First case of Mediterranean spotted fever-associated rhabdomyolysis leading to fatal acute renal failure and encephalitis

Mediterranean spotted fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii. In Italy, about 400 cases are reported every year and nearly half of them occur in Sicily, which is one of the most endemic regions. Although MSF is mostly a self-limited disease characterized by fever, skin rash, and a dark eschar at the site of the tick bite called a 'tache noire', serious complications are described, mainly in adult patients. Nevertheless, severe forms of the disease with major morbidity and a higher mortality risk have been described. We report a fatal case of MSF complicated by rhabdomyolysis, acute renal failure, and encephalitis in an elderly woman

Leprosy-like cutaneous presentation of Histoplasma capsulatum infection in an African HIV+ patient

Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms

Airway dimensions and pathologies of trumpet players vs. non-trumpet players.

Objective: The objective of this retrospective, 3-dimensional cone beam computed tomography study was to determine if there is a significant difference between the most constricted area of the airway, the prevertebral soft tissue thickness and airway dimensions (length and volume) of the nasal cavity, nasopharynx, oropharynx, and maxillary sinuses of university trumpet players versus non-trumpet playing controls. The second objective was to determine significant differences in the prevalence of airway pathologies between university trumpet players and controls. Method: Following IRB approval and consent and reliability studies, measurements of airway parameters and pathology were compared between 66 Caucasian trumpeters and 22 ethnicmatched controls. An analysis of covariance, with age and sex included as covariates, was used to compare the airway measures. Since there was a significant difference in gender and age, comparisons between groups for the presence of any airway pathologies was made using logistic regression including age and sex as covariates. A 5% significance level was used for all comparisons. Result: The trumpet players had significantly smaller nasal cavity volume (18028 + 595 mm3 vs. 25266 + 1116 mm3; p<0.0001) and significantly greater soft tissue thickness at CV2ia (3.29 + 0.10 mm vs 2.70 + 0.10 mm; p=0.03) and CV3sa (4.55 + 0.13 mm vs 3.74 + 0.14 mm; p=0.005) than the controls. No other airway measure demonstrated a significant difference between the two groups. Trumpeters had significantly (p=0.002) more airway pathology (n=33; 50%) than the controls (n=4; 18%). Antral pseudocysts or polyps composed 52% of trumpeter pathologies as compared with 0% controls. Conclusion: The only significant differences in airway dimensions between trumpet players and controls were decreased nasal cavity volume and some areas of prevertebral soft tissue thickness. Trumpeters were almost three times as likely to exhibit airway pathology when compared with controls. Funding: IUPUI Signature Center Initiative – 3D Imaging of the Craniofacial Complex Center and the Joseph and Aida Jarabak Endowed Professorship

A case of Brucella endocarditis in association with subclavian artery thrombosis

Brucellosis is a common zoonosis, endemic in Mediterranean countries, and caused by bacteria of Brucella genus. Brucellosis is a systemic infection and the clinical presentation varies widely from asymptomatic and mild to severe disease. Cardiovascular complications are extremely rare. We present a case of arterial thrombosis in a previously healthy young patient with Brucella endocarditis. Careful attention must be paid to any sign or symptom of thrombosis in patients affected by brucellosis, regardless of the presence of endocarditis and cardiovascular risk factors. PMID:22844622[PubMed] PMCID:PMC3400327Free PMC Articl

Concrete services usage on child placement stability: Propensity score matched effects

Background: Experiencing poverty and financial difficulties are significant barriers to outcomes of permanency and placement stability. This is particularly true for children who are in out of home placements. The provision of concrete services is intended to meet concrete needs of families to address this barrier. However, little is known about how concrete services meet the needs of families in need of these services or if the use of concrete services is a viable treatment for children who are in out of home placements. Methods: The present study examined differences between those who received and those who did not receive concrete services on factors of stability, child and caregiver traumatic stress, number of placements, and current out of home placement. Regression analysis examined the association between amount of concrete service spending and permanency. Then to test concrete services as an intervention for children in a current out of home placement, we used propensity score matching to match participants on characteristics that predicted whether they would receive concrete services. We then ran a hierarchical regression to test the treatment condition of concrete services with children who are in a current out of home placement. Results: Participants who received concrete services were at a much higher level of need with significantly higher levels of traumatic stress and number of placements and lower levels of placement stability. The amount of money spent on concrete services was associated with increases in placement stability. And, children in a current out of home placement had an increase in placement stability when they received concrete services. Conclusions: The present study is the first to evidence concrete service as a treatment for placement stability for children in current out of home placements. Spending on concrete services in addition to child welfare services improves a child's current placement stability. This is an important finding with implications for improving child welfare services' approach to those in their care with financial burdens

Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study).

BackgroundTransseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough needle has historically been used for this procedure, a needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional needle for transseptal LA access.Methods and resultsIn this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) transseptal needle. In an intention-to-treat analysis, the primary outcome was time required for transseptal LA access. Secondary outcomes included failure of the assigned needle, visible plastic dilator shavings from needle introduction, and any procedural complication. The median transseptal puncture time was 68% shorter using the RF needle compared with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access with the assigned needle was less common using the RF versus conventional needle (0/36 [0%] versus 10/36 [27.8%], P &lt; 0.001). Plastic shavings were grossly visible after needle advancement through the dilator and sheath in 0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P &lt; 0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]).ConclusionsUse of an RF needle resulted in shorter time to transseptal LA access, less failure in achieving transseptal LA access, and fewer visible plastic shavings

Considerations for Child Cancer Survivors and Immunocompromised Children to Prevent Secondary HPV-associated Cancers

Survivors of childhood cancer and other immunocompromised children are at high risk for the development of secondary Human Papillomavirus (HPV)-associated cancers. In this overview, the authors examine the epidemiology of vaccine efficacy, the natural history of HPV infections, and accelerated HPV-associated cancer development in these populations. The authors highlight the opportunities for preventive care and future research directives

The Sexual Health Needs of Adolescent Boys Involved in a Pregnancy

Objectives: Little is known about fatherhood in middle adolescence. In order to better understand their sexual health needs, we describe relationship characteristics, perception of masculinity and associated STI risk behaviors in a community-based sample of urban middle adolescent boys who have fathered a child or been involved with a pregnancy. Methods: We employed venue-based sampling to recruit 339 boys (14-17 years old) in neighborhoods with high STI prevalence. We administered a brief survey on sexual, relationship and pregnancy history, STI risk, juvenile justice involvement, and masculinity. Results: Fifteen percent had either fathered a child or been involved with a pregnancy. In multivariate analysis, controlling for age and ethnicity, adolescent fathers were more likely to be involved with juvenile justice and engage in STI risk behaviors. These included condom non-use and partner checking a cell phone. Although of borderline significance, older partners, past STI testing, and drug or alcohol use at last sex improved model fit. Conclusion: Adolescent fathers have distinct relational and sexual health needs. Their specific needs should be targeted by prevention programs. Implications and Contribution: Most research on young men involved in pregnancy is with older adolescents/young adults, and in clinical or institutional settings. Using community engagement and venue-based sampling, this study describes sexual behaviors, masculinity, and relationship characteristics among 14-17 year old boys who have caused a pregnancy. Findings identify their distinct sexual health needs