An evaluation of first responders' intention to refer to post-overdose services following SHIELD training.

BACKGROUND: First responders [law enforcement officers (LEO) and Fire/Emergency Medical Services (EMS)] can play a vital prevention role, connecting overdose survivors to treatment and recovery services. This study was conducted to examine the effect of occupational safety and harm reduction training on first responders' intention to refer overdose survivors to treatment, syringe service, naloxone distribution, social support, and care-coordination services, and whether those intentions differed by first responder profession. METHODS: First responders in Missouri were trained using the Safety and Health Integration in the Enforcement of Laws on Drugs (SHIELD) model. Trainees' intent to refer (ITR) overdose survivors to prevention and supportive services was assessed pre- and post-training (1-5 scale). A mixed model analysis was conducted to assess change in mean ITR scores between pre- and post-training, and between profession type, while adjusting for random effects between individual trainees and baseline characteristics. RESULTS: Between December 2020 and January 2023, 742 first responders completed pre- and post-training surveys. SHIELD training was associated with higher first responders' intentions to refer, with ITR to naloxone distribution (1.83-3.88) and syringe exchange (1.73-3.69) demonstrating the greatest changes, and drug treatment (2.94-3.95) having the least change. There was a significant increase in ITR score from pre- to post-test (ß = 2.15; 95% CI 1.99, 2.30), and LEO-relative to Fire/EMS-had a higher score at pre-test (0.509; 95% CI 0.367, 0.651) but a lower score at post-test (0.148; 95% CI - 0.004, 0.300). CONCLUSION: Training bundling occupational safety with harm reduction content is immediately effective at increasing first responders' intention to connect overdose survivors to community substance use services. When provided with the rationale and instruction to execute referrals, first responders are amenable, and their positive response highlights the opportunity for growth in increasing referral partnerships and collaborations. Further research is necessary to assess the extent to which ITR translates to referral behavior in the field.

Hyperferritinemia as a factor associated with poor prognosis in COVID-19 patients.

Worldwide, hundreds of millions of people have been infected with COVID-19 since December 2019; however, about 20% or less developed severe symptoms. The main aim of the current study was to  assess  the  relationship  between  the  severity of Covid-19 and different clinical and laboratory parameters. A total number of 466 Arabs have willingly joined this prospective cohort. Out of the total number, 297 subjects (63.7%) had negative COVID-19 tests, and thus, they were recruited as controls, while 169 subjects (36.3%) who tested positive for COVID-19 were enrolled as cases. Out of the total number of COVID-19 patients, 127 (75.15%) presented with mild symptoms, and 42 (24.85%) had severe symptoms. The age range for the participants was 20 to 82 years. Compared with controls, the severity of the disease was associated with significantly high ferritin levels (P < 0.001). The severity of the disease was also associated with a significant increase in C-reactive protein (P < 0.001), D-dimer (P < 0.001), white blood cell count (WBC) (P < 0.01), IgM (P < 0.001), and Granulocytes (P < 0.01). In addition, severe COVID-19 symptoms in the current study were associated with a significant decrease in lymphocytes (P < 0.01). There was a four-fold increase in serum ferritin levels in COVID-19 patients presented with severe symptoms upon admission. The former was associated with significantly high levels of CRP and D-dimer. Thus, hyperferritinemia, together with high CRP and D-dimer concentrations, may serve as reliable predictors for disease severity and poor prognosis in Arabs with COVID-19.

Hyperferritinemia as a factor associated with poor prognosis in COVID-19 patients.

