Trends and patterns of cause-specific hospitalizations in mainland Portugal between 2000 and 2016.

OBJECTIVES: This study aimed to describe trends and patterns of cause-specific hospitalizations in mainland Portugal between 2000 and 2016. STUDY DESIGN: This was a retrospective observational study based on hospital discharge data during the period 2000-2016 in mainland Portugal. METHODS: All inpatient hospital discharges among mainland Portuguese public hospitals were considered to evaluate trends and patterns over the years through hospitalization proportions, number of hospitalizations, age-standardized hospitalization rates (direct standardization using the European standard population), and the number of in-hospital stay days (bed-days). Health Cost and Utilization Project Clinical Classifications Software was used to categorize and cluster inpatients' principal diagnosis. RESULTS: Between 2000 and 2002 and between 2014 and 2016, age-standardized hospitalization rates decreased by 8.6%. Moreover, "liveborn," "diseases of the heart," and "respiratory infections" were the leading hospitalization causes in both periods with a variation of -8.8%, -8.3%, and 13.4% on age-standardized hospitalization rate, respectively. The age-standardized hospitalization rate due to "bacterial infection" increased by 108.7%. "Respiratory diseases" are the leading cause responsible for more in-hospital stay days in the period 2014-2016 (48.6% increase). All Portuguese regions presented decreasing overall trends in their age-standardized hospitalization rates in the study period, yet increasing trends were observed until 2004 except for the Lisbon region; in addition, the number of in-hospital stay days remained relatively stable through time. CONCLUSIONS: Hospitalizations in mainland Portugal decreased between 2000 and 2016 with heterogeneous patterns considering time, age group, and gender. "Aspiration pneumonitis; food/vomitus," "diseases of the white blood cells," "other nutritional, endocrine, and metabolic disorders," "bacterial infection," and "pathological fractures" revealed substantial increases, and further evaluations and monitoring are required.

Functional dimorphic enantiostyly in monomorphic enantiostylous species of the subtribe Cassiinae (Fabaceae-Caesalpinioideae).

Monomorphic enantiostylous species produce flowers with a displacement of the style to the left (L) or right (R) on the same individual, and may exhibit different dynamics for the production of these floral types, which may influence levels of selfing. We investigated the production dynamics of L and R floral types in seven species and a variety of monomorphic enantiostylous species of the genera Senna and Chamaecrista. Our hypothesis was that most species present similar proportions of floral morphs each day. Individuals were classified daily over a period of 7 days according to the functional status, i.e. the proportion of floral morphs as functionally L, R or reciprocal (REC, i.e. similar proportions of the two floral morphs), and also according to the number of consecutive days in which they exhibited the same functional status. All species presented low daily flower production. Most species had individuals classified as functionally R, L and REC, and tend to repeat the same functional status over a few days, although they may change functional status during the flowering period. All species exhibited individuals that were classified as functionally reciprocal when both the daily and total number of flowers produced over 7 days was considered. The occurrence of different functional status has not yet been reported in the literature for enantiostylous species. The distinct strategies observed in the dynamics of floral morph production seemed likely to minimise geitonogamy and to favour cross-pollination between individuals (xenogamy).

Assessment of microscopic and molecular tools for the diagnosis and follow-up of cryptosporidiosis in patients at risk.

Cryptosporidiosis is an important though underreported public health concern. Molecular tools might be helpful in improving its diagnosis. In this study, ZR Fecal DNA MiniPrep™ Kit (ZR) and NucliSens® easyMAG® (EM) were compared using four Cryptosporidium-seeded feces and 29 Cryptosporidium-positive stools. Thereafter, ZR was selected for prospective evaluation of Cryptosporidium detection by 18S rDNA and LAXER quantitative PCR (qPCR) in 69 stools from 56 patients after Cryptosporidium detection by glycerin, modified Ziehl-Neelsen (ZN) and auramine-phenol (AP) stainings. The combination of any of the two extraction methods with 18S qPCR yielded adequate detection of Cryptosporidium in seeded stools, but the ZR kit showed the best performance. All 29 Cryptosporidium-positive samples were positive with 18S qPCR, after both ZR and EM extraction. However, false-negative results were found with LAXER qPCR or nested PCR. Cryptosporidiosis was diagnosed in 7/56 patients. All the microscopic methods enabled the initial diagnosis, but Cryptosporidium was detected in 12, 13, and 14 samples from these seven patients after glycerin, ZN, and AP staining respectively. Among these samples, 14 and 12 were positive with 18S and LAXER qPCR respectively. In two patients, Cryptosporidium DNA loads were found to be correlated with clinical evolution. Although little known, glycerin is a sensitive method for the initial detection of Cryptosporidium. When combined with 18S qPCR, ZR extraction, which had not been evaluated so far for Cryptosporidium, was an accurate tool for detecting Cryptosporidium and estimating the oocyst shedding in the course of infection.

