Viral gastrointestinal infections and norovirus genotypes in a paediatric UK hospital, 2014-2015

BACKGROUND: Diarrhoea in children is a common disease; understanding the incidence of causative viruses can aid infection control and vaccine development. OBJECTIVES: Describe the incidence and characteristics of gastroenteric viruses including norovirus genotypes in a paediatric hospital cohort. STUDY DESIGN: Norovirus, adenovirus, sapovirus, astrovirus, rotavirus qPCR and norovirus genotyping results for all stool specimens (n = 4786; 1393 patients) at a UK paediatric tertiary referral hospital June 2014–July 2015. RESULTS AND DISCUSSION: 24% (329/1393) of patients were positive for a GI virus; the majority were positive for norovirus (44%, 144/329) or adenovirus (44%, 146/329). The overall incidence of rotavirus (2%) is reduced compared to pre-vaccination studies; however the incidence of other GI viruses has not increased. Norovirus infections had a significantly higher virus burden compared to other GI viruses (P ≤0.03); sapovirus infections had the lowest viral burden. The number of norovirus cases per month did not follow the typical winter seasonal trend of nationally reported outbreaks. The number of cases per month correlates with the number of hospital admissions (R = 0.703, P = 0.011); the number of admissions accounts for 50% of the variability in number of cases per month. The breadth of genotypes seen (48% non-GII.4), suggests a community source for many norovirus infections and has implications for vaccine development. All GI viruses caused chronic infections, with the majority (50–100%) in immunocompromised patients. Incidence or duration of infection in chronic norovirus infections did not differ between genotypes, suggesting host-mediated susceptibility

Ingrown toenail (onychocryptosis)

This issue of eMedRef provides information to clinicians on the risk factors, anatomy and treatment of an ingrown toenail

Extensional flow convecting a reactant undergoing a first order homogeneous reaction and diffusional mass transfer from a sphere at low to intermediate Peclet and Damkohler numbers

Forced convective diffusion-reaction is considered for viscous axisymmetric extensional convecting velocity in the neighborhood of a sphere. For Peclet numbers in the range 0.1 less than or equal to Pe less than or equal to 500 and for Damkohler numbers increasing with increasing Pe but in the overall range 0.02 less than or equal to Da less than or equal to 10, average and local Sherwood numbers have been computed. By introducing the eigenfunction expansion c(r, Theta) = Sum of c(n)(r)P(n)(cos Theta) into the forced convective diffusion equation for the concentration of a chemical species undergoing a first order homogeneous reaction and by using properties of the Legendre functions Pn(cos Theta), the variable coefficient PDE can be reduced to a system of N + 1 second order ODEs for the radial functions c(sub n)(r), n = 0, 1, 2,..., N. The adaptive grid algorithm of Pereyra and Lentini can be used to solve the corresponding 2(N + 1) first order differential equations as a two-point boundary value problem on 1 less than or equal to r less than or equal to r(sub infinity). Convergence of the expansion for a specific value of N can thus be established and provides 'spectral' behavior as well as the full concentration field c(r, Theta)

Nephron-Sparing Diagnosis and Management of Renal Keratinizing Desquamative Squamous Metaplasia

Background and Purpose: Keratinizing desquamative squamous metaplasia (KDSM) of the upper urinary tract is a rare condition for which there is no defined management plan. A condition historically treated with extirpative surgery, conservative management would be preferable, because this is almost certainly a benign condition. We report the favorable clinical course of two cases of renal KDSM diagnosed and managed with a nephron-sparing approach, relying on ureteroscopy and serial imaging. Patients and Methods: Retrospective chart review was performed to obtain history, physical examination results, radiographic imaging, and diagnostic procedures. Results: Both patients were referred to our institution for evaluation of complex cystic renal masses. Both reported passing flaky material in their urine. Flexible ureteroscopy revealed waxy sediment in the collecting system, which broke up easily with manipulation and proved to be squamous keratin debris on cytologic and histologic examination. In 1 patient, we obtained a percutaneous needle biopsy as well, which revealed benign keratinizing squamous epithelium. All findings were consistent with KDSM. Each patient has since been followed conservatively with CT. In 1 case, there has been slight growth of the mass but no worrisome changes after 42 months. In the other case, there were several new renal collecting system filling defects on CT 17 months after diagnosis. Another ureteroscopy revealed the same findings as the original, with the addition of keratin debris draining out of the lesion into the rest of the kidney. Conclusions: Our two cases of KDSM confirm the feasibility of nephron-sparing management using a combination of diagnostic ureteroscopy and imaging surveillance. The duration of follow-up without adverse events suggests that the finding of renal KDSM is not necessarily an indication for extirpative surgery, and that conservative management is an appropriate option.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78150/1/end.2008.0501.pd