Worldwide, hundreds of millions of people have been infected with COVID-19 since December 2019; however, about 20% or less developed severe symptoms. The main aim of the current study was to  assess  the  relationship  between  the  severity of Covid-19 and different clinical and laboratory parameters. A total number of 466 Arabs have willingly joined this prospective cohort. Out of the total number, 297 subjects (63.7%) had negative COVID-19 tests, and thus, they were recruited as controls, while 169 subjects (36.3%) who tested positive for COVID-19 were enrolled as cases. Out of the total number of COVID-19 patients, 127 (75.15%) presented with mild symptoms, and 42 (24.85%) had severe symptoms. The age range for the participants was 20 to 82 years. Compared with controls, the severity of the disease was associated with significantly high ferritin levels (P < 0.001). The severity of the disease was also associated with a significant increase in C-reactive protein (P < 0.001), D-dimer (P < 0.001), white blood cell count (WBC) (P < 0.01), IgM (P < 0.001), and Granulocytes (P < 0.01). In addition, severe COVID-19 symptoms in the current study were associated with a significant decrease in lymphocytes (P < 0.01). There was a four-fold increase in serum ferritin levels in COVID-19 patients presented with severe symptoms upon admission. The former was associated with significantly high levels of CRP and D-dimer. Thus, hyperferritinemia, together with high CRP and D-dimer concentrations, may serve as reliable predictors for disease severity and poor prognosis in Arabs with COVID-19.

On study of fractional order epidemic model of COVID-19 under non-singular Mittag-Leffler kernel.

This paper investigates the analysis of the fraction mathematical model of the novel coronavirus (COVID-19), which is indeed a source of threat all over the globe. This paper deals with the transmission mechanism by some affected parameters in the problem. The said study is carried out by the consideration of a fractional-order epidemic model describing the dynamics of COVID-19 under a non-singular kernel type of derivative. The concerned model examine via non-singular fractional-order derivative known as Atangana-Baleanu derivative in Caputo sense (ABC). The problem analyzes for qualitative analysis and determines at least one solution by applying the approach of fixed point theory. The uniqueness of the solution is derived by the Banach contraction theorem. For iterative solution, the technique of iterative fractional-order Adams-Bashforth scheme is applied. Numerical simulation for the proposed scheme is performed at various fractional-order lying between 0, 1 and for integer-order 1. We also compare the compartmental quantities of the said model at two different effective contact rates of ß . All the compartments show convergence and stability with growing time. The simulation of the iterative techniques is also compared with the Laplace Adomian decomposition method (LADM). Good comparative results for the whole density have been achieved by different fractional orders and obtain the stability faster at the low fractional orders while slowly at higher-order.

Virus-related neurological lower urinary tract dysfunction: Lessons learned during 4-year follow-up of patients with Congenital Zika Syndrome.

INTRODUCTION: We have previously reported on neurogenic bladder dysfunction among Congenital Zika Vírus Syndrome (CZS) patients, but it is unknown how they will respond to treatment. OBJECTIVE: To assess whether children with neurological lower urinary tract dysfunction and CZS will respond to Standard therapies. METHODOLOGY: A prospective observational cohort study of children with CZS referred for urological assessment between 2016 and 2020 to our quaternary center in Brazil. Urological protocol included clinical history, urinalysis and culture, renal and bladder ultrasonography and urodynamic study. Patients were treated based on findings from the first evaluation, with oxybutynin chloride for overactive bladder and low bladder compliance, clean intermittent catheterization for ineffective bladder emptying, or dual therapy when both were observed. Urological outcomes were evaluated between the first and second visits considering patient's adherence. Outcomes measured included clinical, imaging, and urodynamic variables. Data was analyzed using the IBM SPSS 22 software. RESULTS: From the cohort of 90 patients, 56 completed the second urodynamic assessment and were included. One presented underactive bladder and 55 overactive bladder. Among these 55, 39 were adherent and 16 non-adherents to the prescribed treatment. Among the 39 adherents, 8 adhered regularly to oxybutynin and clean intermittent catheterization (CIC), 29 to oxybutynin alone, and two to catheterization alone. During follow-up, the number of patients with urinary tract infection and postvoid residual increased, but all other parameters had improved. Renal and bladder ultrasonography improved in 10, maximum bladder pressure decreased in 22 and maximum cystometric capacity and compliance increased in 14 patients. Sixteen patients did not adhere regularly to the prescribed treatment and although the number of patients with urinary tract infection reduced with antibiotic therapy, their bladder capacity and compliance did not improve during follow-up. DISCUSSION: Ultrasonographic and urodynamic improvements were observed after 10.8 ± 7.5 months of treatment, including one patient with ureterohydronephrosis that resolved. Adherence to CIC remains a challenge and reflected in the number of patients presenting urinary tract infection and postvoid residual. The immediate clinical relevance is the major study strength, given the previously uncharacterized therapy options for this patient population. The number of patients remains one of the study limitations, reducing our ability to perform more advanced statistical analyses. CONCLUSION: Patients with Zika-related neurological lower urinary tract dysfunction may benefit from conventional therapies. Results confirmed ultrasonographic and urodynamic improvements after treatment, although not statically significant. Adherence to treatment, specifically to CIC, remains a challenge.

