Infected epidermal cyst of the clitoris in an infant

Clitoral enlargement in the pediatric population is a rare condition, usually related to problems of sexual differentiation, but malignant and benign clitoral lesions have also been described. We report the case of a newborn infant, investigated at birth for an intersex disorder because of clitoromegaly. Hormonal screening was normal and ultrasound (US) did not show a pelvic or abdominal mass. Three weeks later, the lesion was larger, tense and erythematous. An abscess was suspected. A drainage was then performed, and the bacteriological culture revealed the presence of Staphylococci aurei. A magnetic resonance imaging (MRI) performed to exclude a tumor of the soft tissue was normal. A diagnosis of infected epidermal cyst was confirmed by the pathology. Two months later, the external genital aspect was normal and the child asymptomatic

Nitric oxide regulates skeletal muscle fatigue, fiber type, microtubule organization, and mitochondrial ATP synthesis efficiency through cGMP-dependent mechanisms

Aim: Skeletal muscle nitric oxide–cyclic guanosine monophosphate (NO-cGMP) pathways are impaired in Duchenne and Becker muscular dystrophy partly because of reduced nNOSμ and soluble guanylate cyclase (GC) activity. However, GC function and the consequences of reduced GC activity in skeletal muscle are unknown. In this study, we explore the functions of GC and NO-cGMP signaling in skeletal muscle. Results: GC1, but not GC2, expression was higher in oxidative than glycolytic muscles. GC1 was found in a complex with nNOSμ and targeted to nNOS compartments at the Golgi complex and neuromuscular junction. Baseline GC activity and GC agonist responsiveness was reduced in the absence of nNOS. Structural analyses revealed aberrant microtubule directionality in GC1−/− muscle. Functional analyses of GC1−/− muscles revealed reduced fatigue resistance and postexercise force recovery that were not due to shifts in type IIA–IIX fiber balance. Force deficits in GC1−/− muscles were also not driven by defects in resting mitochondrial adenosine triphosphate (ATP) synthesis. However, increasing muscle cGMP with sildenafil decreased ATP synthesis efficiency and capacity, without impacting mitochondrial content or ultrastructure. Innovation: GC may represent a new target for alleviating muscle fatigue and that NO-cGMP signaling may play important roles in muscle structure, contractility, and bioenergetics. Conclusions: These findings suggest that GC activity is nNOS dependent and that muscle-specific control of GC expression and differential GC targeting may facilitate NO-cGMP signaling diversity. They suggest that nNOS regulates muscle fiber type, microtubule organization, fatigability, and postexercise force recovery partly through GC1 and suggest that NO-cGMP pathways may modulate mitochondrial ATP synthesis efficiency

A review of blood transfusions in a trauma unit for young children

Background. Trauma is the leading cause of mortality and morbidity worldwide. Blood transfusions play an incremental role in the acute phase, yet practice varies owing to variations in transfusion thresholds and concerns about potential complications, especially in children.Objectives. To evaluate protocol adherence to blood transfusion thresholds in paediatric trauma patients and determine the degree of blood product wastage, as defined by discarded units.Methods. A retrospective, descriptive study of trauma patients (age 0 - 13 years) who received a blood transfusion in the trauma unit at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa, over a 5.5-year period (1 January 2009 - 1 July 2014). Haemoglobin (Hb) transfusion thresholds were defined as 10 g/dL for neurotrauma patients and patients requiring skin grafting or a musculocutaneous flap (group 1). All other trauma patients had an Hb transfusion threshold of 7 g/dL (group 2).Results. A total of 144 patients were included (mean age 5.2 years (standard deviation (SD) 3.3), 68.1% male). The mean Hb increase after transfusion was 3.5 g/dL (SD 1.7). Adherence to the transfusion Hb threshold protocol was 96.7% for group 1 v. 34.0% for group 2. No complications were reported. Average blood wastage was 3.5 units per year during the study period.Conclusions. Adherence to paediatric blood transfusion protocol was low in the Hb threshold group <7 g/dL. However, transfusion-related complications and wastage were minimal. Further prospective research is required to determine optimal blood transfusion guidelines for paediatric trauma patients

Cataract prevalence following a nationwide policy to shorten wait time for cataract surgery

