Appendicitis in a 14-month-old infant with respiratory symptoms

Although appendicitis is the condition that most commonly requires emergent abdominal surgery in the paediatric population, less than 2% of the disease occurs in infants and it is even more uncommon in neonates. In this report, we describe a rare case of a 14-month-old child presenting with abdominal pain first diagnosed with upper respiratory tract infection and then admitted to our Paediatric Surgery Department with a final diagnosis of acute appendicitis. A particular attention has to be kept on children presenting with an upper respiratory tract infection since symptoms can mask abdominal signs. Due to high morbidity and mortality rate related to a delayed diagnosis, appendicitis always has to be considered as a possible diagnosis, in order to ensure a prompt treatment

Response to "Imaging to diagnose acute appendicitis".

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Molecular typing of Staphylococcus pseudintermedius canine strains by three commonly used techniques

Staphylococcus pseudintermedius is a newly described species of Staphylococcus regarded as the main causative agent of canine pyoderma [1]. S. pseudintermedius infection was recently described in humans. An important feature of this pathogen is the high genetic identity with two other species of staphylococci, namely S. intermedius and S. delphini, which are included all together in the Staphylococcus Intermedius Group (SIG) [2]. This scenario seriously hampers phenotypic differentiation of these three pathogens. Despite this, only in 2008 was described the first molecular protocol for diagnostic identification of   S. pseudintermedius [3]. The aim of this work was to investigate the presence of different biotypes of S. pseudintermedius obtained from clinically relevant cases of pyoderma in dogs using three molecular methods commonly used to type bacteria: the Ribosomal Spacers Amplification (RSA), the Random Amplification of Polymorphic DNA (RAPD) and the Restriction Fragment Length Polymorphism (RFLP). A total of 46 different strains were included in this work. The application of the RSA technique, which was applied here for the first time, identified the presence of S. pseudintermedius, although it did not allow any differentiation between biotypes. The RAPD assay showed a single cluster that assembles all the interested strains that are grouped in three different sub-clusters (Fig. 1). The RFLP technique showed the most discriminative power, providing the opportunity to clearly identify this bacterium. In conclusion, the use of these three different techniques allows to clearly identify S. pseudintermedius and to observe the presence of different biotypes. In future it could be interesting to couple these results with the determination of the antibiotic resistance in order to verify if certain Multi Drug Resistant strains have particular RSA and RAPD profiles

El currículum universitario: entre la teoría y la práctica

El problema de la relación teoría-práctica en la formación de profesionales universitarios se ha convertido en un lugar común en casi todos los diagnósticos acerca de las instituciones de educación superior. Este problema, sin embargo, no es conceptualizado siempre de la misma manera, sino que se articula en torno a suposiciones y valoraciones diferentes sobre los aspectos que darían cuenta del mismo. Se podría señalar que un rasgo común a estos planteos es la valoración cada vez mayor del lugar de "la práctica" en la formación de profesionales. Este constituiría uno de los sentidos del problema, el reconocimiento de la falta de preparación de muchos egresados de las aulas universitarias para resolver los problemas que se les presentan en sus primeros ámbitos de ejercicio profesional, o una dificultad para insertarse en el campo profesional. Este hecho, podría deberse, entre otras razones, a la escasez de espacios de práctica en la formación, entendida ésta como la oportunidad para desarrollar en instancias formativas las destrezas y competencias que supone el ejercicio profesional. Desde otra perspectiva, que puede ser complementaria, se podría ver a la práctica como un ámbito de trabajo privilegiado tanto para el acceso, como para el afianzamiento del conocimiento. Es decir, la práctica como el lugar privilegiado de acceso el conocimiento, como modo de conocer "desde la práctica". En el presente trabajo se focalizan algunas de las dimensiones que creemos constituyen esta problemática, las que de ningún modo son excluyentes de otras posibles miradas.Facultad de Humanidades y Ciencias de la Educació

Do we need imaging to diagnose appendicitis in children?