Numerical analysis of COVID-19 model with constant fractional order and variable fractal dimension.

This work has considered a mathematical model describing the spread of COVID-19 in a given population. The model comprised 5 systems of equations that take into account different classes describing the impact of COVID-19 in a given population. The time differential operator was replaced with three different types of nonlocal operators. These operators are defined as the convolution of variable order fractal differential operators with different kernels including power law, exponential decay law, and Mittag-Leffler functions. We presented the well-poseness of the models for different differential operators that were presented in detail. A novel numerical scheme was used to solve numerically the system and numerical simulations were provided.

Role of PDT as an adjunct to SRP on whole salivary RANKL and OPG ratio in type-2 diabetic and normoglycemic individuals with chronic periodontitis.

OBJECTIVE: The aim was to assess the effect of scaling and root planing (SRP) with and without adjunct photodynamic therapy (PDT) on the levels of osteoprotegerin (OPG) receptor activator of NF-kappa B ligand (RANKL) in the unstimulated whole saliva (UWS) of type-2 diabetic and normoglycemic individuals with chronic periodontitis (CP). METHODS: Type-2 diabetic and normoglycemic subjects with CP (Groups 1 and 2, respectively) were divided into test- (SRP + PDT) and control (SRP only) groups. Patient demographics were recorded; and periodontal parameters (marginal bone loss [MBL], probing depth [P.D], plaque index [PI], gingival index [GI], and clinical attachment loss [CAL]) were assessed at baseline and at 3-months-follow-up. Rate of flow of unstimulated whole saliva and levels of RANKL and osteoprotegerin were measured at both time intervals. P < 0.05 was considered statistically significant. RESULTS: Eighty-four persons with CP (42 with and 42 without type-2 DM) were included. At baseline, clinicoradiographic parameters were comparable in all groups. At 3-months of follow-up, there was no significant difference in the clinicoradiographic parameters in all groups. At 3-months of follow-up, there was no significant reduction in whole salivary RANKL and osteoprotegerin levels among individuals in the test and control groups among CP patients with and without CP. CONCLUSION: The whole salivary RANKL/OPG ratio remains high in patients with poorly-controlled type-2 DM after SRP with or without adjunct PDT.

Pathological effect of infectious bronchitis disease virus on broiler chicken trachea and kidney tissues.

AIM: This study aimed to investigate the pathological effects of the infectious bronchitis virus (IBV) on chicken trachea and kidney tissues and also desired to diagnose the virus genome using a molecular tool. MATERIALS AND METHODS: Twenty trachea and kidney samples collected from one broiler farm contain 10,000 chickens at Tikrit city. The chickens showed signs of gasping and mortality (20%) at early ages (20 days old), the presence of IBV investigated using conventional reverse transcriptase-polymerase chain reaction technique with routine histopathological study to tracheal and renal tissue. RESULTS: Postmortem lesion showed severe respiratory inflammation with abscesses at tracheal bifurcation lead to airway blog. Molecular results showed two genotypes of IBV, one of them not included in primer designer research. The histological study showed different stages of inflammation, degeneration, and necrosis to the renal and tracheal tissues. CONCLUSION: The respiratory and renal pathological effect of the virus responsible for the symptoms appeared on the affected chicks that caused mortality, with a high probability of presence of a new viral genotype added to the untranslated region.