Laparoscopic and Open Surgical Nephrectomy for Xanthogranulomatous Pyelonephritis

Background and Purpose: Xanthogranulomatous pyelonephritis (XGP) is a severe, chronic renal-parenchymal infection. Nephrectomy is the treatment of choice. Because of the renal and perirenal inflammatory changes that commonly accompany XGP, the laparoscopic approach is difficult. We compared our experience with laparoscopic and open surgical nephrectomy for XGP. Patients and Methods: A retrospective chart review of all adult nephrectomy specimens with the pathologic diagnosis of XGP between January 1997 and May 2003 was performed. Preoperative presentation, operative details, and postoperative recovery and complications were included in the data collection. Results: Three patients approached laparoscopically and eight patients approached with open surgery were found to have XGP on pathologic analysis. The disease was suspected preoperatively in all patients. Among the laparoscopically treated patients, there was 1 (33%) who suffered major complications; this was the only patient who required conversion to open surgery. Among the open-surgical group, there were 2 (22%) major and 3 (33%) minor complications. Postoperative hospitalization was longer in the open-surgical group (mean 13.7 v 4.7 days), and when the case of open conversion was excluded, narcotic use was less in the laparoscopy group. Conclusions: The treatment of some XGP cases with laparoscopic nephrectomy is a possible, albeit challenging, option. The incidences of intraoperative and postoperative complications were roughly equivalent in the laparoscopic and open-surgery patients in our study. If completed, laparoscopy appears to be associated with decreased postoperative morbidity. However, this may represent selection bias, and larger, prospective studies may better define the suspected benefit.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63141/1/end.2005.19.813.pd

Forced Convective Diffusion and Interphase Heat and Mass Transfer: Computations of Radial Functions, Temperature and Concentration Fields, and Presentation of Local and Average Nusselt and Sherwood Numbers

Theoretical calculations have been carried out for forced convective transport for uniform streaming and uniaxial and biaxial extensional axisymmetric flows past single spheres. Homogeneous and heterogeneous chemical reactions, both of first and of second order have also been or are presently being treated. Orthogonality and other properties of Legendre functions have been used, together with introduction of an eigenfunction expansion, to reduce the mathematical description from a partial differential equation with variable coefficients, which is nonlinear for homogeneous second order chemical reactions, to a system of coupled ordinary differential equations for the radial modes. The numerical solutions of the latter have been obtained using the robust, adaptive grid algorithm of Pereyra and Lentini. Plots of the radial functions for given Peclet and Damkohler numbers give insight into the role and interaction of L and of r∞ (the number of terms necessary for convergence of the expansion and the finite radius at which the boundary conditions at infinity are imposed). From the radial modes, local and average Nusselt and Sherwood numbers, as well as the temperature and concentration fields, can be obtained. Plots of radial function families provide new insights that complement physicochemical understanding gained from isocontour plots of the temperature and concentration fields. Plots of local interphase transfer coefficients reflect the behavior of the flux field over the sphere surface and show how the average coefficients arise

Use of a sample-to-result shotgun metagenomics platform for the detection and quantification of viral pathogens in paediatric immunocompromised patients

Background: Infections by several DNA viruses can severely impact outcomes in paediatric immunocompromised patients. Current testing, which is generally limited to singleplex qPCR assays, can miss both common and rarer viruses if they are not targeted. Objectives: To evaluate the performance of the Galileo Viral Panel (Galileo), a sample-to-result shotgun metagenomics platform for the detection and quantification of 12 DNA viruses, compared to standard of care qPCR assays. Study design: A clinical performance evaluation was carried out using 43 prospectively collected EDTA plasma samples positive for one or more DNA viruses. Agreement between assays was assessed by overall, positive, and negative percent agreement, as well as quantitative agreement by linear regression and Bland-Altman analysis. Results: Overall positive percent agreement was 84% (95% CI: 76%-90%), and negative percent agreement was 95% (95% CI: 92%-97%). There was a high correlation between Galileo and qPCR for ADV, CMV, EBV, and VZV (R2 = 0.91) and a mean difference by Bland Altman of -0.43 log10 IU or cp/ml (95% limits of agreement, -1.37 to 0.51). In addition, there was a high correlation between Galileo Signal Score and qPCR for TTV (R2 = 0.85). Conclusion: We observed high qualitative and quantitative agreement between qPCR and Galileo. Galileo identified additional viruses that were not tested with routine qPCR and could impact clinical outcomes