Surgical rhinoplasty after prior hyaluronic acid based nose remodeling.

BACKGROUND: Medical rhinoplasty by hyaluronic acid injection (HA) has become nowadays a common practice. The number of patients requesting surgical rhinoplasty and having already undergone one or more injections of HA is increasing. However, the literature lacks publications regarding the management of these patients. OBJECTIVES: The aim of this study is to discuss the management of patients who have been treated with previous nasal HA injections and who seek surgical rhinoplasty, and elaborate a treatment protocol and algorithm to standardize surgical plans. METHODS: We are reporting case studies based on our clinical experience. We also reviewed the literature to suggest perioperative management for rhinoplasty with previous HA injections. RESULTS: Hyaluronidase injection preoperatively allows to carry out an accurate preoperative analysis of the nasal deformities to treat, in order to make an adapted treatment plan. Postoperative course is similar to other rhinoplasty cases without the use of this enzyme. CONCLUSION: Hyaluronidase should be used in all patients with nasal injections of HA (unless contraindications), who are willing to undergo a surgical rhinoplasty. The operation can be undertaken at one-week interval as soon as the edema subsides and no further treatments are necessary.

Factors influencing SARS-CoV-2 infection rate in Belgian nursing home residents during the first wave of COVID-19 pandemic.

In April 2020, Belgium experienced high numbers of fatal COVID-19 cases among nursing home (NH) residents. In response, a mass testing campaign was organised testing all NH residents and staff. We analysed the data of Flemish NHs to identify institutional factors associated with increased SARS-CoV-2 infection rates among NH residents. Cross-sectional study was conducted between 8 April and 15 May 2020. Data collected included demographics, group category (i.e. staff or resident), symptom status and test result. We retrieved additional data: number of beds and staff, type of beds (level of dependency of residents) and ownership (public, private for profit/non-profit institutions). Risk factor analysis was performed using negative binomial regression. In total, 695 NHs were included, 282 (41%) had at least one resident tested positive. Higher infection rate among residents was associated with a higher fraction of RVT beds, generally occupied by more dependent residents (incidence rate ratio (IRR) 1.97; 95% CI 1.00-3.86) and higher staff infection rate (IRR 1.89; 95% CI 1.68-2.12). No relationship was found between other investigated NH characteristics and infection rate among residents. Staff-resident interactions are key in SARS-CoV-2 transmission dynamics. Vaccination, regular staff testing, assessment of infection prevention and control strategies in all NHs are needed to face future SARS-CoV-2 epidemics in these settings.

How can we monitor the impact of national health information systems? Results from a scoping review.

BACKGROUND: National health information (HI) systems provide data on population health, the determinants of health and health system performance within countries. The evaluation of these systems has traditionally focused on statistical practices and procedures, and not on data use or reuse for policy and practice. This limits the capacity to assess the impact of HI systems on healthcare provision, management and policy-making. On the other hand, the field of Knowledge Translation (KT) has developed frameworks to guide evidence into practice. METHODS: A scoping review of the KT literature to identify the essential mechanisms and determinants of KT that could help monitor the impact of HI systems. RESULTS: We examined 79 publications and we identified over 100 different KT frameworks but none of these were focused on HI systems per se. There were specific recommendations on disseminating evidence to stakeholders at the institutional and organizational level, and on sustaining the use of evidence in practice and the broader community setting. CONCLUSIONS: We developed a new model, the HI-Impact framework, in which four domains are essential for mapping the impact of national HI systems: (i) HI Evidence Quality, (ii) HI System Responsiveness, (iii) Stakeholder Engagement and (iv) Knowledge Integration. A comprehensive impact assessment of HI systems requires addressing the use of HI in public health decision-making, health service delivery and in other sectors which might have not been considered previously. Monitoring Stakeholder Engagement and Knowledge Integration certifies that the use of HI in all policies is an explicit point of assessment.

Thermal burn in a 30-minute-old newborn: report on the youngest patient with iatrogenic burn injury.

Burns in infants are rare. The majority of neonatal burns occur in the hospital setting. The immaturity of their immune system, their fragile and thin skin, difficulties in resuscitation, engraftment paucity limited by donor sites, and long-term complications make taking care of burned newborns extremely difficult. We present the case of a newborn burned 30 minutes after his birth over a total body surface of 35%, when the hot water bottle used in the hospital accidentally burst. This is the earliest iatrogenic burn in a newborn reported to date. The newborn was discharged home after 30 days in hospital for resuscitation, dressings and skin grafting. He is now under regular observation.