A novel mathematics model of covid-19 with fractional derivative. Stability and numerical analysis.

a mathematical model depicting the spread of covid-19 epidemic and implementation of population covid-19 intervention in Italy. The model has 8 components leading to system of 8 ordinary differential equations. In this paper, we investigate the model using the concept of fractional differential operator. A numerical method based on the Lagrange polynomial was used to solve the system equations depicting the spread of COVID-19. A detailed investigation of stability including reproductive number using the next generation matrix, and the Lyapunov were presented in detail. Numerical simulations are depicted for various fractional orders.

Obtaining contextually relevant geographic data using Facebook recruitment in public health studies.

INTRODUCTION: Online participant recruitment for public health research studies has increased dramatically in recent years, particularly as traditional recruitment strategies have waned in efficiency. The emergence of e-epidemiology offers possibilities for reaching understudied populations as well as conducting large-scale studies. METHODS: We conducted a cross-sectional survey focused on self-reported neighborhood characteristics, perceived stress, and feasibility of obtaining work/residential addresses via online recruitment in St. Louis, Missouri, USA from February 2017 to December 2017. We report the process of using Facebook recruitment and demonstrate how this strategy can enhance collection of geospatial data to better understand context and spatial patterns of disease. RESULTS: A total of 425 participants were recruited via Facebook advertisements. All participants reported their residential and work ZIP codes, though only 64.7% and 45.6% provided their complete residential and work street addresses, respectively. Those who reported their complete residential street addresses were more likely to be female (69.8% vs. 56.1% of males, χ2 = 7.89, 1 df, p = 0.005), though no differences were observed by race, age, or employment status. DISCUSSION: These findings indicate that valuable location data can be successfully collected via Facebook recruitment - data that could potentially include residential history or prospective follow-up time or be combined with other emerging technologies for geographic data in order to better understand the context and the effects of place on health outcomes. CONCLUSIONS: Facebook recruitment may be an underutilized resource for obtaining accurate geospatial and contextually relevant health data and should be considered as a means for finding participants due to the cost-effectiveness, efficiency and flexibility of this recruitment approach.

I Do Not Even Say "It" - a Mixed Methods Study on Breast Cancer Awareness of Omani Women.

BACKGROUND: The incidence of breast cancer is rising in Oman, and the disease is diagnosed at late stages, when treatment success is limited. Omani women might benefit from better awareness, so that breast cancer can be detected early and treated. This study was conducted to assess Omani women's levels of breast cancer awareness and early detection practice, and explore factors which might influence these levels. MATERIALS AND METHODS: A mixed methods study was conducted in 2014, including a quantitative survey of 1,372 and a qualitative assessment of 19 Omani women, aged ≥20 years from five Omani governorates using convenient sampling. Demographic information and scores for awareness levels were used in a multivariate regression model to investigate factors associated with awareness. Thematic analysis and interpretive description were used to analyse the qualitative data. RESULTS: The overall means for early detection and general awareness scores were 0.58 (SD 0.24) and 0.46 (SD 0.21), respectively. General awareness was significantly associated with age, education, income and familiarity with cancer patients (<0.05), while early detection was significantly associated with age, marital status and education. A majority of women (59.5%) agreed with a belief in 'evil eye' or envy as a risk factor for breast cancer. Women discussed various factors which may empower or inhibit awareness, including the cultural-religion-fatalistic system, personal-familial-environmental system, and healthcare-political-social system. CONCLUSIONS: The overall low scores for awareness and early detection, and the survey of local beliefs highlight a severe necessity for a contextually-tailored breast cancer awareness intervention programme in Oman.

Urbanisation and geographic variation of overweight and obesity in India: a cross-sectional analysis of the Indian Demographic Health Survey 2005-2006.

