0.01], Percentage body fat [r=0.701, P<0.01] and children's age [r=0.062, P<0.05]. The central-peripheral and upper-lower body extremity fat patterning components are discernible among the sample of South African children in Pretoria. The results indicated that principal component 1, but not 2 and 3 was significantly correlated with body composition variables and age, suggesting that component 1 is truly an indicator of total body fatness and not fat patterning

Chylous ascites after laparoscopic hand-assisted donor nephrectomy: Is it specific for the left-side?

We describe a case-report of a chylous ascites after laparoscopic donor nephrectomy, summarize the current literature, and hypothesize on the etiology of this complication

Índice de massa corpórea, sobrepeso e pressão arterial em escolares na província de Limpopo, África do Sul / Body mass index, overweight, and blood pressure among adolescent schoolchildren in Limpopo province, South Africa / Índice de masa corporal, sobrepeso y presión arterial en adolescentes de la província de limpopo, Sudáfrica

OBJETIVO: Avaliar a relação entre índice de massa corporal, sobrepeso e pressão arterial em crianças e adolescentes da área rural da África do Sul. MÉTODOS: A amostra abrangeu 1.172 escolares (541 meninos e 631 meninas) com idades entre 10 e 16 anos. Estatura, massa corporal e dobras cutâneas foram medidas por meio de procedimentos padrão. O sobrepeso foi definido pelo índice de massa corporal para idade e sexo. A pressão arterial foi monitorada três vezes em cada criança com o uso de aparelhos eletrônicos validados (Omron HEM-705 CP, Omron, Tóquio, Japão). A hipertensão foi determinada como a média de três leituras da pressão arterial, em que a sistólica ou a diastólica foi igual ou acima do percentil 90 para idade e sexo. Estatísticas descritivas foram calculadas para todas as variáveis. RESULTADOS: A prevalência de sobrepeso foi de 5,5% para meninos e 4,4% para meninas. A taxa de crianças com pressão arterial acima do percentil 90 variou de 2,3 a 5,9%. A probabilidade do desenvolvimento de hipertensão em crianças é perceptível aos dez anos, tanto para os meninos (0,2%) quanto para as meninas (0,1%), e oscilou de 0,2 a 1,7% para o sexo masculino e de 0,1 a 1,2% para o feminino. Considerando-se a amostra total, a prevalência de hipertensão foi de 4,1% para os meninos e 2,8% para as meninas. A pressão arterial apresentou correlação positiva com estatura, massa corporal, índice de massa corporal, gordura corpórea e soma das dobras cutâneas (p<0,001). CONCLUSÕES: A pressão arterial aumentou com a idade tanto para os meninos quanto para as meninas. A medição da pressão arterial de rotina, como parte do exame físico em escolares, é crucial para fins de prevenção e medidas de intervenção precoces.

OBJECTIVE: To evaluate the relationship between body mass index, overweight, and blood pressure among South African rural children and adolescents. METHODS: The sample involved 1,172 schoolchildren (541 boys and 631 girls) aged 10 to 16 years. Stature, body mass, and skinfolds were measured using standard procedures. Overweight was defined by body mass index for gender and age. Blood pressure was monitored in each child three times using validated electronic devices (Omron HEM-705 CP, Device, Tokyo, Japan). Hypertension was determined as the average of three separate blood pressure readings, in which the systolic or diastolic blood pressure was ≥90th percentile for age and sex. Descriptive statistics were calculated for all variables. RESULTS: The prevalence of overweight was 5.5% for boys and 4.4% for girls. The children who had systolic blood pressure >90th percentile ranged from 2.3 to 5.9%. The likelihood of hypertension development among children is noticeable at age 10 for both boys and girls (0.2 and 0.1%, respectively), and ranged from 0.2 to 1.7% for boys and 0.1 to 1.2% for girls. Collectively, the prevalence of hypertension was 4.1 and 2.8% for boys and girls, respectively. Blood pressure correlated positively with stature, body mass, body mass index, body fat, and sum of skinfolds (p<0.001). CONCLUSIONS: Blood pressure increased with age in both genders. The routine measurement of blood pressure, as part of physical examinations of schoolchildren, is crucial for early prevention and intervention programs.