[Significance of the urine strip test in case of stunted growth]. / Intérêt de l'examen des urines à la bandelette en cas de retard de croissance.

Observation of stunted growth in children usually leads the general practitioner to refer the patient to endocrinologists or gastroenterologists. In most cases, after a complementary check-up, the diagnosis is made and treatment is initiated. However, certain cases remain undiagnosed, particularly renal etiologies, such as proximal tubulopathy. The urine strip test at the initial check-up would be an easy and inexpensive test to avoid delayed diagnosis. The aim of the present paper is to increase general physicians' and pediatricians' awareness of the significance of questioning the parents and using the urine strip test for any child presenting stunted growth. We report a patient case of a 20-month-old child admitted to the emergency department for severe dehydration. He had displayed stunted growth since the age of 5 months and showed a negative etiologic check-up at 9 months of age. Clinical examination at admission confirmed stunted growth with loss of 2 standard deviations and signs of dehydration with persistent diuresis. Skin paleness, ash-blond hair, and signs of rickets were also observed and the urine strip test showed positive pads for glycosuria and proteinuria. Polyuria and polydipsia were also revealed following parents' questioning, suggesting proximal tubulopathy (Fanconi syndrome). Association of stunted growth, rickets, polyuria and polydipsia, glycosuria (without ketonuria and normal glycemia), and proteinuria suggest nephropathic cystinosis. Ophthalmic examination showed cystine deposits in the cornea. The semiotic diagnosis of nephropathic cystinosis was confirmed by leukocyte cystine concentrations and genetic investigations. This case report clearly illustrates the significance of the urine strip test to easily and quickly concentrate the diagnosis of stunted growth on a renal etiology (glycosuria, proteinuria), especially on proximal tubulopathy for which the most frequent cause is nephropathic cystinosis. Specificity of nephropathic cystinosis treatment is that the age of treatment initiation is crucial and determinant for the prognosis of the disease and the onset of final stage renal failure. Therefore, the urine strip test should be included in the systematic check-up of stunted growth to identify any renal etiology.

Enantiostylous types of Cassiinae species (Fabaceae-Caesalpinioideae).

Species of the subtribe Cassiinae present a wide diversity of floral types. Until recently it was considered that this diversity did not extend to their reproductive mechanisms. However, studies have recorded some variations in the enantiostylous pattern in this plant group. This study aims to investigate the morphological and functional variations of enantiostyly in species of the subtribe Cassiinae. Additionally, it proposes the recognition of enantiostylous types (ET) based on pollen deposition and capture mode. Morphological data were collected in fresh and fixed (alcohol 70%) buds and flowers, and also using photos and rehydrated material from herbarium sheets, for a total of 59 species. The parameters used to establish the ETs were pollination type, nature of pollen deposition on the pollinator body, deposition type, number of petals involved in pollen deposition, and pollen pathway. Morpho-functional features allowed the recognition of seven enantiostylous types (Flexuosa, Cana, Macranthera, Martiana, Amiciella, Repens and Ramosa) that present several levels of complexity. The type Ramosa was the most common and the Cana type was the least common. The types Repens, Martiana and Flexuosa do not have reciprocal pollen deposition, thus species with these types may be considered atypical. The groups resulting from similarity analysis partially coincide with the clades proposed in phylogenetic studies of Cassiinae. The recognition of functional ETs is important for understanding the evolution of reproductive strategies of Cassiinae species, and indicates an interesting line of investigation of enantiostyly in other plant groups.

Foodborne transmission of sorbitol-fermenting Escherichia coli O157:[H7] via ground beef: an outbreak in northern France, 2011.