OBJECTIVES: We examined the nationwide geographic variation of overweight and obesity in India, as well as a range of potential correlates of excess body fat. METHODS: We conducted cross-sectional analyses of the 2005-2006 Indian Demographic Health Survey (IDHS), based on 161,050 individuals (age range 18-54 years). Multivariate logistic regression models were used to determine odds ratios (OR) of overweight and obesity compared to normal weight with associated correlates. RESULTS: The overall prevalence was 12.4% for overweight, 3.2% for obesity, and 26.5% for underweight. After multivariate adjustment, obesity was nearly thrice more likely in urban areas than in rural (OR 2.73, 95% CI 2.53-2.94). Women were 2.71 times more likely to be obese than men (95% CI 2.50-2.95). Better socioeconomic status was significantly associated with overweight and obesity. Overweight (OR 1.38, 95% CI 1.31-1.47) and obesity (OR 1.46, 95% CI 1.32-1.61) were most likely to occur in India's Southern zone, when controlled for confounding factors. CONCLUSIONS: High-risk estimates for overweight/obesity in urban settings, along with socioeconomic prowess in India and the resulting nutritional transition make a compelling case for public health policy on healthy lifestyles to avert the growing burden of non-communicable diseases associated with overweight/obesity.

Evolución de la frecuentación en un servicio de urgencias hospitalario / Trends in hospital emergency department use

Objetivos: Describir la evolución de la frecuentación del servicio de urgencias hospitalario(SUH) en 10 años (1998-2007), en el Hospital Virgen del Puerto de Plasencia (Cáceres),de la proporción de ingresos respecto al total de urgencias atendidas y de la presión de urgencias. Método: Estudio descriptivo, observacional y retrospectivo, se utilizó las bases de datos del Servicio de Admisión, para obtener el número de urgencias atendidas cada año, los ingresos totales y los realizados desde el SUH. También hemos obtenido del Instituto Nacional de Estadística los mismos datos por comunidades y los globales del país. Resultados: La frecuentación del SUH en el Hospital Virgen del Puerto de Plasencia ha aumentado un 28,9% en todo el periodo estudiado (incremento anual del 2,8%) y no se correlaciona con el aumento poblacional, que ha sido del –3,8% en el mismo periodo. En cambio, ha disminuido la proporción de ingresos respecto a las urgencias atendidas un 4%, así como la presión de urgencias en un 9%. Este comportamiento ha sido similar al observado en Extremadura y el resto de España. Conclusiones: En 10 años la frecuentación hospitalaria ha aumentado pero ha disminuido la proporción de ingresos realizados desde Urgencias, tanto en el Hospital Virgen del Puerto como en el resto de España (AU)

Objectives: To describe trends in emergency department use at Hospital Virgen del Puerto in Plasencia, in the province of Caceres, Spain, over a 10-year period from January 1, 1998 to December 31, 2007. To determine the percentage of emergencies that led to admissions to this university hospital as well as the percentage of all admissions that came from the emergency department. Methods: Descriptive, observational, retrospective study using hospital admission records to obtain the number of emergencies attended annually, the number of emergency patients admitted, and the number of admissions ordered by emergency department physicians. From the National Institute of Statistics, we also obtained the same information for all of Spain and for each Spanish autonomous community. Results: Visits to the hospital's emergency department increased by 28.9% during the 10 years under study (annual increase, 2.8%). Increased use of the hospital was not correlated with the change in population, which fell by 3.8%during the same period. As visits to the hospital emergency department rose, the percentage of emergency patients admitted fell by 4%. Likewise, the percentage of all admissions from the emergency department also fell, by 9%. A similar pattern has been observed in Extremadura and in Spain. Conclusions: Hospital emergency department visits increased during the 10-year study period, but the percentage of admissions ordered by emergency physicians decreased at Hospital Virgen del Puerto and in Spain as a whole (AU)

Acute intoxication of deltamethrin in monosex Nile tilapia, Oreochromis niloticus with special reference to the clinical, biochemical and haematological effects.

