Is Streptococcus bovis a urinary pathogen?

The Streptococcus bovis group (SBG) comprises several microorganisms associated with human infections. They have been associated with bacteremia, endocarditis, biliary tract infection, meningitis, and colorectal cancer, but their role as urinary pathogens is not well known. The objective of this investigation was to discover the incidence and clinical significance of the bacteriuria associated with this complex. A retrospective analysis of all adult patients with bacteriuria caused by SBG during the period 1995-2012 was carried out. During the study period, SBG was isolated in 153 adult patients, who had a mean age of 67 years, most of them being women (80%). Most of our patients (65%) had some underlying disease, with urologic disease being the most common (37%), followed by diabetes mellitus (27%) and neurologic disease (25%). Among the 88 patients in whom we were able to correctly assess symptoms, 45% had asymptomatic bacteriuria, 35% had lower urinary tract infection, and 20% had upper urinary tract infection. In 14 cases (9%), SBG was also isolated in blood cultures. Most of the isolates of SBG (72%) were S. gallolyticus subsp. pasteurianus. All isolates were susceptible to penicillin, 98% to nitrofurantoin, and 77% to fosfomycin. Although SBG bacteriuria is uncommon, it should not always be taken as a contaminant, mainly when S. pasteurianus is isolated, because it may cause urinary tract infections and, occasionally, sepsis, whereas when S. gallolyticus is isolated from urine, it may be a marker of underlying endocarditis and colorectal cancer.

Parental perceptions regarding lifestyle interventions for obese children and adolescents with nonalcoholic fatty liver disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) affects 30% of obese children globally. The main treatment for NAFLD is to promote gradual weight loss through lifestyle modification. Very little is known regarding parental perspectives about the barriers and facilitators that influence the ability to promote healthy lifestyle behaviours in children with NAFLD. OBJECTIVES: To explore and describe parental perspectives regarding barriers to and facilitators of implementing lifestyle modification in children with NAFLD. METHODS: A mixed-methods approach, including qualitative methodology (focus groups) and validated questionnaires (Lifestyle Behaviour Checklist), was used to assess parental perceptions regarding barriers to and facilitators of lifestyle change in parents of children with healthy body weights (control parents) and in parents of children with NAFLD (NAFLD parents). RESULTS: NAFLD parents identified more problem behaviours related to food portion size and time spent in nonsedentary physical activity, and lower parental self-efficacy than parents of controls (P<0.05). Major barriers to lifestyle change cited by NAFLD parents were lack of time, self-motivation and role modelling of healthy lifestyle behaviours. In contrast, control parents used a variety of strategies to elicit healthy lifestyle behaviours in their children including positive role modelling, and inclusion of the child in food preparation and meal purchasing decisions, and perceived few barriers to promoting healthy lifestyles. Internet sources were the main form of nutrition information used by parents. CONCLUSIONS: Lifestyle modification strategies focused on promoting increased parental self-efficacy and parental motivation to promote healthy lifestyle behaviour are important components in the treatment of obese children with NAFLD.

HISTORIQUE: Dans l'ensemble, 30 % des enfants obèses sont atteints d'une stéatose hépatique non alcoolique (SHNA). Le principal traitement de cette maladie consiste à promouvoir une perte graduelle de poids par des modifications au mode de vie. On ne sait pas grand-chose du point de vue des parents sur les obstacles et les incitations à promouvoir des comportements sains chez les enfants ayant une SHNA. OBJECTIFS: Explorer et décrire les points de vue des parents à l'égard des obstacles et des incitations à modifier le mode de vie pour les enfants ayant une SHNA. MÉTHODOLOGIE: Les chercheurs ont utilisé une démarche mixte, incluant une méthodologie qualitative (groupe de travail) et des questionnaires validés (liste de comportements et de modes de vie), pour évaluer les points de vue des parents à l'égard des obstacles et des incitations à modifier le mode de vie pour les parents d'enfants ayant un poids santé (parents témoins) et ceux d'enfants ayant une SHNA (parents SHNA). RÉSULTATS: Les parents SHNA percevaient plus de problèmes liés à la dimension des portions et au temps passé à des activités non sédentaires, et présentaient une autoefficacité parentale plus faible que les parents témoins (P<0,05). Comme obstacles majeurs aux modifications au mode de vie, les parents SHNA citaient le manque de temps, d'automotivation et d'exemple de comportements sains. Par contre, les parents témoins utilisaient diverses stratégies pour favoriser des comportements sains chez leurs enfants, y compris les exemples positifs, la participation des enfants à la préparation des repas et aux décisions relatives à l'achat des aliments, et percevaient peu d'obstacles à la promotion de modes de vie sains. Les parents utilisaient les sources virtuelles comme principales formes d'information en matière de nutrition. CONCLUSIONS: Les stratégies de modifications du mode de vie axées sur la promotion d'une meilleure autoefficacité parentale et sur la motivation des parents à promouvoir des comportements sains sont des éléments importants du traitement des enfants obèses ayant une SHNA.

Polyethylene ribbon and fixed orthodontic retention and porcelain veneers: solving an esthetic dilemma.

The patient, a 58-year-old woman, had started orthodontic treatment to correct spacing between the maxillary anterior teeth 6 year prior to presentation with a chief complaint of tooth discoloration and spacing. The treatment had consisted of the use of a removable appliance to retract the maxillary anterior teeth. The patient continued to wear the appliance sporadically. When she presented, the maxillary incisors were in primary occlusal trauma with Grade 2 mobility. The patient discontinued wearing the appliance. The periodontal condition was addressed with initial therapy. As part of the treatment plan to stabilize the maxillary anterior teeth and provide the patient with an esthetic result, it was decided to do a limited occlusal adjustment of the maxillary anterior teeth to control fremitus, and to place a fixed, composite resin, polyethylene ribbon-reinforced splint, using a facial approach. The esthetic restoration of these teeth was accomplished with bonded porcelain veneers.

Acute psychosis secondary to bromocriptine treatment in a patient with a prolactinoma.

Paciente femenino de 68 anos de edad con diagnostico clinico de prolactinoma. Los signos y sintomas clinicos presentados por la paciente incluian amenorrea secundaria desde los 28 anos de edad, cefalea supraorbitaria, hemianopsia bitemporal e hipotiroidismo. Se dio tratamietno sustitutivo con hormonas tiroideas y bromocriptina logrando una mejoria clinica evidente de la sintomatologia. El proposito de este trabajo es reportar el comportamiento psicopatologico desarrollado por la paciente despues de 3 meses de tratamiento con bromocriptina