Sorbitol-fermenting Escherichia coli O157:[H7] is a particularly virulent clone of E. coli O157:H7 associated with a higher incidence of haemolytic uraemic syndrome and a higher case fatality rate. Many fundamental aspects of its epidemiology remain to be elucidated, including its reservoir and transmission routes and vehicles. We describe an outbreak of sorbitol-fermenting E. coli O157:[H7] that occurred in France in 2011. Eighteen cases of paediatric haemolytic uraemic syndrome with symptom onset between 6 June and 15 July 2011 were identified among children aged 6 months to 10 years residing in northern France. A strain of sorbitol-fermenting E. coli O157:[H7] stx2a eae was isolated from ten cases. Epidemiological, microbiological and trace-back investigations identified multiply-contaminated frozen ground beef products bought in a supermarket chain as the outbreak vehicle. Strains with three distinct pulsotypes that were isolated from patients, ground beef preparations recovered from patients' freezers and from stored production samples taken at the production plant were indistinguishable upon molecular comparison. This investigation documents microbiologically confirmed foodborne transmission of sorbitol-fermenting of E. coli O157 via beef and could additionally provide evidence of a reservoir in cattle for this pathogen.

Enantiostyly in Chamaecrista ramosa (Fabaceae-Caesalpinioideae): floral morphology, pollen transfer dynamics and breeding system.

Enantiostyly is a form of reciprocal herkogamy, in which floral morphs present reciprocal differences in the position of sexual elements, and occurs in monomorphic and dimorphic forms. This polymorphism maximises cross-pollination and reduces self-pollination, being very common within the subtribe Cassiinae (Fabaceae). Nevertheless, few studies have investigated the functionality of enantiostyly, particularly in this plant group. The present study aimed to investigate enantiostyly and its functionality in Chamaecrista ramosa, a monomorphic enantiostylous shrub, in an area of coastal vegetation in northeast Brazil. Pollen deposition and capture on the body of floral visitors, the relationship of these data with floral biology and breeding system, and morph ratio were evaluated. Pollen deposition and capture occurred in specific sites of the floral visitor body, showing the functionality of enantiostyly. The floral architecture, associated with the floral visitor behaviour, resulted in indirect pollen deposition on the floral visitor body. This occurred through a loop made by the pollen upon the inner petal surface, similar that generally reported for other Cassiinae. Chamaecrista ramosa is self-compatible, although no fruit set was observed through spontaneous self-pollination. The occurrence and number of floral morphs was similar within clumps. Enantiostyly seems to be advantageous for this species, as it results in efficient pollen capture and deposition, reduces the chances of autogamy and maximises intermorph pollen flow.

Mortality in pediatric renal transplantation: a study of the French pediatric kidney database.

OBJECTIVE AND METHODS: To assess patient survival in pediatric renal transplantation, we retrospectively reviewed 573 transplants in 553 patients, registered from 1995 to 2005. RESULTS: Mean age at transplantation was 9.9 years. Patient survival at 1, 5 and 10 years was respectively 99%, 97% and 96%. Death occurred at a median time of 2.6 years after transplantation. Long-term patient survival was significantly lower in recipients younger than 5 years old. Seventeen patients (3.1%) died. Two deaths occurred while under maintenance dialysis. Among the remaining patients, the two main causes of death were infections (33%) and malignancies (27%). Interestingly, initial disease-related complications were a major cause of death (34%). CONCLUSION: A low mortality rate was observed, with the majority of deaths due to malignancies and infections, and with a notable participation of complications related to the initial disease. No impact of cardiovascular disease was noted with the given follow-up period. Improvements in managing immunosuppression may contribute to reducing mortality in pediatric renal transplantation.

Limited approach to the right flank for placement of a duodenostomy tube.

A new enterostomy tube placement technique is described for provision of nutrients into the duodenum. Placement of the duodenostomy tube (d-tube) is performed through a limited right flank approach under sedation and local anesthesia. Seven client-owned animals (three dogs and four cats) requiring enteral nutritional support were selected for d-tube placement. Patients were fed via the d-tube for two to 28 days. Complications included discomfort when manipulating and exteriorizing the duodenum, discomfort with bolus feedings, local cellulitis, and tube site infection. All complications resolved without further incident. This technique should be considered in patients that are not good candidates for prolonged general anesthesia or esophageal or gastric feeding, or patients being mechanically ventilated.

Chronic renal failure after Puumala virus infection.