Deltamethrin, a synthetic pyrethroid pesticide, potential toxic pollutant and significant direct risk to the aquatic ecosystems, was investigated in the present study for its toxic impact on adult monosex Nile tilapia on the basis of acute static bioassay test, and comparison of clinical, biochemical and haemato logical examinations with deltamethrin-free control group. The 96hLC(50) value of deltamethrin for monosex tilapia was 14.6µg/L. The abnormal behavioral responses and toxic symptoms were described. Fish exposed to the higher deltamethrin concentration (15µg/L) for 96h showed significantly higher lymphocytes, total leucocytic and erythrocytic counts, haemoglobin percentage and packed cell volume content and significantly lower neutrophils compared to the control group. Deltamethrin caused adverse effects in the form of hypoproteinemia, hypoalbuminemia, hypercholesterolemia, hypoglycemia and significant increase of serum aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase activities. The results provide evidence that deltamethrin pollution may have adverse impacts and was highly toxic to monosex tilapia.

Central venous dialysis catheters: catheter-associated infection.

Tunneled dialysis catheters (TDC) are extensively used for long-term venous hemodialysis access and their use is frequently associated with infectious complications. Catheter-related bacteremia (CRB) is the most common and important infection associated with TDC use and may be caused by a wide variety of Gram-positive or Gram-negative organisms. Prevention of CRB can be difficult despite use of rigorous infection-control techniques for catheter insertion and access. A number of antibacterial catheter-packing solutions hold promise for reduction of CRB. Treatment of CRB with antibiotics alone yields poor results and may increase the risk for other infectious complications, especially endocarditis. In selected cases where initial infection control can be achieved with antibiotics, guidewire exchange of the TDC results in cure rates equivalent to those of TDC removal and subsequent replacement. Dialysis programs should monitor TDC infections with attention to incidence, bacteriology, and outcomes.

Bacteremia associated with tunneled, cuffed hemodialysis catheters.

Bacteremia is a frequent complication associated with tunneled, cuffed, permanent catheters (PCs). The incidence, spectrum of infecting organisms, and optimal treatment for catheter-associated bacteremia (CAB) have not been clearly established. In this study, 101 chronic hemodialysis (HD) patients with PCs for blood access were prospectively monitored for infection during a 24-month period. Data recorded for each patient included the number of catheter-days, episodes of suspected bacteremia, blood culture results, method of treatment, complications, and outcomes. All patients with CAB were treated with a 21-day course of intravenous antibiotics. The PC was removed if the patient had uncontrolled sepsis or if other vascular access was ready for use. Once the infection was controlled, catheter salvage was attempted, either by exchanging for a new catheter over a guidewire or treating with antibiotics only, leaving the original PC in place. Catheter exchange was the recommended approach in our program, but this was decided in each case by the treating nephrologist. During this study, there were 15,581 catheter-days, with 86 episodes of CAB, or 5.5 episodes/1,000 catheter-days (95% confidence interval, 4.5 to 6.8/1,000 d). Forty-five infections (52.3%) were caused by gram-positive cocci only, including Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococcus species. Twenty-three infections (26.7%) were caused by gram-negative rods only, including a wide variety of enteric organisms. Eighteen infections (20.9%) were polymicrobial. Thirty-nine of 86 episodes (45.3%) included at least one gram-negative organism. Five PCs were removed because of severe uncontrolled sepsis, and eight PCs were removed because they were no longer required. Of the remaining 73 cases, attempted PC salvage was successful in 11 of 30 patients (36.7%) treated with antibiotics alone versus 35 of 43 patients (81.4%) who underwent PC exchange in addition to antibiotic therapy (P = 0.0005). The only important complication of CAB was endocarditis, occurring in 3 of 86 episodes (3.5%). We conclude that in our HD units, CAB is relatively common and frequently involves gram-negative bacteria. PC salvage is significantly improved when antibiotic treatment is combined with PC exchange over a guidewire.