Les brûlures des nouveau-nés sont rares et surviennent dans la plus part des cas à l'hôpital. L'immaturité de leur système immunitaire, leur peau fine et fragile, les difficultés de la réanimation, les possibilités limitées de greffes en raison de l'exiguïté des sites donneurs rendent leur prise en charge extrêmement difficile et la survenue de séquelles fréquente. Nous rapportons le cas d'un enfant brûlé sur 35% SCT à 30 mn de vie en raison de la rupture d'une bouteille d'eau chaude à l'hôpital, la brûlure iatrogène la plus précoce rapportée à ce jour. Il est sorti de l'hôpital à J30, ayant eu besoin de greffes et est actuellement régulièrement suivi.

Natural infection by Cryptosporidium sp., Giardia sp. and Eimeria leuckarti in three groups of equines with different handlings in Rio de Janeiro, Brazil.

To detect Cryptosporidium sp., Giardia sp. and Eimeria leuckarti in horses, fecal samples were collected from three different handling horse groups from the state of Rio de Janeiro, Brazil. Group A was composed of "Mangalarga Marchador" pure breed horses, Group B was formed by horses of a Military Corporation and Group C by stray horses captured by the Center of Zoonosis Control Paulo Dacorso Filho. A total of 396 fecal samples were collected, 212 samples from Group A, 154 samples from Group B and 30 from Group C. The material was submitted to the centrifugation - flotation technique and staining by the safranin-methylene blue technique and analyzed. Oocysts of Cryptosporidium sp. were identified in 0.75% of the samples (n=3); cysts of Giardia sp. in 0.5% (n=2) and oocysts of E. leuckarti in 0.5% (n=2). One case of E. leuckarti in group A and one of Cryptosporidium sp. in group B were observed. In group C were observed two cases of Cryptosporidium, two of Giardia and one of E. leuckarti,. Horses of group C were more parasitized by the three protozoans than animals from the other groups (p<0.01). It was possible to verify that factors related to the animals, like host individual susceptibility and sanitary factors may influence the occurrence of natural infections by gastrointestinal protozoans, although the age did not have influence. This study reports, for the first time, the occurrence of Cryptosporidium sp., Giardia sp. and E. leuckarti in equines of the State of Rio de Janeiro.

Dermatitis in a dog associated with an unidentified Toxoplasma gondii-like parasite.

Protozoal dermatitis was diagnosed in a 6-year-old female Great Dane dog from Rio de Janeiro, Brazil. The dog died because of a chronic illness with an Ehrlichia-like organism. Numerous apicomplexan parasites were identified histologically in the section of dermal lesions. The protozoan reacted with Toxoplasma gondii polyclonal rabbit serum but not with Neospora caninum or Sarcocystis neurona antibodies. Ultrastructurally, the protozoa was not T. gondii because it had schizont-like structures with merozoites arranged around a prominent residual body, and the merozoites had several rhoptries with electron-dense contents; rhoptries in T. gondii tachyzoites are electron-lucent and a residual body is not found in groups of tachyzoites. This is the first report of unidentified T. gondii-like protozoa in the skin of a dog.

Exercise-induced symptomatic ischaemia predicts a poor long-term prognosis after acute myocardial infarction.

STUDY OBJECTIVES: To evaluate the long-term prognostic significance of symptomatic ischaemia during exercise testing performed 3 weeks after acute myocardial infarction (AMI). DESIGN: A prospective study with long-term follow-up. SETTING: A Cardiac Rehabilitation Clinic in a University Hospital. SUBJECTS: A total of 446 patients were allowed to perform exercise testing 3 weeks after AMI and followed for 72 +/- 20 months. MEASUREMENTS AND RESULTS: Patients were divided into three groups according to whether they had no ECG evidence of ischaemia during exercise testing (334 patients), silent ischaemia (90 patients) or symptomatic ischaemia (22 patients). Cardiac death was significantly more frequent in patients with symptomatic ischaemia when compared with silent ischaemia (31.8% vs. 7.8%, P < 0.01) or when compared with no ischaemia (31.8% vs. 10.2%, P < 0.01). The three groups had a low cardiac mortality during the first 48 months of follow-up. The prognosis of patients with symptomatic ischaemia worsens markedly thereafter. The results of exercise testing did not predict recurrence of myocardial infarction. Coronary revascularization was performed in 34.4% of those without ischaemia, 47.8% of those with silent ischaemia and 45.5% of those with symptomatic ischaemia (P < 0.01). CONCLUSIONS: Patients with symptomatic ischaemia have a good prognosis during the first 4 years of follow-up. Their prognosis worsens thereafter as opposed to patients with or without silent ischaemia. This high-risk group of patients with symptomatic ischaemia deserves optimal management including revascularization when appropriate.