OBJETIVO: Este estudio evalúa la relación entre índice de masa corporal, sobrepeso y presión arterial en adolescentes rurales sudafricanos. MÉTODOS: La muestra incluyó a 1.172 niños de 10-16 años de edad (541 del sexo masculino y 631 del sexo femenino). La estatura, la masa corporal y los pliegues cutáneos se midieron utilizando procedimientos estándares. El sobrepeso se definió según el índice de masa corporal para sexo y edad. Se monitorizó la presión arterial por tres veces en cada niño utilizando aparatos electrónicos validados (Omron HEM-705 CP, Omron, Tokio, Japón). Se determinó la hipertensión cuando los promedios de la presión sistólica o diastólica, calculados con base en las tres mediciones de presión arterial, fueron ≥percentil 90 para edad y sexo. Se calcularon estadísticas descriptivas para todas las variables. RESULTADOS: La prevalencia de sobrepeso fue del 5,5% en los niños y 4,4% en las niñas. El porcentaje de adolescentes con presión arterial sistólica >percentil 90 osciló entre el 2,3 y el 5,9%. La probabilidad de desarrollo de hipertensión entre los jóvenes fue notable a los 10 años tanto en los niños como en las niñas (0,2 y 0,1%, respectivamente) y osciló entre el 0,2 y el 1,7% en los niños y entre el 0,1 y el 1,2% en las niñas. Colectivamente, la prevalencia de hipertensión fue del 4,1 y el 2,8% en niños y niñas, respectivamente. La presión arterial estuvo positivamente correlacionada con estatura, masa corporal, índice de masa corporal, grasa corporal y suma de pliegues cutáneos (p=0,00). CONCLUSIONES: La presión arterial se elevó con la edad tanto en los niños como en las niñas, y estuvo positivamente correlacionada con estatura, masa corporal, índice de masa corporal, grasa corporal y suma de pliegues cutáneos. La medición de rutina de la presión arterial como parte del examen físico de escolares es crucial para la prevención precoz y la implementación de programas de intervención.

Intravenous thrombolysis associated with a high risk of hemorrhagic transformation in ischemicstroke patients with cardiac myxoma and over 70 years of age

Objectives: Although thrombolytic therapy has been shown to be benefi cial to stroke patients, its safety and effectiveness in stroke patients with cardiac tumor is unknown. This study assessed the safety and effi cacy of intravenous thrombolysis with recombinant-tissue plasminogen activator (rtPa) in stroke patients with cardiac myxoma. Methods: We systematically searched databases for all publications on thrombolysis in patients with cardiac tumor-related strokes. The literature on thrombolysis in ischemic stroke patients with myxoma was systematically analyzed; information on the hemorrhagic transformation and response rates in patients over and under 70 years of age was extracted and compared. Statistical tests were performed to evaluate the odds ratios for these factors. Results: Twelve case reports were identifi ed. Four patients were 70 years of age or older, two (50%) of whom had demonstrated hemorrhagic transformation, which was not found in patients under 60 years of age. The rate of response to treatment was 60% (3/5) in patients under 60 and 25% (1/4) in those ≥70 years of age. The rate of hemorrhagic transformation in the patients ≥70 years of age was higher than that in patients <70 years of age (odds ratio 7). Conclusion: Intravenous thrombolysis in ischemic stroke patients with myxoma who were over 70 years of age was associated with a lower response rate and a higher risk of hemorrhagic transformation.

Rasburicase for huge hepatocellular carcinoma with tumor lysis syndrome: case report

To report a case of huge hepatocellular carcinoma associated with tumor lysis syndrome and its management. A 51-year-old hepatitis B carrier visited our clinic with progressive weight loss over recent months. Abdominal ultrasonogra-phy and magnetic resonance imaging revealed a huge hepatic mass in a cirrhotic liver, identified as hepatocellular carcinoma. A hepatologist and surgeon recommended transarterial chemoembolization followed by hepatectomy. The patient underwent the procedure, with the complication of tumor lysis syndrome. He was treated with a single high dose [9 mg] of rasburicase and his clinical condition improved dramatically, with acute kidney injury subsiding without emergent hemodialysis. This was a case of hepatocellular carcinoma with tumor lysis syndrome and acute kidney injury, treated successfully with rasburicase