Background: To evaluate the role of clinical assessment with selective use of imaging studies in the management of suspected acute appendicitis in children. Patients and Methods: Medical records of children referred to Emergency Room in 2010 for suspected appendicitis were retrospectively reviewed. Diagnostic investigations divided by age and sex were related to pathological findings. Negative appendectomy and complication rates were calculated. Results: 923 children needed surgical assessment : i0 n 75.7% of them surgical indication was excluded and 24.3% were admitted to surgical ward for observation. Appendectomy was eventually performed in 137 patients (61.9%), 82.4% of them without any preoperative imaging while 17.6% underwent selective studies, mainly abdominal ultrasonography (14.6%). Imaging was requested twice as frequently in not operated admitted children (39.3%) than in the operated ones (17.5%, P < 0.001). Overall complicated appendicitis rate (peritonitis and abscess) resulted 26.4% and negative appendectomy rate 8.8%. Females older than 10 years presented histologically not-confirmed appendicitis in 22.2% of cases, while the younger ones presented more frequently complicated appendicitis (29.3%). Conclusions: Clinical assessment is the key to diagnose appendicitis. Nevertheless, in girls older than 10 years, selected use of imaging should be implemented to avoid unnecessary appendectomies. Imaging of choice in equivocal cases should be ultrasonography

Epidemiology of tuberculosis in a low-incidence Italian region with high immigration rates: differences between not Italy-born and Italy-born TB cases

<p>Abstract</p> <p>Background</p> <p>Emilia Romagna, a northern Italian region, has a population of 4.27 million, of which 9.7% are immigrants. The objective of this study was to investigate the epidemiology of tuberculosis (TB) during the period 1996-2006 in not Italy-born compared to Italy-born cases.</p> <p>Methods</p> <p>Data was obtained from the Regional TB surveillance system, from where personal data, clinical features and risk factors of all notified TB cases were extracted.</p> <p>Results</p> <p>5377 TB cases were reported. The proportion of immigrants with TB, over the total number of TB cases had progressively increased over the years, from 19.1% to 53.3%. In the not Italy-born population, TB incidence was higher than in Italians (in 2006: 100.7 cases per 100 000 registered not Italy-born subjects and 83.9/100 000 adding 20% of estimated irregular presences to the denominators. TB incidence among Italians was 6.5/100 000 Italians). A progressive rise in the not Italy-born incident cases was observed but associated with a decline in TB incidence. Not Italy-born cases were younger compared to the Italy-born cases, and more frequently classified as "new cases" (OR 2.0 95%CI 1.61-2.49 for age group 20-39); 60.7% had pulmonary TB, 31.6% extra pulmonary and 7.6% disseminated TB. Risk factors for TB in this population group were connected to lower income status (homeless: OR 149.9 95%CI 20.7-1083.3 for age group 40-59).</p> <p>Conclusions</p> <p>In low-incidence regions, prevention and control of TB among sub-groups at risk such as the foreign-born population is a matter of public health concern. In addition, increasing immigration rates may affect TB epidemiology. TB among immigrants is characterized by particular clinical features and risk factors, which should be analyzed in order to plan effective action.</p

Supra-transumbilical laparotomy (STL) approach for small bowel atresia repair: Our experience and review of the literature

Background : Supra-Transumbilical Laparotomy (STL) has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with small bowel atresia were treated via STL approach at our Institution over a 5-year period and their charts were retrospectively reviewed. Results: STL procedure was performed at mean age of 3.1 day. No malrotation disorders were detected with pre-operative contrast enema. Eight patients (54.1%) presented jejunal atresia, five (35.7%) ileal atresia, and one (7.1%) multiple ilealand jejunal atresias. Standard repair with primary end-to-back anastomosis was performed in all but one patient. In the newborn with multiple atresia, STL incision was converted in supra-umbilical transverse incision due to diffi culty of exposition. After surgery, one patient developed anastomotic stricture, and another developed occlusion due to adhesions: Both infants required second laparotomy. No infections of the umbilical site were recorded, and cosmetic results were excellent in all patients. Conclusions: Increasing evidence suggests that STL approach for small bowel atresia is feasible, safe and provides adequate exposure for small bowel atresia surgery. When malrotation and colonic/multiple atresia are pre-operatively ruled out, STL procedure can be choosen as first approach. Key words : Jejuno-ileal atresia, mini-invasivesurgery, newborn

Acid Gastroesophageal Reflux Disease and Apparent Life-Threatening Events: Simultaneous pH-metry and Cardiorespiratory Monitoring.