Long-term value of exercise testing after acute myocardial infarction: influence of thrombolytic therapy.

OBJECTIVES: To evaluate the long-term predictive value of exercise testing performed early after acute myocardial infarction (AMI) in patients receiving thrombolytic therapy. DESIGN: Nonblinded prospective follow-up study. SETTING: Cardiac rehabilitation unit in a 900-bed university hospital. SUBJECTS: Four hundred forty-three patients allowed to perform exercise testing 3 weeks after AMI were followed for a median of 75 months; 183 received IV thrombolysis and 263 did not. RESULTS: Cardiac death hazard ratios were significantly increased in the presence of reduced physical working capacity on exertion, left ventricular dysfunction, and > or = 1-mm (but < 2-mm) ST-segment depression on exertion. In the group receiving thrombolytic therapy, no patient with > or = 2-mm ST-segment depression on exercise died; this group was characterized by a high rate of revascularization, whereas the group with > or = 1-mm but < 2-mm ST-segment depression was not. No parameter related to clinical or exercise testing predicted recurrent infarction in the group receiving thrombolytic therapy. Among patients not receiving thrombolysis, cardiac death was significantly related to > or = 2-mm ST-segment depression on exertion, to reduced physical working capacity, and to the lack of revascularization during follow-up. CONCLUSION: Exercise test-derived parameters have variable value in predicting long-term survival of patients performing exercise test after AMI depending on the following: (1) whether thrombolytic therapy was given or not; (2) the degree of ST-segment depression during exercise testing; and (3) the rate of revascularization.

Measuring leg muscle and fat mass in humans: comparison of CT and dual-energy X-ray absorptiometry.

Dual-energy X-ray absorptiometry (DEXA) is reported to be inferior to computed tomography (CT) to measure changes in appendicular soft tissue composition. We compared CT- and DEXA-measured thigh muscle and fat mass to evaluate the random and systematic discrepancies between these two methods. Thigh skeletal muscle area (single-slice CT) was suboptimally (r(2) = 0.74, P < 0.0001) related to DEXA-measured thigh fat-free mass (FFM). In contrast, thigh muscle and adipose tissue volumes (multislice CT) were highly related to DEXA-measured thigh FFM and fat (both r(2) = 0.96, P < 0.0001). DEXA-measured leg fat was significantly less than multislice-CT-measured leg adipose tissue volume, whereas multislice-CT-measured leg muscle mass was less (P < 0.0001) than DEXA-measured leg FFM. The systematic discrepancies between the two approaches were consistent with the 10-15% nonfat components of adipose tissue. In conclusion, CT and DEXA measures of appendicular soft tissue are highly related. Systematic differences between DEXA and CT likely relate to the underlying principles of the techniques.

The influence of thrombolytic therapy on the predictive value of exercise testing 3 weeks after acute myocardial infarction.

OBJECTIVES: To evaluate the prognostic value of exercise testing performed soon after acute myocardial infarction (AMI) in patients treated with thrombolytic therapy. DESIGN: A 1-year prospective follow-up of 185 subjects treated with thrombolytic therapy who survived AMI, and who performed exercise testing 3 weeks after AMI. These patients were compared with 272 patients not receiving thrombolytic therapy during the same period. SUBJECTS: Patients recovering from AMI, without medical contraindications to exercise testing performed 3 weeks after AMI. MAIN OUTCOME MEASURES: ST-segment deviations during exercise testing 3 weeks post-AMI were related to clinical outcome 1-year post-AMI and to the administration of thrombolytic therapy during the acute phase of infarction. RESULTS: In patients treated with thrombolytic therapy, the only exercise-test-related parameter predicting subsequent cardiac events was ST-segment elevation. In contrast, patients not receiving thrombolytic therapy and demonstrating ST-segment depression of > or = 1 mm during exercise had more clinical cardiac events than those without this finding (12.3 vs. 3.9%; P < 0.05). CONCLUSION: This study casts doubt on the ability of exercise testing to select a high-risk population requiring early intervention to prevent recurrent coronary events after thrombolysis for AMI.

Angina pectoris and ST-segment depression during exercise testing early following acute myocardial infarction.