Prophylactic antibiotic therapy prior to dental treatment for patients with end-stage renal disease.

In the United States, there is a large and growing population of patients undergoing dialysis because of end-stage renal disease (ESRD). These patients present special management considerations for dentists, including antibiotic prophylaxis for the prevention of bacterial endocarditis (BE). ESRD patients, particularly those with an arteriovenous shunt for hemodialysis access, are predisposed to valvular endocarditis. Thus, BE prevention is the primary goal of antibiotic prophylaxis prior to dental or other invasive procedures in these patients. Bacteremia may predispose to infection of synthetic vascular access grafts, although this form of endovascular infection in ESRD patients has not been as well-characterized as BE. Antibiotic prophylaxis may be of some benefit for prevention of synthetic graft infections as well as BE. Poor dentist and physician compliance with BE prophylaxis regimens, as well as errors in dosing, timing, or duration of prophylaxis, have been reported. These problems are of particular concern in the treatment of chronically ill patients. In this article, we review the rationale for prophylactic antibiotic therapy prior to dental procedures in ESRD patients with vascular access. We also elaborate on the current American Heart Association guidelines for BE prophylaxis, and address special considerations for ESRD patients.

A new salvage procedure for peritoneal dialysis catheters with exit site infections.

The management of catheter-related infections has become a major challenge in continuous ambulatory peritoneal dialysis treatment. We identified five patients on continuous ambulatory peritoneal dialysis who failed conservative medical management for exit site infections. Each patient underwent incision and debridement along the subcutaneous course of the catheter, exteriorization of the superficial cuff, and establishment of a new exit site at the medial aspect of the wound. This novel technique of incision and debridement along the subcutaneous tunnel and relocation of the exit site has not been described in the literature. In four of five patients, this technique controlled the exit site infection and arrested the progression of the infection to peritonitis, preventing the need for catheter removal.

Outcome of congenital hydronephrosis in qatar.

Three hundred and eleven patients diagnosed to have congenital hydronephrosis proven by postnatal ultrasonography in a ten-year period between 1987 and 1996 were studied retrospectively. These were classified into mild degree of hydronephrosis in H (64%), moderate in 94 (30%) and severe in 18 (6%) patients, according to first post natal sonography and depending on the measurement of the anterio-posterior transverse diameter of the pelvi-calyceal system. Significant obstructive uropathy was documented in 66 patients by Technetium-Diethylene triamine penta acetic acid renogram (Tc99m DTPA Renogram Vesicoureteric reflux was found in 22 patients by voiding cysto-urethrogram. On follow-up the hydronephrosis regressed spontaneously in 99 (31.8%), was stable in 167 (53.6%) and needed operative intervention in 45 (14.4%) patients. The types of surgical operations were pyeloplasty in 49% and ureteric re-implantation in 27%. Fifteen (83%) of the children with severe hydronephrosis and 32 (34%) of the moderate hydronephrosis group were operated o while none of the children with the mild form required operative intervention. We recommend ultrasound follow-up for mild hydronephrosis and a coordinated approach and work-up for congenital moderate and severe hydronephrosis. Surgery should only be considered if renal function is affected.

Hemodialysis vascular access: emerging concepts.

Vascular access complications remain a leading cause of morbidity and hospitalization in patients on chronic maintenance hemodialysis. Although arteriovenous fistulas remain the dialysis access of choice, an increasing percentage of patients are dialyzed using synthetic grafts or permanent catheters. The most frequent vascular access complications are the development of stenosis and of thrombosis. In recent years, increasing attention is being paid to screening techniques designed to detect vascular access stenosis prior to thrombosis. Aggressive screening techniques coupled with interventional procedures such as angioplasty may reduce the incidence of graft thrombosis. Once thrombosis has occurred, mechanical or pharmacomechanical thrombolysis in conjunction with angioplasty may be an effective alternative to surgical thrombectomy.