To investigate the prevalence and the characteristics of gastroesophageal reflux disease (GERD) in infants with apparent life threatening events (ALTE). Materials and methods: Infants with at least one episode of ALTE in absence of predisposing factors were included. All infants underwent a cardiorespiratory recording with simultaneous 24-hour pH-monitoring. Patients were divided into 3 groups according to the severity of GERD: A. Reflux Index (RI) 7%. Monthly evaluations were performed and the anti-reflux therapy was maintained till normalization of monitoring and clinic. Results: 41 infants were enrolled. GERD was found in 80% of patients (moderate in 54%, severe in 27%). A normalization of the cardiorespiratory tracks was recorded on average after 1 month for group A, 7 months for the group B and 9.5 months for group C. A significant difference was registered between group A and both group B and C (P < 0.0001), as well as between the group B and C (P < 0.05). Conclusion: GERD influences significantly the time of normalization of the cardiorespiratory monitoring in infants with ALTE. GERD diagnosis and treatment are mandatory in these patients

Mental health during the COVID-19 quarantine in five countries

University Cooperativa of Colombia, Colombia, University of Pavia, ItaliaIntroduction. In the current COVID-19 pandemic governments and health entities urgently responded to the biological threat developing diagnostic tests, treatments, vaccines, additionally the economic concerns were approached, however there is little effort directed to the mental health, which is part of the holistic concept of health, and from where interventions for the prevention of contagion and coping with the disease and its consequences can be focused. The present study sought to describe, compare, and analyze the association of the perceived stress, coping strategies, emotional regulation, hopelessness, impact of the event, psychological distress, suicidality, as components of mental health, and sociodemographic characteristics during the quarantine in various countries in Europe and Latin America. Material and methods. Multicentric and epidemiological study approved by the Ethics Committee of the Universidad Cooperativa de Colombia. Convenience online snowball sampling of general population and university students. The questionnaire contained the informed consent, sociodemographic data, and the Impact of Event Scale-Revised, Perceived Stress Scale, Coping Orientations to Problems Experienced, Emotion Regulation Questionnaire, Symptom Check-List-90 Revised, Beck's Hopelessness Scale, and Okasha Suicidality Scale. Data were collected between April and June 2020. Statistical analysis: Internal consistency of scales was estimated by Cronbach's alpha. Normality of distribution was assessed by Kolmogorov-Smirnov tests. Univariate (Kruskal-Wallis test, Spearman correlation) and multivariate analyses (Generalized Linear Models) were performed using STATA 16. Results. 1.179 participants (27.48% male) aged between 15 to 76 years (M=33.52, SD=13.4) from Colombia (N=356), Brazil (N=364), Mexico (N=202), Italy (N=166), and Spain (N=91). The majority are students and workers, whit high level of education, and living with family during the quarantine. There are significant differences in the medians of all variables among countries and sociodemographic characteristics showing greater psychological affectation in young people, students, women, and inhabitants of Brazil, Italy and Spain. Most variables correlate with each other in a statistically significant way as theoretically expected. Conclusions. Due to the complexity of the pandemic, there are differences in terms of contagion containment measures, restrictions, laws and sanctions, government and health authorities’ management, type of information disseminated by media, resources available for diagnoses, treatments and aid, number of infections and deaths, job and economic losses, that significantly affect the impact in mental health worldwide. The results of the present research contribute to the understanding of mental, emotional and behavioral reactions of people across different countries and according to sociodemographic characteristics and underline the urgency of monitoring mental health in vulnerable groups, in order to design specific prevention and intervention programs

Metabolic reprogramming identifies the most aggressive lesions at early phases of hepatic carcinogenesis

Metabolic changes are associated with cancer, but whether they are just bystander effects of deregulated oncogenic signaling pathways or characterize early phases of tumorigenesis remains unclear. Here we show in a rat model of hepatocarcinogenesis that early preneoplastic foci and nodules that progress towards hepatocellular carcinoma (HCC) are characterized both by inhibition of oxidative phosphorylation (OXPHOS) and by enhanced glucose utilization to fuel the pentose phosphate pathway (PPP). These changes respectively require increased expression of the mitochondrial chaperone TRAP1 and of the transcription factor NRF2 that induces the expression of the rate-limiting PPP enzyme glucose-6-phosphate dehydrogenase (G6PD), following miR-1 inhibition. Such metabolic rewiring exclusively identifies a subset of aggressive cytokeratin-19 positive preneoplastic hepatocytes and not slowly growing lesions. No such metabolic changes were observed during non-neoplastic liver regeneration occurring after two/third partial hepatectomy. TRAP1 silencing inhibited the colony forming ability of HCC cells while NRF2 silencing decreased G6PD expression and concomitantly increased miR-1; conversely, transfection with miR-1 mimic abolished G6PD expression. Finally, in human HCC patients increased G6PD expression levels correlates with grading, metastasis and poor prognosis. Our results demonstrate that the metabolic deregulation orchestrated by TRAP1 and NRF2 is an early event restricted to the more aggressive preneoplastic lesions