Background: Cataract is an age-related eye disease. Visual impairment from cataract can be restored by cataract surgery. In 2004 the Canadian federal government invested in a multibillion dollar wait time strategy to shorten the wait time for cataract surgery, a government-insured health service in all Canadian jurisdictions. We assessed if this nationwide policy reduced the number of Canadians waiting for cataract surgery as more individuals with cataract were free of cataract following the rapidly conducted surgery. Methods: In this cross-sectional study we analyzed data from randomly selected individuals aged greater than or equal to 45 years responding to the Canadian Community Health Survey (CCHS) in 2000/2001, 2003, 2005, and the CCHS Healthy Aging in 2008/2009. Information on cataract was obtained from self-reported questionnaire. The age- and sex-standardized prevalence of cataract was calculated for comparisons. Results: Cataract was reported by 0.93 million Canadians in 2000/2001, 0.99 million in 2003, 1.10 million in 2005, and 1.34 million in 2008/2009. This corresponds to an age- and sex-standardized prevalence of 8.9% in 2000/2001, 9.0% in 2003, 9.5% in 2005, and 10.2% (P <0.05) in 2008/2009. The increase in age- and sex-standardized prevalence was greater in individuals without secondary school graduation than those with secondary school graduation or higher (4.3% versus 1.3%, P < 0.05) and was seen in all Canadian provinces. The largest increase was documented in a province (Saskatchewan, from 9.8% in 2000/2001 to 12.6% in 2008/2009, P < 0.05) with the longest median wait times for cataract surgery (118 days in 2008) and the lowest number of ophthalmologists per 100,000 population (1.96 versus 3.35 national average). Conclusions: The age- and sex-standardized prevalence of cataract increased 4-5 years after the multibillion-dollar wait time strategy was launched in 2004. A lower threshold to diagnose cataract may be one potential reason for this finding. Further research is needed to understand the true reasons for the increase

Comparison of United States and Canadian Glaucoma Medication Costs and Price Change from 2006 to 2013

Objective. Compare glaucoma medication costs between the United States (USA) and Canada. Methods. We modelled glaucoma brand name and generic medication annual costs in the USA and Canada based on October 2013 Costco prices and previously reported bottle overfill rates, drops per mL, and wastage adjustment. We also calculated real wholesale price changes from 2006 to 2013 based on the Average Wholesale Price (USA) and the Ontario Drug Benefit Price (Canada). Results. US brand name medication costs were on average 4x more than Canadian medication costs (range: 1.9x–6.9x), averaging a cost difference of $859 annually. US generic costs were on average the same as Canadian costs, though variation exists. US brand name wholesale prices increased from 2006 to 2013 more than Canadian prices (US range: 29%–349%; Canadian range: 9%–16%). US generic wholesale prices increased modestly (US range: −23%–58%), and Canadian wholesale prices decreased (Canadian range: −38%–0%). Conclusions. US brand name glaucoma medications are more expensive than Canadian medications, though generic costs are similar (with some variation). The real prices of brand name medications increased more in the USA than in Canada. Generic price changes were more modest, with real prices actually decreasing in Canada

Monitoring of behavior, sex hormones and boar taint compounds during the vaccination program for immunocastration in three sire lines

Immunocastration (vaccination against boar taint) is an alternative method to prevent boar taint without the need for surgical castration. This study investigates the evolution of boar taint compounds in serum and fat, serum steroid compounds as well as behavior in immunocastrated pigs from 3 sire lines: 15 stress positive Belgian Pietrain (BP), 20 stress negative French Pietrain (FP), and 20 stress negative Canadian Duroc (CD). Hormone and boar taint compounds in serum were determined at 4 time points; boar taint compounds in fat were determined at 3 time points. Behavior, skin lesions, animal and pen fouling were also recorded before the first vaccination ( V2). Aggressiveness, eating and drinking and general activity behavior declined from V2 for all sire lines. Pigs from BP were cleaner than FP and CD pigs. Even though immunocastration was effective in general (reduced testosterone, estradiol as well as androstenone in serum) for all sire lines, some individual pigs showed either androstenone or skatole levels in fat above cutoff values. While the immunocastration mechanism works as intended for androstenone, and also for skatole for the three sire lines, the risk of carcasses with boar taint compounds above cutoff levels (respectively 1.9 and 3.7%) still remains to some extent

Clinical Significance of Optic Disc Progression by Topographic Change Analysis Maps in Glaucoma: An 8-Year Follow-Up Study

Aim. To investigate the ability of Heidelberg Retina Tomograph (HRT3) Topographic Change Analysis (TCA) map to predict the subsequent development of clinical change, in patients with glaucoma. Materials. 61 eyes of 61 patients, which, from a retrospective review were defined as stable on optic nerve head (ONH) stereophotographs and visual field (VF), were enrolled in a prospective study. Eyes were classified as TCA-stable or TCA-progressed based on the TCA map. All patients underwent HRT3, VF, and ONH stereophotography at 9–12 months intervals. Clinical glaucoma progression was determined by masked assessment of ONH stereophotographs and VF Guided Progression Analysis. Results. The median (IQR) total HRT follow-up period was 8.1 (7.3, 9.1) years, which included a median retrospective and prospective follow-up time of 3.9 (3.1, 5.0) and 4.0 (3.5, 4.7) years, respectively. In the TCA-stable eyes, VF and/or photographic progression occurred in 5/13 (38.4%) eyes compared to 11/48 (22.9%) of the TCA-progressed eyes. There was no statistically significant association between TCA progression and clinically relevant (photographic and/or VF) progression (hazard ratio, 1.18; P=0.762). The observed median time to clinical progression from enrollment was significantly shorter in the TCA-progressed group compared to the TCA-stable group (P=0.04). Conclusion. Our results indicate that the commercially available TCA progression criteria do not adequately predict subsequent photographic and/or VF progression