Chronic renal failure has never been described after Puumala hantavirus infection, which usually causes acute renal failure with spontaneous full recovery. We report a 15-year-old boy who presented with Puumala hantavirus infection and initial severe acute renal failure. His renal function gradually improved, but more than 2 years after the acute episode it was still moderately impaired, with a creatinine clearance of about 60 ml/min per 1.73 m(2)

Surgical repair of nasopharyngeal stenosis in a cat using a stent.

An intraluminal stent was used to maintain patency of a recurrent nasopharyngeal stenosis (NPS) in a cat. The stenotic membrane within the nasopharynx was resected, and a 2-cm long, braided-wire endoprosthesis was placed as a stent. The patient was evaluated at one day, six weeks, 19 weeks, and 49 weeks following surgery. The cat tolerated the stent well. The 19-week recheck revealed granulation tissue partially obstructing the pharyngeal aspect of the stent which was subsequently surgically resected. Complications after excision of the granulation tissue included intermittent upper respiratory congestion and nasal discharge. The 49-week recheck showed no increased granulation tissue; however, upper respiratory congestion was still present. This particular stent, and its use as described in this paper, is recommended in cases of chronic recurrent NPS.

Compliance measurement in respiratory distress syndrome: the prediction of outcome.

Dynamic compliance (Cdyn) measurements within the first three days of life predicted survival in 60 preterm infants suffering from respiratory distress syndrome. Cdyn was measured in 47 survivors at 2.3 +/- 1.4 days of life and in 13 nonsurvivors on 2.7 +/- 1.7 days. All nonsurvivors died from respiratory failure within the first two weeks of life. Mean Cdyn of the survivors was 0.83 +/- 0.33 ml/cm H2O and of the nonsurvivors 0.35 +/- 0.19 ml/cm H2O (p less than 0.001). Cdyn values below 0.45 ml/cm H2O predicted 11 of 13 deaths in infants, and Cdyn measurements above this value predicted 45 of 47 survivals, with a specificity of 81% and a sensitivity of 89%. Eleven of the survivors, who subsequently developed bronchopulmonary dysplasia (BPD), had a mean Cdyn of 0.56 +/- 0.23 ml/cm H2O. When these infants were matched with infants of comparable weight without evidence of BPD, the BPD group had a significantly lower Cdyn (p less than 0.05). Cdyn measurements during the first three days of life are useful in predicting outcome of respiratory failure secondary to respiratory distress syndrome.

Ventilatory responses to carbon dioxide in infants at risk for sudden infant death syndrome.

We examined the ventilatory response to inhaled CO2 in 77 infants at postconceptional ages ranging from 31 to 50 wk, 43 of whom were also evaluated with a 12-h pneumocardiogram (PCG). Infants were tested after sedation with chloral hydrate, and monitored with ECG and transcutaneous oxygen and CO2 monitors. Sleep state was evaluated by visual inspection of the infant's behavior. Among the 43 infants examined with the PCG, 22 had abnormal PCGs. Of these, 27% had significantly (p less than .05) abnormal CO2 response slopes, compared to 9% of those with normal PCGs. Breathing frequency did not change after CO2 inhalation in 82% of the abnormal PCG and in 33% of the normal PCG groups.

Effect of caffeine on pneumogram and apnoea of infancy.

We studied the efficacy of caffeine in improving pneumogram abnormalities and relieving clinically important apnoea of infancy in 23 infants. After obtaining a 12 hour pneumogram we administered caffeine citrate in a loading dose of 20 mg/kg followed by 5 mg/kg once daily. This dose achieved a trough caffeine blood concentration of 9.6 (SD 2.0) micrograms/ml. A repeat pneumogram performed seven to 10 days after the first pneumogram showed a significant reduction in the number of short and prolonged attacks of apnoea as well as in the per cent periodic breathing and apnoea density. Episodes of prolonged apnoea disappeared in all infants after administration of caffeine and in 11 infants all pneumogram abnormalities resolved. This improvement in the results of pneumograms was associated with resolution of clinically important apnoea requiring intervention. Caffeine was administered for 3.4 (SD 1.3) months and was well tolerated by all except two infants. We conclude that treatment with caffeine is helpful in preventing attacks of apnoea that require intervention, and improvement in the results of pneumograms after administration of caffeine predicts this favourable response.