This study evaluates the prognostic value of ST-segment depression and angina pectoris occurring alone or in combination during exercise testing performed 3 weeks after myocardial infarction in 281 of 570 consecutive survivors of acute myocardial infarction. Neither angina pectoris (36 patients) nor ST-segment depression of at least 1 mm (46 patients) correlated with the occurrence of acute coronary events (cardiac death, myocardial infarction, unstable angina pectoris requiring hospitalization) during the subsequent year. Even a small group of patients (n = 13) with both angina and ST-segment depression did not suffer a higher occurrence of acute events. However, the presence of angina and/or ST-segment depression was strongly correlated with the subsequent performance of coronary arteriography. This study indicates that acute coronary events cannot be predicted by clinical or ECG evidence of myocardial ischemia during exercise tests performed 3 weeks after acute myocardial infarction.

The current value of exercise testing soon after acute myocardial infarction.

We performed exercise testing in 236 of 289 survivors of acute myocardial infarction to test the hypothesis that exercise-related parameters contribute to cardiac prognosis. Beta-blockers and/or calcium antagonists were used by 50% and 55% respectively of the study population. Of the 236 patients 67 had received thrombolytic therapy during the acute event. By either univariate or multivariate analysis, we found that exercise-related parameters were poor predictors of cardiac prognosis. Therefore, in our population, exercise testing performed 3 weeks after myocardial infarction provides little information of prognostic value.

Analysis and prediction of left ventricular performance under load changes during cardiac catheterization.

The applicability of a computer model, which relates the transmural mechanical distribution in the left ventricle (LV) to its global function at different loading conditions, was evaluated in patients with normal to near normal LV function undergoing cardiac catheterization. Left ventriculography and measurements of aortic and LV pressures were performed at baseline conditions and repeated following rapid volume expansion with intravenous infusion of 250 to 300 ml of physiologic saline and also after sublingual isosorbide-dinitrate (ISDN) administration. Twenty patients (18 men and 2 women, average age = 53 years) underwent coronary angiography and left ventriculography. Sixteen patients had coronary artery disease with one- to three-vessel involvement and 4 had normal coronary arteries. The measured input data into the model included the end-diastolic LV volume and wall thickness, aortic pressure, heart rate, and the peripheral resistance. The model parameters of myocardial contractility and arterial system capacitance for the control baseline conditions were estimated so that an accurate match was obtained between the predicted and the measured end-systolic (ES) volume and pressure. Using these parameters, model predictions for the two load perturbations were compared to the measurements. An excellent correlation was found between the predicted and measured LV ES volumes and peak-systolic pressures (PSP) (R2 greater than 0.994). In four patients, who developed ischemic symptoms during saline injection, the prediction of end-systole volumes were lower than the measured values, suggesting an actual reduction in contractility during acute ischemia. Therefore, the model is sensitive to contractility changes. The model predicts global LV performance, under different loading conditions, including stroke work, peak developed wall stress, velocity of fiber shortening, and myocardial oxygen consumption.

The slope of the end-systolic pressure-volume relationship compared with the global end-systolic pressure-volume ratio in humans.

The slope of the end-systolic pressure-volume relationship (Emax), which is generated clinically by load manipulation, as well as the "absolute" peak systolic pressure end-systolic volume ratio (denoted as pressure-volume ratio), have been suggested as indices defining left ventricular function. This study represents an attempt to determine the relationship between these two indices by studying 20 patients (16 with coronary artery disease and 4 with normal coronary arteries) undergoing cardiac catheterization. Left ventriculography was performed three times in each patient: (1) in the control baseline state, (2) after rapid intravenous infusion of 250-300 cc of saline, and (3) after sublingual administration of 5 mg isosorbide dinitrate. Emax was approximated by linear regression using the peak left ventricular pressure (replacing end-systolic pressure) and the smallest left ventricular (end-systolic) volume for these three different loads. Acute ischemia with typical chest pain and ECG changes developed in 4 patients during saline loading. The pressure-volume ratio showed no change with load manipulation in patients who did not demonstrate ischemia. In the 4 patients who developed acute ischemia, the pressure-volume ratio dropped from 4.4 +/- 1.3 to 2.9 +/- 0.9 mmHg/ml (p less than 0.001). In all of the patients, the pressure-volume ratio, but not the Emax, correlated with the ejection fraction (r = 0.6; p less than 0.05). In addition, the Emax line demonstrated a markedly nonphysiological Vo. There was no correlation between Emax and pressure-volume ratio.(ABSTRACT TRUNCATED AT 250 WORDS)